Stepped-Wedge Cluster RCT to Assess the Effects of an Electronic Medication System on Medication Administration...

Area of Science:

• Pediatric patient safety
• Health informatics
• Clinical error reduction

Background:

• Medication errors are a significant cause of preventable harm in hospitals.
• Electronic medication systems (EMS) effectively reduce prescribing errors.
• Evidence on EMS impact on pediatric medication administration errors is limited.

Purpose of the Study:

• To investigate the effect of EMS on medication administration error rates in a pediatric setting.
• To evaluate changes in error rates, including potentially serious and harmful errors, post-EMS implementation.
• To assess the impact of EMS on medication administration errors by different routes.

Main Methods:

• A stepped wedge cluster randomized controlled trial was conducted in a pediatric referral hospital.
• Direct observations of 284 nurses preparing and administering 4555 medication doses.
• Observational data were compared against patient records to identify administration errors.

Main Results:

• No significant change in overall medication administration error rates was observed post-EMS implementation (aOR 1.09; 95% CI 0.89-1.32).
• Rates of potentially serious administration errors (aOR 1.18; 95% CI 0.9-1.56) and errors resulting in harm (aOR 0.92; 95% CI 0.34-2.46) also showed no significant change.
• Errors in medication administration via certain routes increased following EMS introduction.

Conclusions:

• The implementation of an electronic medication system did not lead to a reduction in medication administration errors in this pediatric hospital.
• Initial findings suggest that EMS may not improve, and could potentially worsen, medication administration safety in pediatric care.
• Further research is needed to understand the nuances of EMS impact on pediatric medication administration.