definition, a still higher rate of 30 percent was observed in a pediatric ICU (2,049 prescribing errors out of 6,803 orders) (Potts et al., 2004).

The French study cited above observed sharply differing error rates for handwritten and computerized prescribing. The study found a handwritten prescribing error rate of 88 percent (518 prescribing errors out of 589 orders) and a computerized prescribing error rate of 11 percent (419 errors out of 3,943 orders) (Fontan et al., 2003).

A more focused study in a neonatal ICU observed 14 Gentamicin prescription dosage errors in 105 very-low-birthweight infants (13 percent error rate) prior to the implementation of computerized physician order entry (CPOE) (Cordero et al., 2004). In 92 post-CPOE infants, no medication errors occurred. In another study in a neonatal ICU, 60 total parenteral nutrition errors were observed out of 557 total parenteral nutrition orders (11 percent error rate) (Lehmann et al., 2004).

Finally, another study evaluated ten-fold prescribing errors that were intercepted before reaching the patient. The occurrence of such errors in a 631-bed tertiary care teaching hospital was 0.53 per 100 pediatric admissions (Lesar, 2002b).

Medication Documentation

Three studies evaluated transcription/documentation errors for medications in hospital pediatric care (see Table C-18). In a study of two academic pediatric units, 85 documentation errors were found in 10,778 orders (0.8 percent) (Kaushal et al., 2001). In another study, 49 pediatric medication cardexes out of 540 (9 percent) were found to disagree in a major way (different dose, wrong medication, wrong frequency or duration, missing route) from the physician’s original medication order (Cable and Croft, 2004). In a third study, at the first transcription, 20.7 percent (41 out of 198) of nonchemotherapy prescriptions and 11.8 percent (16 out of 135) of chemotherapy prescriptions were transcribed incorrectly in a pediatric oncohematology unit (Pichon et al., 2002).

TABLE C-18 Hospital Pediatric Care: Documentation Errors

Medication documentation errors

Percentage of orders containing an error—detection method

0.8 (Kaushal et al., 2001)—chart review

9 (Cable and Croft, 2004)—chart review

Medication transcription errors in a pediatric oncohematology unit

Percentage of orders containing an error—detection method

20.7 nonchemotherapy prescriptions (Pichon et al., 2002)—chart review

11.8 chemotherapy prescriptions (Pichon et al., 2002)—chart review



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