Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting

Abstract

ABSTRACT: Objective: To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting. Methods: A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success. Results: Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%. Conclusion: The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings.