Evaluation prospective du paramétrage de la prescription médicale informatisée en pédiatrie. Analyse des pratiques professionnelles de prescription, de préparation et d'administration des médicaments.

Details

Supervisors

Dalleur Olivia ; Desmedt Sophie

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

Background. Computerized physician order entry (CPOE) reduces the risk of medication errors in pediatrics. However, only a few of these programs have specific pediatric settings. Since November 2020, The Cliniques universitaires Saint-Luc use EPIC®, a software that enables pediatric settings. For some medications, pharmacists configured such pediatric settings. Objectives. The primary objective of this study was to compare and describe discrepancies and missing information between medication settings in the CPOE and clinical practices of drugs preparation and administration. The secondary objectives were to compare type and prevalence of discrepancies between (a) the different pediatric care units and (b) between medications with and without pediatric settings. Methods. Two observation periods of drugs preparation and administration practices were conducted on each of the eight pediatric care units of the hospital. Observation data were collected using a standardized observation chart and electronic prescription data were extracted from EPIC®. Then, observation and prescription data were compared on the basis of dose, route of administration, drug reconstitution, dilution, duration of administration and infusion rate. Results. Among all opportunities of discrepancies, 117 were observed (9,8%, n=1198) and 17 prescriptions had missing information (1,4%, n=1222). The most frequent type of discrepancies concerned the drugs reconstitution (55,6%, n=54). No discrepancy of administration route was observed. Two discrepancies linked to the dose were identified but were due to a change in the infusion rate by oral order. The prevalence of discrepancies was lower in care units collaborating with a clinical pharmacist (intensive care units) and in those where continuous administration was more frequent. In this study, no difference was observed in the prevalence of discrepancies with and without pediatric setting (10,1%, n=811 vs 9,0%, n=387, p-value=0,5607). Conclusion. Preparation and administration of drugs differ in one observation out of ten with CPOE settings, regardless the presence of pediatric specific settings. Several ways of improvement were identified. Furthermore, the awareness of field actors and interdisciplinarity collaboration also appear to be essential for the implementation of settings adapted to the needs of each patient while ensuring their safety.