Electronic Prescribing in the Neonatal Intensive Care Unit: Analysis of Prescribing Errors and Risk Factors.

Abstract

Patients admitted to neonatal intensive care units are up to eight times more likely to experience medication errors than patients admitted to adult intensive care units. Prescribing errors account for up to 74% of medication errors. Electronic prescribing has been postulated as a tool to reduce errors. The objective was to analyse prescribing errors with the e-prescribing system and risk factors. All patients who were admitted for at least 24 h and who received active pharmacological treatment during the study period were included. Prescriptions were made using electronic assisted prescription software integrated into the medical record system. Treatment was reviewed daily by a pharmacist, and errors were graded according to taxonomic criteria. A total of 240 patients were included, 13,876 prescriptions were reviewed and 455 errors were found (3.3% of prescriptions were wrong). Prescribing errors were concentrated in 40 drugs/nutritional products. The most frequent error was a discrepancy between the prescription and the associated text-free field (n = 196). The drugs with the most errors were Lactobacillus acidophilus, caffeine citrate, acetaminophen, gentamycin and cholecalciferol. Patients with a birth weight from 1000 to 1500 g were 82% more likely to experience an error than those with an extremely low birth weight (< 1000 g) (OR = 1.81, 95% CI = 1.42-2.89, p < 0.05). Patients at the highest risk were those with gestational ages from 28 to 32 weeks, with a 29.80% greater risk of prescribing errors than those with gestational ages less than 28 weeks (OR = 1.29, 95% CI = 1.02-1.65, p < 0.05). Prescribing errors occur due to complex dosing rules based on patient characteristics and free-text use, highlighting process issues rather than specific medication risks.