Reducing pediatric prescription errors: a quality improvement initiative in a tertiary-care outpatient setting

Priyanka R. Solanki; Harsh P. Purohit; Rashmi S. Thanvi; Nehal H. Patel; Dipti S. Shah; Bhumika J. Patel

doi:10.18203/2349-3291.ijcp20260099

Authors

Priyanka R. Solanki Department of Pediatrics, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
Harsh P. Purohit Department of Pediatrics, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
Rashmi S. Thanvi Department of Pediatrics, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
Nehal H. Patel Department of Pediatrics, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
Dipti S. Shah Department of Pediatrics, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
Bhumika J. Patel Department of Pharmacology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20260099

Keywords:

Rational drug use, Clinical audit, Drug dosing, Medication safety, Standard treatment protocol

Abstract

Background: Prescription errors are among the most common preventable causes of harm in healthcare, especially in pediatrics. This study was conducted to identify, analyze and reduce prescription errors using Quality improvement methods like Plan-Do-Study-Act (PDSA) cycles. Our study question was “Does implementing PDSA-based quality improvement interventions reduce prescription errors in the pediatric outpatient department of a tertiary care hospital in Western India?

Methods: This study was conducted in the pediatric out-patient department (OPD) of a GMERS Medical College and Sola hospital in Western India from February 2025 to April 2025. The intervention was implemented in two PDSA cycles. PDSA-1 involved the introduction of a revised pediatric formulary and daily pre-OPD educational briefings. PDSA-2 introduced standard treatment protocols (STP) reinforced through interactive sessions. Prescription errors were classified into predefined categories and analyzed across three phases: baseline, PDSA-1, and PDSA-2. Data were analyzed using descriptive statistics, chi-square tests, and ANOVA test with significance set at p<0.05.

Results: A total of 1,188 prescriptions were reviewed (baseline: 591; PDSA-1: 353; PDSA-2: 244). The overall error rate declined from 27.2% at baseline to 20.1% during PDSA-1 and 9.0% during PDSA-2 (p<0.001). Significant reductions were observed in wrong dose errors (5.58% to 1.64%), dose omissions (1.69% to 0.41%), and missing duration (2.54% to 1.23%). Wrong drug errors showed minimal change, indicating the need for more advanced interventions.

Conclusions: Low-cost QI interventions can significantly enhance prescribing safety in resource-limited settings, although more complex errors may require digital or system-level solutions.

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