Mary Beth Wroblewski
ORLANDO, Fla. — A study presented at the AAP National Conference & Exhibition found that residents of all levels made errors when writing pediatric prescriptions.
“While this was only a needs assessment project from a single institution, I believe this is applicable to other institutions involved in medical education,” Mary Beth Wroblewski, MD, director of the pediatric residency program at the University of Toledo College of Medicine and Life Sciences, told Infectious Diseases in Children. “With the advent of electronic prescribing, medical students are less likely to be trained on how to write prescriptions because they can't write within the electronic prescribing systems. Most medical schools are not teaching the basics of prescription writing, yet residents are expected to write prescriptions in all settings starting on day 1 of residency.”
Wroblewski and colleagues reviewed the first 10 electronic prescriptions of each resident during their continuity clinic starting in July 2017 (n = 270). They judged whether the prescription was correct or incorrect based on guidelines for preventing medication errors in pediatrics.
The researchers found that the most common error made by pediatric residents was not tying “as needed” with a reason, with 57% of 77 prescriptions written on an “as-needed” basis. The next most common error made was an incorrect duration of treatment, occurring in 26% percent of 73 prescriptions. For weight-based prescriptions, neither the patients’ weight nor the weight-based dosing standard was noted in 98% of cases. The study also found that there was a significant difference in errors made with the free text and drop-down methods of Sig entry. Routes were not noted as often when a Sig was written with free text (P < .001), whereas an as-needed indication was noted less often when a drop-down decision aid was used (P < .001). Junior- and senior-level residents made the same number and types of errors. During the study, a problem with the drop-down decision feature was discovered because there were no drop-down options available to record an as-needed indication. The issue was addressed by an electronic medical records team.
The study suggests that residents would benefit from further education about safe prescribing guidelines and from feedback on their prescribing habits throughout their training.
“It is important to remember that electronic medical records and electronic prescribing programs are not error-proof, and some are not developed with pediatric prescribing in mind,” Wroblewski said. “We cannot assume that residents will just ‘pick up’ how to prescribe safely or that the systems will stop them from making errors.”– by Erin Michael
Wroblewski MB, et al. Can I trust you? Do pediatric residents write safe prescriptions? Presented at: AAP National Conference & Exhibition; Nov. 2-6, 2018; Orlando, Fla.
Disclosure: Wroblewski reports no relevant financial disclosures.