Amy Kiskaddon, PharmD, BCPPS
CVICU/Cardiac Transplant Pharmacist
Johns Hopkins All Childrens Hospital
Saint Petersburg, Florida
Disclosure information not submitted.
Title: Internal Quality Improvement to Reduce Medication Order Entry Error After Pediatric Cardiac Surgery
Introduction: Medication errors are significant causes of preventable harm in hospitalized children, in whom medication errors are 3 times more common than adults. Errors in prescribing, dispensing, and administering medications represent a substantial portion of preventable medical errors in children despite electronic prescribing. At Johns Hopkins All Children’s Hospital (JHACH), a quality improvement (QI) project was developed to minimize preventable medical errors associated with computerized provider order entry (CPOE) in pediatric patients following cardiac surgery. The goal was to decrease medication error order entry on post-operative cardiac surgery patients by 20%, decrease pharmacist time spent on medication orders related to order entry error by 30%, and reduce associated costs by 50%.
Methods: From October 2020 to February 2021, 127/388 (32.7%) post-operative medication orders in 38/42 (90.5%) pediatric patients undergoing cardiac surgery required modification prior to verification. Analgesia, antimicrobial, and anticoagulation medication orders accounted for 87/127 (68.5%) of all modifications. As a result, target interventions were developed: order set adjustments to force functions, cardiac surgery to ICU handoff checklists, and standardization of anticoagulation orders. One PDSA cycle has been completed, which consisted of anticoagulation standardization and education to nursing and pediatric cardiac intensive care providers. The proportion of orders modified per doses were calculated for the PDSA cycle.
Results: Following PDSA 1 (May 2021 to July 2021), errors decreased from 127/388 (32.7%) to 21/186 (11.3%) in post-operative medication orders. This reduced associated costs by 69.5%, resulting in a cost savings of $881 per 100 medication orders. Pharmacist time spent on order modification was reduced by 34.7%, resulting in a time savings of 64 minutes per 100 medication orders. Specific to anticoagulation medication orders, errors decreased from 41/87 (47.1%) to 6/21 (28.6%).
Conclusion: Using an internal collaborative model and QI methodologies focused on medication order entry in pediatric cardiac surgery patients reduced order entry errors by 21.4%, decreased pharmacist time spent on medication order entry error by 34.7%, and reduced cost associated with order entry error by 69.5%.