Medication Errors in Paediatric Inpatients

Abstract

The complexity of the prescribing process for children makes it prone to errors. However, the majority of these errors are preventable, making them good targets for improvement. A prescribing error is an outcome of an incorrect behaviour or a behaviour that was performed incorrectly. Therefore, when efforts are made to reduce errors that focus on the prescribers, interventions should aim at changing their behaviour. While behaviour change approaches have been demonstrated as effective for understanding and changing behaviour, this approach has rarely been used to develop interventions to potentially reduce prescribing errors. As a result, we conducted a programme of research to begin the development process of a complex behavioural intervention aimed at reducing prescribing errors. Four studies were conducted to achieve the aim of this programme. A systematic review identified the evidence on previously used interventions that aimed to reduce prescribing errors for hospitalised children. Then, a series of three separate but interrelated studies were conducted in a paediatric oncology ward in Saudi Arabia (SA). Three primary collection methods were used to obtain data on prescribers’ behaviour and errors: observation, prospective chart reviews, and focus groups. One of these studies used a prospective chart review to identify prescribing errors made by prescribers and to create the error scenarios used in subsequent studies. Another study used observation to describe the detail of the prescribing tasks undertaken during decision-making and prescription writing processes, using the hierarchal task analysis. Tasks performed during prescription writing were then analysed using the behaviour change wheel in order to identify and prioritise behaviours that could be targeted to reduce errors. These behaviours were identified based on evidence obtained from the chart review, focus group discussions, and the literature. In the final study, the error scenarios developed in the prospective chart review study were presented during focus groups in order to understand prescribers’ behaviour that caused errors. Thematic analysis and the COM-B (i.e. capability, opportunity, motivation, and behaviour) model were then used to analyse prescribers’ behaviour and identify the sources of incorrect prescribing. Ethical approval from both the Institutional Review Board (IRB) in SA and the University of Manchester Research Ethics Committee (UREC) was obtained. The results show that the prescribing process is complex and involves multiple tasks that are typically performed in five steps: three to assist in the decision-making process and two to write a prescription. In addition, various candidate behaviours that could possibly be targeted to reduce PEs were identified. However, after prioritising these behaviours, only two emerged as promising candidate behaviours for intervention. Various sources of incorrect prescribing behaviour were identified that are related to prescribers’ capability, opportunity, and motivation. After a thorough understanding of the prescribers’ behaviours was established, future work could focus on continuing the intervention development process by selecting intervention functions and policies that could bring about the desired behavioural changes.

Date of Award	1 Aug 2018
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Tully (Supervisor), Mackinnon (Supervisor) & Douglas Steinke (Supervisor)