6 Reduction of risks in the medication process after adapting the EMR-system to children and introduction of the national Swedish medication database for children

Introduction Drug treatment in children is complex with a high risk of medication errors. One of the most frequent medication errors identified are dosing errors, occurring in all parts of the medication process (prescription, preparation, and administration). The aim of this study was to evaluate interventions directed at reducing medication errors at Queen Silvia Children´s Hospital in Gothenburg, delivered through the electronic medical record (EMR). Between the two years in focus 2013 and 2020, the following changes were made: The introduction of a Clinical Decision Support System (CDSS) with weight-based dose calculation and Dose Range Check into the EMR. The integration of the national Swedish medication database for children ePed into the EMR, delivering experience- and evidence-based pediatric drug information with diagnosis-specific dose recommendations and standardised dilutions as well as relevant information for administration. Methodology Drug related incidents for children 0–18 years were extracted from the incident reporting system MedControl PRO for the years 2013 and 2020, i.e. before and after the changes were introduced. We classified and compared medication errors reported through this system to evaluate the impact of the introduced changes on the quality of medication process (prescription, preparation, and administration) and the potential consequences regarding medication errors. Results The total number of drug related incidents in the medication process was unchanged; 309 medication errors were reported in both 2013 and 2020. Instead, we found a change in the quality of errors. The biggest reduction was found for dosing errors during prescription (-27), preparation (-13) and administration (-11). We categorized primary errors which were discovered and stopped as well as primary errors who continued and led to secondary errors. The number of primary errors with a subsequent secondary error was reduced; in 2013 there were 77 errors resulting in 90 secondary medication errors, whereas in 2020 there were 31 primary errors that led to 37 subsequent errors. Conclusion We conclude that the integration of the experience- and evidence-based pediatric drug information ePed together with weight-based dose calculation and Dose Range Check prevented medications errors, especially dosing errors, in prescription, preparation and administration of medicines to children at Queen Silvia Children´s Hospital.