Quality of orders for medication in the resuscitation room of a pediatric emergency department.

OBJECTIVE

The aim of this study was to evaluate both the errors and completeness of orders for intravenous medications and fluids in the resuscitation/trauma room of a pediatric emergency department before and after implementation of a standard order form.

METHODS

After implementing a standard order form in March 2004, a retrospective chart review of patients admitted to the resuscitation/trauma room of a pediatric tertiary care hospital in March, May, and July 2003 and, again in the same months 1 year later, in 2004. The completeness criteria were based on recommendations from the Institute for Safe Medication Practice and are the same as the ones used in our hospital. Medication errors and their severity were classified according to definitions of the American Society of Health-System Pharmacists.

RESULTS

In the 3 months studied in 2003, 14 (5%) of 276 written orders fit the standard of completeness, whereas in the 3 months studied in 2004, 93 (33%) of 281 were complete. There were 55 (15%) medication errors of 372 orders in 2003 and 20 (6%) of 347 orders in 2004. Thus, during the 2 study periods, there was an increase in completeness (Delta 28%; 95% confidence interval, 22%-34%) and a decrease in medication errors (Delta 9%; 95% confidence interval, 5%-13%). Most of the errors had no adverse effects on patients. However, 11 errors (10 in 2003 and 1 in 2004) required some intervention. Most interventions resulted in the need for an additional dose of medication because of underdosage.

CONCLUSIONS

A standard designated order form was associated with an increase in completeness and with a decrease in prescribing errors in the resuscitation/trauma room of a pediatric emergency department.