Reducing Antibiotic Prescription Errors in the Emergency Department: A Quality Improvement Initiative

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Health Informatics

Background:

• Discharge prescription errors are frequent in pediatric emergency departments (EDs).
• Existing clinical pathways and electronic health record aids have not eliminated antibiotic prescription errors for common infections.
• Errors persist despite recommendations for specific antibiotic therapies.

Purpose of the Study:

• To reduce antibiotic prescription errors for pediatric urinary tract infections (UTI) and skin and soft tissue infections (SSTI) discharged from the ED.
• To improve adherence to institutional clinical pathways through standardized order panels.
• To achieve a 50% reduction in antibiotic prescription errors within six months of implementation.

Main Methods:

• Developed and implemented electronic antibiotic discharge order panels for UTI and SSTI.
• Panels were designed to align with institutional clinical pathways for antibiotic therapy.
• The study measured error rates before and after the implementation of the order panels.

Main Results:

• Overall prescription error rates for UTI and SSTI decreased from 29.3% to 12.6% (P < 0.001).
• Specific error rates for UTI decreased from 26.1% to 13.8%.
• Specific error rates for SSTI decreased from 32.8% to 12.5%, with sustained improvement for 17 months.

Conclusions:

• ED antibiotic discharge order panels effectively reduce prescription errors for UTI and SSTI.
• Implementation improves compliance with established clinical pathways.
• Recommends developing similar order panels for other conditions to further minimize discharge prescription errors.