Patient Safety and Quality

Preprinted prescription forms can improve compliance with prescription guidelines in neonatal intensive care units

Harm or injury due to medication errors are three times more common among children than adults, especially among newborns. Handwritten, "free-form" medication prescriptions are a frequent source of medication errors among hospitalized children. Use of preprinted medication order forms can significantly improve compliance with medication prescription guidelines in neonatal intensive care units (NICUs), according to a study supported in part by the Agency for Healthcare Research and Quality (HS11583).

Researchers collected medication prescriptions received by a hospital pharmacy from the NICU over a 2-week period before and after introduction of the new forms and evaluated them for compliance with medication prescription guidelines. The preprinted form was designed to guide prescribers through the process of handwriting a complete inpatient prescription by using "forcing functions" (i.e., requiring the entry of order date and time, patient medication dosing weight, medication name, dose, route, frequency, reference dose, and printed name or pager number of the prescriber). About 60 percent of commonly prescribed pediatric medications were included on a single page, with blank fields only for the order components that were variable. Standard dose recommendations were printed on the form's reverse side.

Using the preprinted forms increased inclusion of prescription time from 86 to 99 percent, patient weight from 57 to 98 percent, weight-based dose from 37 to 91 percent, route of administration from 89 to 98 percent, and prescriber's name or pager number from 70 to 99 percent. An audit a year later revealed 99 to 100 percent inclusion of all these items. Preprinted forms help by reducing reliance on memory and reducing transcription and interpretation errors by limiting handwritten elements. They also make it easier to contact the provider for clarification or correction of intercepted errors.

See "Preprinted prescription forms decrease incomplete handwritten medication prescriptions in a neonatal intensive care unit," by Laurie A. Hogden, M.D., Jeffrey K. Low, Pharm.D., Kimberly D. Knoerlein, A.R.N.P., and William H. Edwards, M.D., in the June 2005 Journal of Patient Safety 1(2), pp. 100-104.

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