Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart

Abstract

Background: Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors.

Objective: To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. Setting: Acute general hospital in Malta.

Method: A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups’ response.

Main outcome measure: This was set at a 70 % level of agreement.

Results: Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70 % consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process.

Conclusion: Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients.