Abstract
Background Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors. Objective To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. Setting Acute general hospital in Malta. Method A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups’ response. Main outcome measure This was set at a 70 % level of agreement. Results Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70 % consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process. Conclusion Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients.
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References
Otero P, Leyton A, Mariani G, Ceriani Cernadas JM. Patient Safety Committee. Medication errors in pediatric inpatients: prevalence and results of a prevention program. Pediatrics. 2008;122(3):e 737–43.
Ghaleb MA, Barber N, Franklin BD. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95(2):113–8.
Conroy S, Appleby K, Bostock D, Unsworth V, Cousins D. Medication errors in a children’s hospital. Paediatr Perinat Drug Ther. 2007;8(1):18–25.
Miller MR, Takata G, Stucky ER, Neuspiel DR. Policy statement- principles of pediatric patient safety: reducing harm due to medical care. Pediatrics. 2011;127(6):1199–210.
Stucky ER. American Academy of Pediatrics Committee on Drugs, American Academy of Pediatrics Committee on Hospital Care. Prevention of medication errors in the pediatric inpatient setting. Pediatrics. 2003;112(2):431–6.
Simpson J, Lynch R, Grant J, Alroomi L. Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F 480–2.
Suresh G, Horbar JD, Plsek P, Gray J, Edwards WH, Shiono PH, et al. Voluntary anonymous reporting of medical errors for neonatal intensive care. Pediatrics. 2004;113(6):1609–18.
Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79(5):718–22.
Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA J Am Med Assoc. 2001;285(16):2114–20.
Raju TNK, Thornton JP, Kecskes S, Perry M, Feldman S. Medication errors in neonatal and paediatric intensive-care units. Lancet. 1989;334(8659):374–6.
Snijders C, van Lingen RA, Molendijk A, Fetter WPF. Incidents and errors in neonatal intensive care: a review of the literature. Arch Dis Child Fetal Neonatal Ed. 2007;92(5):F 391–8.
Ghaleb MA, Wong ICK. Medication errors in paediatric patients. Arch Dis Child Educ Pract Ed. 2006;91:20–4.
Walsh K, Kaushal R, Chessare J. How to avoid paediatric medication errors: a user’s guide to the literature. Arch Dis Child. 2005;90(7):698–702.
Levine SR, Cohen MR, Blanchard NR, Frederico F, Magelli M, Lomax C, et al. Guidelines for preventing medication errors in pediatrics. J Pediatr Pharmacol Ther. 2001;6:427–43.
Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. Br J Clin Pharmacol. 2009;67(6):624–8.
Coombes ID, Reid C, Mc Dougall D, Stowasser D, Duiguid M, Mitchell C. Pilot of a National Inpatient Medication Chart in Australia: improving prescribing safety and enabling prescribing training. Br J Clin Pharmacol. 2011;72(2):338–49.
Coombes ID, Stowasser DA, Reid C, Mitchell CA. Impact of a standard medication chart on prescribing errors: a before-and-after audit. Qual Saf Health Care. 2009;18(6):478–85.
National Patient Safety Agency. Promoting safer use of injectable medicines [Internet]. London: National Patient Safety Agency; 2007 [cited 2011 Oct 15]. Available from. http://www.nrls.npsa.nhs.uk/resources/?entryid45=59812.
Government of Western Australia Department of Health. WA paediatric inpatient medication chart & paediatric long-stay medication chart: introduction and rationale [internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 2011 Oct 15]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/Paediatric_Medication_Charts_Guide_using_chart.pdf.
Academy of Medical Royal Colleges, Royal Pharmaceutical Society, Royal College of Nursing. Standards for the design of hospital in-patient prescription charts (Internet). London: Academy of Medical Royal Colleges; 2011 (cited 17 Nov 2011). Available from. http://www.aomrc.org.uk/projects/standards-for-the-design-of-hospital-in-patient-prescription-charts.html.
Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, Tully M, Wass V. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. Equip study [Internet]. [place unknown: publisher unknown]; 2009 [cited 18 May 2013]. Available from. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf.
Millar JA, Silla RC, Lee GE, Berwick A. The national inpatient medication chart: critical audit of design and performance at a tertiary hospital. Med J Aust. 2008;188(2):95–9.
Agrawal A. Medication errors: prevention using information technology systems. Br J Clin Pharmacol. 2009;67(6):681–6.
Reeve J, Sweidan M. Setting a standard for electronic prescribing systems. Aust Prescr. 2011;34(1):2–4.
Radley DC, Wasserman MR, Olsho LEW, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013;20(3):470–6.
