P12 Do paediatric dosing sets for intravenous (IV) Piperacillin/Tazobactam and oral morphine make it more likely to get ‘the dose right first time’ in an electronic prescribing system?
Authors: Hill Amy , Cuevas Octavio Aragon , Lockett Jasmine , Gill Andrea 
Published: April 2022

Aim

Dosing errors are the most predominant type of paediatric medication error in a hospital setting.1–3 The main aim was to investigate the effect of dosing sets, a type of clinical decision support (CDS) software, on paediatric prescribing safety in an electronic prescribing system. The secondary aim was to determine the impact of dose range checking (DRC) software on erroneous prescribing.

Method

A retrospective observational clinical audit was conducted in a large tertiary paediatric hospital. The dosing sets and DRC software were fully integrated within the hospitals existing electronic prescribing system, namely MeditechV6. Data from before and after the introduction of dosing sets and DRC alert data from IV Piperacillin/Tazobactam and oral morphine prescriptions was extracted from MeditechV6 and analysed. The main outcome measures included the proportion of prescriptions with dosing errors, the type of errors and the level, and appropriateness of alert overrides.

Results

The error rate did not significantly reduce following the introduction of either dosing sets. In the pre-intervention period 7/180 (3.9%) IV Piperacillin/Tazobactam prescriptions resulted in error and in the post-intervention period there were 5/180 (2.8%) prescription dosing errors (n=12, Pearson χ2 value=0.345, p=0.557). All detected errors comprised of sub-therapeutic doses and prescribing inaccuracies were more prevalent in patients over 12 years and less than 50 kilograms (kg). A total of 54/180 (30%) orders did not apply the dosing sets following implementation and 2/54 (3.7%) orders were subsequently erroneous. There was 1/120 (0.8%) prescribing error following accurate dosing set selection and 2/6 (33.3%) prescribing errors following inaccurate selection.

After the introduction of dosing sets, 23/50 (46%) oral morphine to take out (TTO) prescriptions contained a dosing inaccuracy versus 11/50 (22%) prescriptions pre-introduction (p=0.011). Inpatient oral morphine prescribing inaccuracies decreased following dosing set introduction from 14/50 (28%) to 9/50 (18%) respectively (p=0.235).

A total of 36/45 (80%) IV Piperacillin/Tazobactam DRC alerts were overridden at the point of prescribing and such actions were deemed clinically inappropriate for 6/36 (16.7%) prescriptions. Similarly, 6/20 (30.0%) of overridden oral morphine DRC alerts were deemed clinically inappropriate when audited against hospital guidelines.

Conclusion

The introduction of drug-specific dosing sets did not significantly reduce the incidence or nature of prescribing errors for neither IV Piperacillin/Tazobactam nor oral morphine. In addition, the generation of DRC alerts did not prevent the submission of all erroneous prescriptions.

References

Ghaleb MA, Barber N, Franklin BD, et al. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Archives of Disease in Childhood 2010;95:113–118.

Wong ICK, Ghaleb MA, Franklin BD, et al. Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Safety 2004;27:661–670.

Wong ICK, Wong LYL, Cranswick NE. Minimising medication errors in children. Archives of Disease in Childhood 2009;94:161-164.