Division of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington.
Division of Pediatric Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Pediatrics. 2022 Jun 1;149(6). doi: 10.1542/peds.2020-014696.
Prescription errors are a significant cause of iatrogenic harm in the health care system. Pediatric emergency department (ED) patients are particularly vulnerable to error. We sought to decrease prescription errors in an academic pediatric ED by 20% over a 24-month period by implementing identified national best practice guidelines.
From 2017 to 2019, a multidisciplinary, fellow-driven quality improvement (QI) project was conducted using the Model for Improvement. Four key drivers were identified including simplifying the electronic order entry into prescription folders, improving knowledge of dosing by indication, increasing error feedback to prescribers, and creating awareness of common prescription pitfalls. Four interventions were subsequently implemented. Outcome measures included prescription errors per 1000 prescriptions written for all medications and top 10 error-prone antibiotics. Process measures included provider awareness and use of prescription folders; the balancing measure was provider satisfaction. Differences in outcome measures were assessed by statistical process control methodology. Process and balancing measures were analyzed using 1-way analysis of variance and χ2 testing.
Before our interventions, 8.6 errors per 1000 prescriptions written were identified, with 62% of errors from the top 10 most error-prone antibiotics. After interventions, error rate per 1000 prescriptions decreased from 8.6 to 4.5 overall and from 20.1 to 8.8 for top 10 error-prone antibiotics. Provider awareness of prescription folders was significantly increased.
QI efforts to implement previously defined best practices, including simplifying and standardizing computerized provider order entry (CPOE), significantly reduced prescription errors. Synergistic effect of educational and technological efforts likely contributed to the measured improvement.
处方错误是医疗保健系统中医源性伤害的一个重要原因。儿科急诊（ED）患者尤其容易出错。我们试图通过实施已确定的国家最佳实践指南，在 24 个月内将学术性儿科 ED 的处方错误减少 20%。
从 2017 年到 2019 年，使用改进模型进行了一项多学科、研究员驱动的质量改进（QI）项目。确定了四个关键驱动因素，包括简化电子医嘱进入处方夹、提高按适应证给药的知识、增加对处方者的错误反馈以及提高对常见处方陷阱的认识。随后实施了四项干预措施。结果指标包括所有药物的每 1000 张处方的处方错误率和前 10 种易出错的抗生素。过程指标包括提供者对处方夹的意识和使用情况；平衡指标是提供者满意度。使用统计过程控制方法评估结果指标的差异。使用单向方差分析和 χ2 检验分析过程和平衡措施。
在我们的干预措施之前，每 1000 张处方中发现 8.6 个错误，其中 62%的错误来自前 10 种最易出错的抗生素。干预后，每 1000 张处方的错误率从 8.6 总体上降至 4.5，前 10 种易出错的抗生素从 20.1 降至 8.8。提供者对处方夹的意识显著提高。
实施先前定义的最佳实践的 QI 努力，包括简化和标准化计算机化医嘱输入（CPOE），显著减少了处方错误。教育和技术努力的协同作用可能促成了所测量的改进。
