Approach to the prevention of medication errors using electronic barriers in PICU and NICU: an ESPNIC survey

Abstract

Medication errors (MEs) are a major cause of preventable harm in critically ill pediatric patients. Electronic safety systems — such as Computerized Physician Order Entry (CPOE), smart pumps, and barcode medication administration — are increasingly adopted to reduce MEs, yet their implementation in pediatric and neonatal intensive care units (PICUs and NICUs) remains highly variable. This study evaluated the availability of health information technologies (HIT) supporting medication safety, the perceived barriers to implementation, and the infrastructure for incident and error reporting in European PICUs and NICUs. A multicenter, cross-sectional, survey-based study developed by the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Pharmacology Section. A 48-item questionnaire was distributed to PICUs and NICUs in 38 European countries from October 2022, and responses received up to April 30th, 2023 were analyzed. One clinician per unit responded. A total of 143 ICUs from 21 countries participated (response rate: 40%). Electronic medication safety systems were used in 58% of ICUs. Smart pumps (56%) and CPOE (47.6%) were most common. Overall, electronic tool adoption was highest during the prescribing phase (81.9%), followed by administration (50.6%), drug distribution (42.2%), and preparation (32.5%). Cost and organizational issues were the main barriers (85.3% and 63.6%). Incident reporting systems were present in 66% of ICUs, but regular review in only 49%. Electronic medication safety tools are not yet widely implemented in European PICUs/NICUs. Greater standardization, integration, and structured error review are urgently needed, with priority given to interoperable, closed-loop systems spanning the full medication-use process.