Evidence map›Paper›PMID 35641470›Full record

ArticlePediatrics2022

Reducing Pediatric Emergency Department Prescription Errors.

Veena Devarajan, Nicole L Nadeau, Jessica K Creedon, Timothy E Dribin, Margaret Lin, Alexander W Hirsch, Jeffrey T Neal, Amanda Stewart, Erica Popovsky, Danielle Levitt and 6 more

Abstract read
In one paragraph

Article in Pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Veena DevarajanDivision of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington.
Nicole L NadeauDivision of Pediatric Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Jessica K CreedonDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Timothy E DribinDivision of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Margaret LinDepartment of Emergency Medicine and Pediatrics, University of California, San Francisco, California.
Alexander W HirschDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Jeffrey T NealDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Amanda StewartDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Erica PopovskyDivision of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Danielle LevittDivision of Emergency and Transport, Children's Hospital Los Angeles, Los Angeles, California.
Jennifer A HoffmannDivision of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Michael LeeDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Catherine PerronDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Dhara ShahDepartment of Pharmacy, Boston Children's Hospital, Boston, Massachusetts.
Matthew A EisenbergDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Joel D HudginsDepartments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts.

Funding

LCenter for Clinical and Translational Science and TrainingUL1TR001425 · NCATS · UNIVERSITY OF CINCINNATI · PI HEUBI, JAMES E., KISSELA, BRETT M · 2015 to 2024
$37.5M
KL2 Training ProgramKL2TR001426 · NCATS · UNIVERSITY OF CINCINNATI · PI ZELLER, MARGARET H · 2015 to 2024
$6.8M
NCATS NIH HHS KL2 TR001426NCATS NIH HHS UL1 TR001425
6 · The paper itself

Abstract

backgroundPrescription 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.

methodsFrom 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.

resultsBefore 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.

conclusionQI 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.

Indexed as

Medical Order Entry SystemsMedication ErrorsAnti-Bacterial AgentsChildDrug PrescriptionsEmergency Service, HospitalHumansAnti-Bacterial Agents

Identifiers

PMID35641470
PMCPMC10680440

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.