The study setting was the Johns Hopkins Outpatient Pharmacy
at the Arcade located near the Bloomberg Children's
Center at The Johns Hopkins Hospital, a tertiary academic
medical center. This pharmacy fills approximately 450 prescriptions
per day, of which approximately 30% of the prescriptions
are for pediatric patients. Approximately 60%-70% of
patients discharged from the Children's Center have their
discharge medications filled at the aforementioned outpatient
pharmacy.A retrospective outpatient prescription record review was
performed for all pediatric prescriptions filled between July 1,
2013, and December 31, 2013, at the Johns Hopkins Outpatient
Pharmacy at the Arcade. Patients younger than 18 years were
considered pediatric patients. From these data, only prescriptions
sent to the problem queue because of the weightbased
dosing infraction were analyzed. The problem queue is
an electronic database in which prescriptions in the
dispensing process are held because of an issue that must be
resolved with the prescriber or patient insurance. Prescriptions
sent to the problem queue for any reason other than
weight-based dosing were excluded.
Prescriptions that met the criteria for inclusion were
described based on types of inappropriate prescribing. This
included overdosing, suboptimal dosing, inappropriate dosing
interval, and incomplete or illegible prescriptions. Prescriptions
were also analyzed to determine the error prevalence by ISMP high-alert drug classes. These classes include antiretroviral
agents, chemotherapeutic agents, immunosuppressant agents,
and opioids. Prescriptions were also analyzed to describe patient
demographics of age, weight, and sex. The prescriber
origin was also analyzed to determine whether the prescriber
was house staff or not. A house staff prescriber is defined as
residents and fellows in training, and non-house staff prescribers
were categorized as attending physicians and physician
extenders. Lastly, the prescription origin was described as
either computer generated or hand written. This study was
approved by The Johns Hopkins Medical Institutions Institutional
Review Board.