Frequency of dosage prescribing medication errors associated with manual prescriptions for very preterm XXXX .

@entity1 @entity910
WHAT IS KNOWN AND OBJECTIVE: The risk of dosage @entity910 ( @entity910 ) among manually written prescriptions within 'mixed' prescribing system (computerized physician order entry (CPOE)  +  manual prescriptions) has not been previously assessed in neonatology. This study aimed to evaluate the rate of dosage @entity910 related to manual prescriptions in the high-risk population of very preterm @entity1 (GA  <  33  weeks) in a mixed prescription system. METHODS: The study was based on a retrospective review of a random sample of manual daily prescriptions in two neonatal intensive care units (NICU) A and B, located in different French University hospitals (Dijon and La Reunion island). Daily prescription was defined as the set of all drugs manually prescribed on a single day for one @entity1 . Dosage error was defined as a deviation of at least   10% from the weight-appropriate recommended dose. RESULTS AND DISCUSSION: The analyses were based on the assessment of 676 manually prescribed drugs from NICU A (58 different drugs from 93 newborns and 240 daily prescriptions) and 354 manually prescribed drugs from NICU B (73 different drugs from 131 newborns and 241 daily prescriptions). The dosage error rate per 100 manually prescribed drugs was similar in both NICU: 3  8% (95% CI: 2  5-5  6%) in NICU A and 3  1% (95% CI: 1  6-5  5%) in NICU B (P  =  0  54). Among all the 37 identified dosage errors, the over-dosing was almost as frequent as the under-dosing (17 and 20 errors, respectively). Potentially severe dosage errors occurred in a total of seven drug prescriptions. None of the dosage @entity910 was recorded in the corresponding medical files and information on clinical outcome was not sufficient to identify clinical conditions related to dosage @entity910 . Overall, 46  8% of manually prescribed drugs were off label or unlicensed, with no significant differences between prescriptions with or without dosage error. The risk of a dosage @entity910 increased significantly if the drug was included in the CPOE system but was manually prescribed (OR  =  3  3; 95% CI: 1  6-7  0, P  <  0  001). WHAT IS NEW AND CONCLUSION: The presence of dosage @entity910 in the manual prescriptions written within mixed prescription systems suggests that manual prescriptions should be totally avoided in neonatal units.
