558 - Pattern of Medication Errors in a Tertiary Care NICU Before and After a Decade of Electronic Medical Record Implementation

Publication Number: 558.5918

Kabir M. Abubakar, Georgetown University School of Medicine, Washington, DC, United States

Background: Medication errors (MEs) are a significant cause of morbidity in hospitalized patients. Infants in the Neonatal Intensive Care Unit (NICU) are particularly at risk because their drug dose is dependent on weight and age, which change over time. Most MEs in the NICU occur during drug dose calculation where a decimal point error can result in a 10-fold dose difference but can also occur during dispensing and administration. Studies in adults and children have shown that computerized physician order entry (CPOE) systems reduce medication errors and adverse drug events (ADEs). Our NICU has a rigorous medication error tracking program and implemented an electronic medical record system (EMR) 10 years ago. We evaluated the frequency and types of medication errors in the period 10 years before and 10 years after the implementation of EMR in the NICU..

Objective: To evaluate the effect of EMR CPOE on the frequency and types of MEs 10 years before and 10 years after the implementation of an EMR in the NICU.

Design/Methods: EMR was implemented in our tertiary care academic NICU in September 2013. All Residents, Fellows, Nurse Practitioners, Nurses and dispensing Pharmacists were trained on the use of the EMR. The accuracy of all orders was checked by the pharmacist and bedside nurse. The frequency and types of all MEs were recorded over a 10-year period before EMR (period 1) and compared to the 10 years after EMR implementation (period 2). Data were analyzed using Chi-square.

Results: There were a total of 644803 orders in the study period. Our overall ME rates were low but there was a significant decrease in prescription, dispensing and administration errors after EMR implementation. There was a substantial decrease in total medication errors even though the total number of orders, patient population and staffing patterns were similar between the 2 time periods.

Conclusion(s): Implementation of EMR based CPOE significantly reduced medication errors in our NICU. There was an initial learning curve involved with the implementation of a new system. A built in EMR decision support system and vigilant error monitoring and tracking system is still needed to prevent/reduce medication errors in the NICU.

Pattern of Medication Errors Before and after EMR
* P<0.05

Pattern of Medication Errors Before and After EMR