Kasmire Kathryn E, Cerrone Crista, Hoppa Eric C
Division of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
Pediatr Qual Saf. 2020 Jun 26;5(4):e314. doi: 10.1097/pq9.0000000000000314. eCollection 2020 Jul-Aug.
Discharge prescription errors from the pediatric emergency department (ED) are common. Despite the implementation of clinical pathways for common infections recommending specific antibiotic therapy and aids built into the electronic health record, errors in antibiotic prescriptions for patients discharged home from the ED persist.
We developed and implemented ED antibiotic discharge order panels for urinary tract infection (UTI) and skin and soft tissue infections (SSTI) that modeled antibiotic therapy from our institutional clinical pathways. We aimed to reduce antibiotic prescription errors by 50% within 6 months of implementation.
With the implementation of the ED discharge order panels, the overall error rate for prescriptions for UTI and SSTI improved from a baseline rate of 29.3% to 12.6% ( < 0.001). Individually, the baseline number of prescriptions with errors for UTI and SSTI improved from 26.1% and 32.8%, respectively, to 13.8% and 12.5% within 6 months. Sustained improvement continued for 17 months after the implementation of the order panels.
Development and implementation of ED antibiotic discharge order panels decrease antibiotic prescription errors for UTI and SSTI by improving compliance with institutional clinical pathways. Additional order panels should be developed and implemented for other conditions to help reduce discharge prescription errors.
儿科急诊科的出院处方错误很常见。尽管针对常见感染实施了临床路径，推荐了特定的抗生素治疗方法，并且电子健康记录中也有辅助功能，但从急诊科出院回家的患者抗生素处方错误仍然存在。
我们开发并实施了针对尿路感染（UTI）和皮肤及软组织感染（SSTI）的急诊科抗生素出院医嘱模板，这些模板参照了我们机构临床路径中的抗生素治疗方法。我们的目标是在实施后的6个月内将抗生素处方错误减少50%。
随着急诊科出院医嘱模板的实施，UTI和SSTI处方的总体错误率从基线率29.3%降至12.6%（<0.001）。单独来看，UTI和SSTI有错误的处方数量在6个月内分别从26.1%和32.8%降至13.8%和12.5%。医嘱模板实施后持续改善持续了17个月。
开发并实施急诊科抗生素出院医嘱模板通过提高对机构临床路径的依从性，减少了UTI和SSTI的抗生素处方错误。应针对其他病症开发并实施更多医嘱模板，以帮助减少出院处方错误。
