Medication errors in children

Prescribing, dispensing and administration of medicines for children pose a unique set of risks, predominantly because of the wide variation in body mass, which requires doses to be calculated individually based on patient age, weight or body surface area, and their clinical condition. This increases the likelihood of errors, and tenfold errors, as 

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USPCenterfortheAdvancementof Patient Safety. USP issues recommendations for preventing medication errors in children. January 21, 2003. 

Table 3.4 Case reports of medication errors in children... 

Cousins D, Clarkson A, Conroy S, Choonara I (2002). Medication errors in children - an eight year review using press reports. Paediatr Perinatal Drug Ther 5 52-58. 

Cowley E, Williams R, Cousins D (2001). Medication errors in children a descriptive summary of medication error reports submitted to the United States Pharmacopoeia. Curr Ther Res 62 627-640. 

Ghaleb M A, Wong I C K (2006). Medication errors in children. Arch Dis Child Educ Pract 91 20. 

That medication errors occur frequently in U.S. hospitals has been well-documented [2-4]. In observation studies done between 1962 and 1995 on the rate of administration errors in a variety of in-patient settings, rates ranged from 0 to 59% [5]. Estimates that medication errors occur in almost 7% of hospitalized patients have been reported [6]. One study found that the frequency of medication errors was 1.4 per admission [4]. When approximately 290,000 medication orders were analyzed, Lesar et al. estimated that there were almost two serious errors for every 1,000 orders written. Based on a review of death certificates, it was estimated that almost 8,000 people died from medication errors in 1993, as opposed to almost 3,000 people in 1983 [3]. Researchers foimd an error rate at tv 0 children s hospitals of 4.7 per 1,000 orders [7]. Several... 

There are many pediatric medical, nursing, and pharmacy journals that include articles on pediatric drug therapies (Table 2). Pediatrics, the journal of the American Academy of Pediatrics (AAP), and the Journal of Pediatrics are considered by most pediatric practitioners to be the top in the field. Pediatrics is of particular use to clinicians because it includes the policy statements developed by the AAP. These statements are considered to represent standards of practice by pediatricians. Many of these statements are also of interest to clinical pharmacists, such as the yearly schedule for routine childhood immunizations. Other AAP policy statements of note include recommendations on the administration of medications during breastfeeding, the ethical treatment of children enrolled in clinical research trials,and methods to reduce medication errors in the pediatric inpatient setting. The Journal of Pediatrics has also published useful practice recommendations, such as the guidelines for antithrombotic therapy.The pediatric journal for the American Medical Association, Archives of Pediatrics and Adolescent Medicine, often contains large-scale sur-... 

This new textbook, not least because it deals with the pharmacokinetics and pharmacodynamics of drugs and formulations in children of different ages, also provides a timely discussion of pharmacogenomics and addresses the real problem of medication errors in paediatric practice, often caused by the need to manipulate adult dose forms to deliver drugs to very young people. There are many challenges in the formulation of established, new and orphan drugs for use in paediatric... 

Farrar K, CaldweU N, Robertson J, et al. Use of structured paediatric-prescribing screens to reduce the risk of medication errors in the care of children. Br J Healthc Comput Inf Manag. 

Eolli HE, Poole RE, Benitz WE, et al. Medication error prevention by clinical pharmacists in two children s hospitals. Pediatrics 1987 79 718-722. 

Allopurinol is contraindicated in patients who have exhibited serious adverse fffects or hypersensitivity reactions to the medication, and in nursing mothers and children, except those with malignancy or certain inborn errors of purine metabolism (e.g., Lesch-Nyhan syndrome). Allopurinol generally is used in complicated hyperuricemia (see above), to prevent acute tumor lysis syndrome, or in patients with hyperuricemia post-transplantation. If necessary, it can be used in conjunction with uricosuric agents. 

Ghaleb and Wong s review (2006) demonstrates that the spontaneous reporting systems tend to yield a lower rate of paediatric medication errors than the other methods. This is due to underestimation and under-reporting. In contrast, observation methods tend to find higher incidences than the other two methods. These published reports confirm that paediatric medication errors are at least as common as errors in adults. A study by Kaushal and colleagues (2001) has shown that potential adverse drug events may be three times more common in children than in adults. 

Significant correlation between duration of atypical meds and NAA signal in ACC in patients on atypical antipsychotics typical neuroleptic users showed progressive decrease in NAA levels in ACC 4 NAA in ACC and fewer errors on Wisconsin Card Sort Task in patients treated with atypical meds compared with patients treated with typical antipsychotics 4 NAA/Cr in FL of children with schizophrenia spectrum disorders no medication effects or other metabolite differences found... 

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