High-risk medicines and technology-related prescribing errors in 2 pediatric hospitals

OBJECTIVE: High-risk medicine (HRM) prescribing errors in pediatrics are a safety concern. Technology-related errors (TREs) occur when the design of computerized provider order entry (CPOE) facilitates errors. We aimed to measure the proportion of HRM errors that were TREs and the HRM TRE rate at 2 pediatric hospitals, describe TRE types, and examine their underlying mechanisms.

METHODS: We identified 7014 HRM orders from retrospective medical record review of 18 951 medication orders for 2192 pediatric inpatients at 2 hospitals with the same CPOE in 2020. HRM prescribing errors were classified by clinical error type (eg, wrong dose, route) and potential harm. TREs were identified and their mechanisms (how they occurred-eg, selection error, editing error) classified. The rate was TREs/100 HRM orders. CI was estimated from Poisson models for rates and Wilson method for proportions.

RESULTS: Of the HRM orders, 20% (n = 1404) had at least 1 error. Of 1589 errors, 23.8% (n = 378) were TREs, with a rate of 5.39/100 HRM orders (95% CI, 4.86-5.96), and 32.5% (95% CI, 28.0-37.4) were potentially serious. TREs most frequently resulted in duplicate drug errors (47.4% of TREs; 95% CI, 42.4-52.4) and wrong-dose errors (20.9% of TREs; 95% CI, 17.1-25.3). The medications most frequently associated with TREs were insulin, anticoagulants, and narcotics. The most frequent TRE mechanism was "workflow" issues.

CONCLUSIONS: One in 4 HRM prescribing errors was technology related, one-third were potentially serious, and almost half were duplicate drug errors. Understanding HRM TREs can inform CPOE optimization to mitigate these errors and improve safety.