P37 A model for reducing paediatric prescribing errors in secondary care

BackgroundA prescribing error is a preventable error that may lead to inappropriate medication use and patient harm(1). Prescribing errors are particularly important in paediatrics where dose calculations are complicated and small errors can result in significant morbidity and mortality.1 In 2017 pharmacy data showed that paediatric prescribing errors were an issue at our Hospital regarding the severity and high numbers of errors, especially for antibiotics and analgesia.ObjectivesTo achieve a zero prescribing error rate for paediatric within the hospital.MethodForm the Paediatric Medication Errors Prevention (PMEP) group consisting of the Paediatric Consultant, Paediatric Pharmacist, Children’s Assessment Unit Sister and Practice Education Senior Nurse.Paediatric Pharmacist to record and feedback all paediatric prescribing errors weekly at Doctors’ handover.Paediatric Pharmacist/Nurses to DATIX report all significant medication prescribing errorsPaediatric Pharmacist to produce and communicate monthly pharmacy prescribing newsletter.Paediatric Pharmacist to produce quick reference charts for the drugs with the most common prescribing errors e.g. antibiotics and analgesiaPaediatric Doctors to request a second check from another Doctor or Ward Sister when prescribing any medication on the drug chart of take home prescription.Paediatric Pharmacist to target Doctors’ induction to improve prescribing and implement a prescribing test.Doctors to complete reflections for errors with their educationsal supervisors.This study did not require ethics approval.ResultsFollowing implementation of the above strategies, there was a 33% reduction in the number of prescribing errors recorded by the Paediatric Pharmacist daily intervention log from 2017/2018 to 2018/2019. There were 163 prescribing errors for 2017/2018 compared to 110 for 2018/2019.ConclusionThe formation of the PMEP group and implementation of strategies to reduce paediatric prescribing errors has positively impacted on reducing the error rate at the hospital. It has also raised awareness of the necessity to report all errors and actively find ways to prevent these from re-occurring. Further work is required to reduce these errors to zero including targeting non paediatric teams prescribing on paediatrics and implementing Pharmacists prescribing on consultant ward rounds. Future work would also include replicating this model in other specialities e.g. neonatal intensive care to achieve the same success rate in reducing medication errors.ReferenceDavis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91. Accessed via http://adc.bmj.com on 2/4/19.

O1 Use of a multi-disciplinary teaching platform for teaching paediatric prescribing

AimWe present a case study of the development of a structured, holistic, multidisciplinary prescribing teaching program for medical students in our paediatric department. The aim was to integrate theory and practise into one multidisciplinary delivered teaching session.MethodPrescribing is an area that medical students consistently report as challenging with poor teaching and minimal paediatric specific prescribing teaching as an undergraduate. After collaboration with our pharmacist colleagues the agreed objective was to design a teaching session run by doctors and pharmacists together in order to more accurately simulate paediatric prescribing in clinical practice for the inpatient environment. The method was based on Blooms Taxonomy,1 starting with a pharmacist delivering teaching on the theory of paediatric prescribing. Following this, junior doctors delivered case based prescribing scenarios to allow assimilation and application of theory. At the end of the 150 minute session feedback was collected from both session facilitators and students. These were evaluated to allow for revision and improvement of the session.ResultsBoth facilitators and students very enthusiastically received the session with phrases such as ‘amazing session thank- you!’ added to the feedback forms. Feedback was gathered from 32 students over the first 8-week cycle of the project. The majority of students stated that prior to this session they had little or no paediatric prescribing teaching. When asked the question ‘how prepared do you feel for prescribing in paediatrics?’ and asked to rank themselves from 1 (not at all) to 5 (very well) the average improved from 1.44 pre session to 3.55 post session. The feedback was consistent between sessions demonstrating no significant variation between facilitators. This highlights that the standardised, formal structure of the session allows it to be delivered by pharmacists and doctors of different grades and levels of experience without changing the success of the session for the students.ConclusionThis project demonstrates that there is a significant gap in undergraduate teaching on prescribing, especially paediatric prescribing. This teaching session is low cost, produces similar feedback despite variation in facilitators between sessions, and is easily transferable to multiple inpatient areas. Our students demonstrated that after one teaching session they felt more prepared for prescribing in paediatrics and following the feedback changes have been made to the session and ongoing feedback has further improved. We propose that this style of teaching session could be used across the country for both adult and paediatric prescribing undergraduate teaching sessions. We aim to compare our session with other universities approaches to prescribing teaching and establish whether this is a national area that requires focused educational attention.ReferenceBloom BS. Taxonomy of educational objectives: The classification of educational goals 1956.

Electronic prescribing in paediatric secondary care: are harmful errors prevented?

ObjectiveThe aim of this research was to ascertain the effectiveness of current electronic prescribing (EP) systems to prevent a standardised set of paediatric prescribing errors likely to cause harm if they reach the patient.DesignSemistructured survey.SettingUK hospitals using EP in the paediatric setting.Outcome measuresNumber and type of erroneous orders able to be prescribed, and the level of clinical decision support (CDS) provided during the prescribing process.Results90.7% of the erroneous orders were able to be prescribed across the seven different EP systems tested. Levels of CDS varied between systems and between sites using the same system.ConclusionsEP systems vary in their ability to prevent harmful prescribing errors in the hospital paediatric setting. Differences also occur between sites using the same system, highlighting the importance of how a system is set up and optimised.

Choosing medications wisely: Is it time to address paediatric polypharmacy?

There is a growing focus in the medical community on de-escalating medical treatments where appropriate; however, specific efforts to reduce medication burden in patients with polypharmacy has largely been targeted toward adult populations. Polypharmacy increases the risk of adverse drug reactions in children, and that risk may be further increased by the use of off-label drugs. The paediatric prescribing community should explore pharmacovigilance strategies and deprescription initiatives that prioritize patients with polypharmacy. Currently, best practices may be extrapolated from the adult literature, including medication review algorithms and patient education tools. Enhancing access to nonpharmacological modalities to address child and youth mental health may mitigate psychotropic polypharmacy. The aim of these initiatives should be to improve patient outcomes and experiences by avoiding adverse drug events and drug–drug interactions.

STAMP: a continuous improvement approach to improve paediatric prescribing and medication safety

We describe an ongoing quality improvement project focusing on paediatric prescribing and medication safety for medical, surgical and oncology patients in a district general hospital. The project is called STAMP—Safe Treatment and Administration of Medicine in Paediatrics. The project has been running continuously for 24 months. No one factor has been identified to sustain a reduction in prescribing error rates. However, we have improved the quality and frequency of feedback to prescribers following errors. We believe that this ongoing project is changing the local prescribing culture, and with further Plan–Do–Study–Act cycles we hope to see improvement in prescribing error rates.