Influence of Dietitians in Preventing Parenteral Nutrition Prescription Errors in Children

Abstract

Background: The purpose of this study is to determine whether direct involvement by dietitians in parenteral nutrition (PN) ordering resulted in a reduction in PN prescriptions errors. Methods: A prospective audit of PN prescriptions was undertaken at a pediatric hospital over 50 weeks. Prescriptions for PN that had dietitian involvement (dietitian group) were compared with prescriptions in which dietitians were not directly involved (nondietitian group). The number of total prescriptions, the number of prescriptions with errors, and the types of errors from both groups were recorded. Errors were classified into “dietitian-preventable errors” and “nondietitian-preventable errors.” Comparisons were made between prescriptions with and without errors, between dietitian-preventable and nondietitian-preventable errors, and between the dietitian and nondietitian groups per error type. Results: The total number of PN prescriptions was 725 (from 45 patients) and 471 (from 66 patients) for the dietitian and nondietitian groups, respectively. The nondietitian group was more likely than the dietitian group to prescribe PN incorrectly—18.0% (85 of 471) versus 12.4% (90 of 725; P = .007)—with the nondietitian group having 1.5-times more PN prescriptions with errors (risk ratio = 1.5, 95% CI: 1.1–1.9). The total number of prescription errors was 126 and 146 for the dietitian and nondietitian groups, respectively. The dietitian group was less likely than the nondietitian group to be associated with dietitian-preventable errors: 65.9% (83 of 126) versus 87.0% (127 of 146; risk ratio = 1.3, 95% CI: 1.1–1.5; P < .0001). Conclusion: Dietitian input into prescription of PN reduced the number of prescriptions with errors.