Evaluation of a preprinted pediatric antimicrobial orderset at a free standing childrens hospital

Purpose: Hospitalized children are at high risk for medication errors. Antimicrobials are the most frequently associated drugs, and account for up to 44% of pediatric errors. Preprinted ordersets are an effective tool to reduce pediatric medication errors. The objective of this study was to compare prescribing accuracy for antimicrobial orders prescribed in hospitalized children with and without a preprinted antimicrobial orderset.

Methods: From January through March 2010, target intravenous (IV) antimicrobial orders for patients less than 18 years of age were eligible for inclusion in this prospective study. Target IV antimicrobials included acyclovir, ampicillin, ampicillin/sulbactam, cefepime, cefotaxime, ceftriaxone, clindamycin, fluconazole, gentamicin, linezolid, meropenem, metronidazole, piperacillin/tazobactam, and vancomycin. Orders were excluded if they were modified from a previous order or if they were written by a pharmacist on behalf of the prescriber. Prescribers were able to choose to write orders via a blank order sheet (Group 1) or via a preprinted pediatric antimicrobial orderset (Group 2). In addition to patient demographics, data collected included antimicrobial selection, dose, frequency, and indication. Prescribing accuracy between the two groups were compared. Accuracy was determined if both antimicrobial dose (mg/kg) and frequency were correct when compared to institutional references.

Results: Two hundred twenty-eight orders (Group 1: n = 132 and Group 2: n = 96) from 102 patients were included during the study period. Group 1 patients (median: 15 months, range: 0.04 months 17 years) were younger when compared to Group 2 (median: 1 month, range: 0.03 months 17 years; p < 0.005). In Groups 1 and 2, overall prescription accuracy was 66% and 84%, respectively (p = 0.002). Dose (89% vs. 74%, p = 0.005) and frequency (97% vs. 88%, p = 0.01) accuracies were greater in Group 2 vs. 1, respectively. Use of the preprinted orderset was associated with a significantly higher prescription accuracy rate (odds ratio: 2.8, 95% confidence interval: 1.3 5.2). Prescription accuracy did not differ between medical and surgical services.

Conclusion: Preprinted antimicrobial order forms improve prescription accuracy for commonly utilized IV antimicrobial prescribing in children. Mandatory use of preprinted antimicrobial ordersets may have a role in further optimization of pediatric antimicrobial utilization.