Academy of Medical Royal Colleges. Helping to reduce prescribing errors by developing standards for the design of hospital in-patient prescription charts [Internet]. London: Academy of Medical Royal Colleges; 2011 [cited 17 Nov 2011]. Available from. http://www.aomrc.org.uk/projects/standards-for-the-design-of-hospital-in-patient-prescription-charts.html.
Stephenson H. Electronic prescribing in hospitals: the road ahead. Aust Prescr. 2001;24:2–3.
Mäkinen M, Rautava P, Forsström J, Aärimaa M. Electronic prescriptions are slowly spreading in the European Union. Telemed J E Health. 2011;17(3):217–22.
Routledge PA. A national in-patient prescription chart: the experience in Wales 2004–2012. Br J Clin Pharmacol. 2012;74(4):561–5.
U.S. National Library of Medicine. Fact Sheet Medline® [Internet]. Bethesda: US. National Library of Medicine; 2004–2011 (cited 12 Sep 2011). Available from. http://www.nlm.nih.gov/pubs/factsheets/medline.html.
EBSCO. Nursing Resources from EBSCO Health [Internet]. Ipswich: EBSCO Industries, Inc.; 2011 [cited 12 Sep 2011]. Available from. http://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete.
Government of Western Australia Department of Health. Paediatric National Inpatient Medication Chart, Short-Stay [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/11388_Paed_Short_Stay_Med_Chart.pdf.
Government of Western Australia Department of Health. Paediatric National Inpatient Medication Chart, Long-Stay [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/HP8870_NIMC_long_stay.pdf.
Government of Western Australia Department of Health. Neonatal Medication Chart [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/neonatal_medication_chart.pdf.
Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311(7001):376–80.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 15–16 p. ISBN: 9781405187541.
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, La Calle JR, Lazaro P, et al. The RAND/UCLA Appropriateness Method. Santa Monica, Arlington: RAND; 2001. 6–7 p. ISBN:0833029185.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 3–4 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 3 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 7–8 p. ISBN: 9781405187541.
SurveyMonkey. Create Surveys. Get Answers [Internet]. [place unknown]: SurveyMonkey; 1999–2011 [cited 2011 Dec 29]. Available from. http://www.surveymonkey.com.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 9 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 8 p. ISBN: 9781405187541.
Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–6.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 46 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 54 p. ISBN: 9781405187541.
Paediatric Formulary Committee. British National Formulary for Children. London: BMJ Group, Pharmaceutical Press and RCPCH Publications; 2011–2012. 4–5 p. ISBN: 9780853699590.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 76 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 78–81 p. ISBN: 9781405187541.
Holey EA, Feeley JL, Dixon J, Whittaker VJ. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol. 2007;29(7):52.
Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. J Inf Manag. 2004;42(1):15–29.
Smith F. Conducting your pharmacy practice research project. London: Pharmaceutical Press: 2010. 183 p. ISBN: 978 0 85369 869 2.
Smith F. Conducting your pharmacy practice research project. London: Pharmaceutical Press: 2010. 126–127 p. ISBN: 978 0 85369 869 2.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 57 p. ISBN: 9781405187541.
Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care. 2009;27(18):165–8.
Hughes RG, Edgerton EA. Reducing pediatric medication errors: children are especially at risk for medication errors. Am J Nurs. 2005;105(5):79–84.
Shane R. Current status of administration of medicines. Am J Health-Syst Pharm. 2009;66(5):s42–8.
Chua SS, Chua HM, Omar A. Drug administration errors in paediatric wards: a direct observation approach. Eur J Pediatr. 2010;169(5):603–11.
Institute for Safe Medication Practices. Independent Double Checks: Undervalued And Misused: Selective Use Of This Strategy Can Play An Important Role In Medication Safety [Internet]. Horsham: Institute for Safe Medication Practices; 2013 [cited 2014 Jul 08]. Available from. http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=51.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 11 p. ISBN: 9781405187541.
Powell C. The Delphi technique: myths and realities. J Adv Nurs. 2003;41(4):376–82.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 29 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 70 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 77 p. ISBN: 9781405187541.
Moore CM. Group Techniques for Idea Building. California: Sage Publications; 1987. 56 p. ISBN: 978-0803923850.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 63 p. ISBN: 9781405187541.
Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 28 p. ISBN: 9781405187541.
Sweidan M, Williamson M, Reeve JF, Harvey K, O’Neill JA, Schattner P, Snowdon T. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Medical Informatics and Decision Making. 2010 Apr 15; 10 (21).
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Cassar Flores, A., Marshall, S. & Cordina, M. Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart. Int J Clin Pharm 36, 1179–1189 (2014). https://doi.org/10.1007/s11096-014-0014-y
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DOI: https://doi.org/10.1007/s11096-014-0014-y