Short- and long-term effects of an electronic medication management system on paediatric prescribing errors

Area of Science:

• Pediatric Patient Safety
• Health Informatics
• Clinical Pharmacy

Background:

• Electronic medication management (eMM) systems aim to enhance patient safety in healthcare settings.
• Evidence for eMM effectiveness in pediatric populations is limited.
• Prescribing errors and adverse drug events (ADEs) pose significant risks in pediatric care.

Purpose of the Study:

• To evaluate the short-term and long-term effectiveness of an eMM system in reducing prescribing errors and their associated harm in a pediatric hospital.
• To assess the impact of eMM implementation on potential and actual adverse drug events.

Main Methods:

• A stepped-wedge cluster randomized controlled trial (SWCRCT) involving eight clusters at a pediatric referral hospital.
• Analysis of 35,260 medication orders for 4821 patients, comparing pre- and post-eMM implementation periods.
• Assessment of prescribing errors, potential ADEs, and actual harm, with a one-year follow-up.

Main Results:

• No significant change in overall prescribing error rates during the initial 70 days of eMM use; however, potential ADEs increased by 62%.
• One year post-implementation, overall prescribing errors decreased by 36%, and high-risk medication errors by 33%.
• Dose errors were consistently more frequent than other error types and were associated with most harm events.

Conclusions:

• Short-term eMM implementation in pediatrics did not improve error rates and showed an initial increase in some safety risks.
• Long-term use of eMM systems demonstrated significant reductions in prescribing errors, indicating potential patient safety benefits.
• Optimization efforts for eMM systems should prioritize reducing dose errors due to their high incidence and potential for harm.