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. 2013 Jan;18(1):53-62.
doi: 10.5863/1551-6776-18.1.53.

Effect of a resident physician educational program on pediatric emergency department pharmacy interventions and medication errors

Megan E Foster  1 , Donald E Lighter, Ashok V Godambe, Brandon Edgerson, Randy Bradley, Sandip Godambe
Affiliations

Effect of a resident physician educational program on pediatric emergency department pharmacy interventions and medication errors

Megan E Foster et al. J Pediatr Pharmacol Ther. 2013 Jan.

Abstract

Purpose: To determine the effects of a resident physician educational program in a pediatric emergency department (ED) on pharmacy interventions and medication errors, particularly dose adjustments, order clarifications, and adverse drug events (ADE).

Methods: The ED pharmacist recorded all interventions and medication errors on weekdays from 3 to 11 pm during a 9-month period, consisting of a preobservational (Quarter 1), observational (Quarter 2), and interventional (Quarter 3) phases. Program implementation occurred in Quarter 3, with an initial 3-hour lecture during the ED orientation, followed by daily patient case discussions. Weekly interventions and errors were analyzed using statistical process control u-chart analyses. Chi-square analyses of independence were also performed. Resident and ED staff feedback on the program was obtained through anonymous internet-based surveys.

Results: A total of 3507 interventions were recorded during the 9-month period. Chi-square approximation and interval estimation of odds ratio showed a statistically significant decrease between Quarters 1 and 3 in the number of dose adjustments (95% confidence interval [CI], 0.324-0.689) and order clarifications (95% CI, 0.137 to 0.382) after initiation of the program. The decline in ADE, while not as substantial (95% CI, 0.003 to 1.078), still achieved a level of significance (90% CI, 0.006 to 0.674). Survey results were positive toward the program.

Conclusions: The implementation of a resident physician educational program in our pediatric ED significantly decreased the number of medication errors, increased resident physician awareness of the potential for errors, and increased ED pharmacist utilization.

Keywords: emergency medicine; medication errors; pediatrics; pharmacy; quality improvement.

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Figures

Figure 1.
Figure 1.
Total number of ED pharmacist interventions before and after Quality 101 program. Black bar, Quarter 1; white bar, Quarter 2; Gray bar, Quarter 3
Figure 2.
Figure 2.
U-chart analysis of dose adjustments (DA) over the 9 month period. The areas of statistical significance are shown by a dotted line.
Figure 3.
Figure 3.
U-chart analysis of order clarifications (OC) over the 9 month period. The areas of statistical significance are shown by a dotted line.
See this image and copyright information in PMC

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