{
  "abstract": "Aim To review clinical incidents reported for paediatric patients treated with parenteral nutrition (PN), before and after implementation of an electronic prescribing and medicines administration (ePMA) system. It is proposed that use of ePMA systems can reduce medication prescribing and administration errors 1; software for electronic prescribing of paediatric PN is also recommended in international guidance as a method of reducing prescribing errors.2 Method Analysis of clinical incidents relating to paediatric PN, reported using the Datix® incident reporting system, for one year after go-live with an ePMA, compared with previously reported data. 3 All paediatric inpatients treated with PN during December 2020 to December 2021, and June 2024 to June 2025 were included; from all clinical areas, across a dedicated children’s hospital providing regional paediatric specialties. Previously evaluated interventions continued, including increased PN Pharmacist resource, training within the Paediatric Intensive Care Unit, and an out-of-hours PN policy.3 Primary outcomes were the number and severity of clinical incidents (per 1000 PN days) before and after go-live with an ePMA. Clinical incident severity was determined using the National Council for Medication Error Reporting and Prevention (NCCMERP) Index for Categorizing Medication Errors Algorithm,4 an internationally recognised tool for classifying incident severity.3 4 Secondary outcomes included the type of error (prescribing, dispensing, administration and monitoring), patient age, and ward type.Results After the ePMA was introduced incidents were increased from 6.55 incidents per 1000 PN to 10.44 per 1000 PN days. No harm (NCCMERP Category A-C) incidents increased from 4.37 to 9.14 per 1000 PN days. Category A (capacity to cause error), and Category B (error did not reach patient) incidents increased from 0 to 3.92 and 0 to 3.26 per 1000 PN days respectively. Category D incidents (harm did not occur as result of an intervention or additional monitoring), increased from 0.55 to 1.31 per 1000 PN days. Harm incidents (NCCMERP Category E-I) reduced from 1.64 to 0 per 1000 PN days. Chi-squared test (p=0.05) demonstrated statistical significance. Incidents related to prescribing were reduced by 16.5% from 5.46 to 4.56 per 1000 PN days. Incorrect infusion rate incidents reduced from 76.9% to 18.8% of all prescribing errors. Most incidents continued to be reported in babies less than 1 year of age; and also within the surgical ward.Conclusions While an increase in clinical incidents reported related to parenteral nutrition was observed, overall the severity was reduced; and after introduction of an ePMA there were no incidents reported that resulted in patient harm. Increased numbers of no harm incidents suggests increased reporting levels, and an overall low reporting threshold. Incidents should be periodically re-assessed to determine impact of ePMA beyond the initial go-live period, particularly after further optimisation of the system. The reduction in prescribing errors, particularly in incorrect rate prescribing errors, is potentially due to fewer steps in prescribing process, and no longer a need for duplicate prescribing on separate administration charts. Targeted training could be introduced within the surgical ward, as the clinical area with highest number of incidents reported.References Franklin BD, O’Grady K, Donyai P, et al. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study. Quality and Safety in Health Care 2007;16(4):279–84.Riskin A, Picaud JC, Shamir, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines in pediatric parenteral nutrition: standard versus individualised parenteral nutrition. Clinical Nutrition 2018;37:2409–2417.Pedlow S. P18 A review of paediatric parenteral nutrition incidents. BMJ Paediatrics Open 2025;9(Suppl 2):A13.2.National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). NCC MERP Index for Categorizing Medication Errors Algorithm. Rockville (MD): NCC MERP; 2001. Available from: https://www.nccmerp.org/sites/default/files/algorColor2001-06-12.pdf",
  "authors": [
    {
      "affiliations": [
        "Belfast Health and Social Care Trust, UK"
      ],
      "name": "Sarah Pedlow"
    }
  ],
  "title": "P30 Is paediatric parenteral nutrition safer with electronic prescribing and medicines administration systems?",
  "uid": "b4fec877-718b-54a7-979a-21702ab13233"
}