Prescription errors related to the use of computerized provider order-entry system for pediatric patients.

OBJECTIVES: To evaluate the nature and frequency of medication errors resulting from the use of a computerized provider order-entry (CPOE) system in a pediatric department. METHODS: We conducted a retrospective study to examine errors related to computerized orders using the software Pharma® (Computer Engineering, France) in pediatric department between 31/05/2015 to 01/12/2015. These errors were signaled by pharmacists who examine CPOEs daily. RESULTS: A total of 302 pharmacist interventions (PharmInt) were carried out by clinical pharmacists during the study period. Of the 302 PharmInts, a total of 95 (31.5%) contained no data on the patient's bodyweight, which should have been provided by the prescriber (Table 1). After the PharmInt, information on bodyweight was then provided in 47 of these cases (15.6%). Incomplete information about administration frequency accounted for 19.9% of total PharmInts. Prescribing an excessive dose occurred in 17.6% of PharmInts, inappropriate modifications of prescription unit accounted for 9.9% of PharmInts, and incorrect dosage was prescribed in 8.3% of PharmInts. Of the 302 PharmInts, 255 concerned prescription errors and bodyweight missing not provided after PharmInt. Paracetamol, in its different forms (injectable, solid or liquid oral forms) accounted for 35.7% of total PharmInts. Noted errors for paracetamol included an incorrect dosage form, co-administration of two paracetamol-containing drugs, modification of the prescription unit, incorrect frequency of administrations, and absence of the patient's bodyweight. Inconsistent use of a contradicted or a non-used drug for pediatric patients was noted along with prescriptions for inadequate dosages. DISCUSSION AND CONCLUSION: Our work revealed several error types in prescribing for pediatric patients, mainly absence of bodyweight, incorrect frequency of administration and excessive doses. Information on bodyweight is crucial in pediatric patients: our study highlights the need to make it mandatory to complete prescriptions via CPOE systems. The role of better software design is pivotal to avoiding these errors. In addition to optimizing the quality of CPOE-entries, well-designed software, better-trained users, and improved communication among healthcare will reduce errors.

Hospital morphine preparation for abstinence syndrome in newborns exposed to buprenorphine or methadone.

OBJECTIVE: This study was undertaken to evaluate the adequacy of a hospital formulated oral morphine preparation for management of neonatal abstinence syndrome (NAS) and to compare clinical features in infants exposed to methadone or buprenorphine in utero. METHOD: Between October 1998 and October 2004 all infants born to mothers treated with buprenorphine or methadone during pregnancy were enrolled into this prospective study. Morphine hydrochloride solution (0.2 mg/ml) was prepared without preservatives under a flow laminar air box (class 100). MEAN OUTCOME MEASURE: Morphine solution: quantitative and qualitative HPLC analysis and microbiological study at regular intervals during storage at 4 degrees C for 6 months. Maternal characteristics: age, opiate dose during pregnancy. Neonatal characteristics: gestational age at delivery, birth weight, Lipsitz scores. Morphine dose: daily morphine dose, maximum morphine dose, duration of NAS, and duration of treatment required to achieve stable Lipsitz scores below 4. STATISTICS: Kruskal-Wallis test for comparison of median values. RESULTS: Microbiological and HPLC analysis showed that the morphine preparation remained stable for 6 months at 4 degrees C. Nine methadone-exposed infants and 13 buprenorphine-exposed infants were included in the study. All infants presented NAS requiring treatment with the morphine solution. Lipsitz scores at birth were significantly different in the methadone and buprenorphine groups (P < 0.05). The methadone group required significantly higher doses of morphine preparation than the buprenorphine group during the first 38 days of treatment (P < 0.05): 0.435 +/- 0.150 mg/kg/day vs. 0.257 +/- 0.083 mg/kg/day. CONCLUSION: This hospital morphine solution is adequate for management of NAS. Preparations showed good stability and doses could be adjusted with a margin of 0.02 mg. The onset of NAS occurred within 24 h after birth in methadone-exposed infants (range 6-24 h) and within 48 h after birth in buprenorphine-exposed infants (range 24-168 h). Due to the possibility of delayed onset of NAS up to 7 days, infants born to mothers treated with buprenorphine should be kept in the hospital for an appropriate surveillance period. Treatment time was significantly longer (45 vs. 28 days) and the mean morphine doses were higher (1.7 fold) in methadone-exposed than buprenorphine-exposed infants.