Pediatric medication order error rates related to the mode of order transmission

This study was undertaken to measure the medication error rates associated with verbal orders compared with handwritten and computer-entered orders in an acute-care children's hospital.

All medication and intravenous fluid orders for a 3-month interval were entered into a computer database. For the same interval, all errors pertaining to the transmission of a medication or intravenous fluid order were also entered into the database. Errors were detected by the hospital pharmacy, which continuously reviews all inpatient medication and intravenous fluid orders for potential errors before dispensing. Errors were also detected by nurses on the floors, who submit incident reports when medication or intravenous fluid errors occur.

Verbal orders were associated with significantly lower error rates than either handwritten orders or computer-entered orders (2.6, 8.5, and 6.3 per 1000, respectively), with transcription errors and dosage errors in particular being reduced. Total error rates did not differ between residents and attending physicians. Error rates did not differ between verbal, written, and computer orders for medications with a low frequency of verbal orders and therefore presumed greater complexity. However, the verbal order error rates seemed more sensitive to order complexity than order error rates in general.

The hypothesis that verbal orders are more prone to transmission error than written or computer orders is not supported by the findings in this study. Identifying medications with high levels of order complexity for restriction of verbal order use seems justified. Suggested guidelines for verbal order transmission are presented.