In November 2006 a fax machine installed in the pharmacy was programmed to receive orders only from the pediatric wards and the neonatal intensive care unit (NICU). At the same time, a pharmacy technician repro- grammed the fax machines on the pediatric wards and in the NICU to send documents directly to the dedicated pediatric fax machine in the pharmacy. Programming was confirmed by sending test faxes from the ward fax machines. The emergency department had 2 pediatric beds, but it was not possible to include those beds in the study described here. The dedicated pediatric fax machine was stocked with blue paper to help pharmacy staff mem­bers identify pediatric orders once they had been removed from the fax machine. Pharmacy staff members were informed that, from that time forward, pediatric orders would arrive on the dedicated fax machine. No addition­al instruction or education was provided.

Medication orders were processed according to usual procedures. Oral and topical medications, as well as parenteral drugs to be prepared by nursing staff, were dispensed according to a traditional system, with 5-day supplies; parenteral medications prepared by pharmacy staff were dispensed daily. Not all orders from the NICU were entered into the pharmacy computer system, as the NICU does not use pharmacy-generated medication administration records; however, all orders from the NICU were to be reviewed by a pharmacist.For this study, the clinical pharmacy specialist for pediatrics performed a retrospective audit of the pediatric orders. A sample of records was obtained by randomly selecting 9 days’ worth of orders from up to 2 months before and 6 to 8 months after installation and program­ming of the dedicated pediatric fax machine. The pediatric medication orders were reviewed to determine the total number of orders received and processed and whether doses had been checked. A dose was deemed to have been checked if a notation such as “dose ok” or a milligram per kilogram or milligram per square metre calculation appeared on the order. eriacta

Doses were considered to be in the acceptable range if they matched recommen­dations in the BC Children’s Hospital 2002/2003 Pediatrics Drug Dosage Guidelines, the 2005-2006 Drug Handbook and Formulary of the Hospital for Sick Children, Toronto, or the pediatric dosage recommendations of Lexi-Comp, Neofax, or Micromedex. Missed orders were those that had been received by the pharmacy department and filed, with no evidence that the order had been reviewed, processed, or filled by a pharmacy staff member. For the pediatric ward, missing orders were confirmed by receipt of a refaxed order and missing medication memo request from nursing staff. All orders were screened for the correct patient, drug, and route. In addition, the appropriateness of formulations (i.e., use of pediatric formulations) and label instructions were reviewed. Descriptive statistics were used to compare the scrutiny of orders before and after implementation of the dedicated pediatric fax machine.