Medication errors, paediatric

Miller MR, Robinson KA, Lubomski LH, et al. Medication errors in paediatric care a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 2007 16 116-126. 

Raju TN, Kecskes S, Thornton JP, et al. Medication errors in neonatal and paediatric intensive-care units. Lancet 1989 2 374-376. 

The variation in the error rates was probably due to the differences in the definitions of medication errors, the methodologies used and the settings. For example, the error rate in a neonatal intensive care unit is much higher than that in a general paediatric ward. Furthermore, the systems of prescribing, dispensing and drug administration vary... 

Table 3.1 Studies that used spontaneous reporting as method of detecting medication errors of all types in paediatrics...

Paton and Wallace, 1997 (UK) 2 years (April 1994-June 1996) Paediatric hospital Analysis of routinely collected medication error reports Number of reports 92. No reporting rate given... 

AE, administration error ED, emergency department ME, medication error NICU, neonatal intensive care unit PCICU, paediatric cardiac intensive care unit PICU, paediatric intensive care unit PE, prescribing error PCW, paediatric cardiac ward DE, dispensing error. 

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. 

Cousins et al. (2002) conducted an analysis of press reports highlighting the outcomes of 24 cases of paediatric medication errors (Table 3.4). Most of the cases reported resulted in fatal consequences, hence making the news headlines. 

The review by Wong and colleagues concluded that the most common type of paediatric medication errors are dosing errors, especially tenfold errors (Wong et al., 2004). Other paediatric medication errors have been reported in the literature, including ... 

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. 

Nixon P, Dhillon S (1996). Medication errors in paediatrics. Progress in Practice UKCPA Autumn Symposium, 18-19. 

Ross L M, Wallace J, Paton J Y (2000). Medication errors in a paediatric teaching hospital in the UK five years operational experience. Arch Dis Child 83 492-497. 

Wilson D G, McAitney R G, Newcombe R G, et al. (1998). Medication errors in paediatric practice insights from a continuous quality improvement approach. Eur J Pediatr 157 769-774. 

To achieve an appropriate strength, it is sometimes necessary to dilute the commercial preparations. Not only can physical and chemical stability be compromised but dilution may also render preservatives ineffective. For complex formulations in particular the suitability of the diluent must be assessed prior to manipulation. When drugs are unstable in solution, they are usually formulated as dry powders for reconstitution with an appropriate diluent (water) and most paediatric doses will require withdrawal of a dose volume that is different to the total volume after reconstitution. This can lead to medication errors (Wong et ah, 2004). 

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. 

Porter, M., Gerrish, P, Tyler, L., Murray, S., Mauriello, R., Soto, E, Phetteplace, G., Hareland, S., Reliability Considerations for Implantable Medical ICs, Proceedings of the 46th Annual International Reliability Physics Symposium, 2008, pp. 516-552. Preboth, M., Medication Errors in Paediatric Patients, American Family Physician, Vol. 63, No. 2,2001,pp. 678. 

USA) 1995. Phase 1 14 days phase 2 5 days paediatric teaching hospital. Phase 1 2 units (ICU and medical surgical unit). Phase 2 3 units (ICU, medical and surgical units) Following medication order written from prescribing through administration. Also review of medical record, pharmacy s clinical interventions and quality control log, and incident reports. Also review of medication administration record Sample 3312 medication orders Error rate 24/100 orders Administration error 0.15% doses administered... 

USA) 1999) teaching hospital and all paediatric wards in a general teaching hospital Identified incidents from reporte, medication order sheets and medication administration records and chart reviews Sample 10 778 medication orders orders Error rate 5.7/100 orders... 

Fontan et al., 2003 (France) 8 weeks Paediatric hospital Prospective study Prescription and administration documents were analysed daily and medical record analysis was used to compare the prescription with administration report Sample = 49 patients Prescriptions = 511 Prescribed drugs = 4532 Prescription error rate 20.7% (1.9 errors per patient per day) Administration error rate 23.5%... 

Cimino et al, 2004 (USA) 2 weeks pre-intervention 3 month site-specific error reduction interventions 2 weeks post-intervention Paediatric hospitals - 9 PICUs Prospective study Three levels of surveillance used (1) pharmacy order review for errors and computer order entry step (2) PICU nurse order transcription and review for errors step (3) an oversight team check Sample = 12 026 medication orders ror rate 0.22 per order... 

Nixon and Dhillon, 1996 (UK) 2 weeks General hospital -two paediatric wards (one medical and one surgical) 487 and 425 administration observed for medical and surgical wards respectively. No. of patients not mentioned Observation from Sam to 8pm, Monday to Saturday Administration errors 5.6% and 4.5% for respective wards... 

The majority of paediatric medications do not result in harm. Blum and co-workers (1988) reported that only 0.2% of the errors could be classified as potentially lethal, whereas Folli et al. (1987) reported 5.6% as potentially lethal. Interestingly, no actual harm to children was reported in most of the epidemiological studies. This might be because the errors were identified and rectified before any harm resulted, but it could be due to publication bias - some healthcare providers may be reluctant to publish studies reporting patients with serious harm. 

Wong I C K, Ghaleb M, Dean Franklin B, Barber N (2004). Incidence and nature of dosing errors in paediatric medications - A systematic review. Drug Safety 27 661-670. 

---