Prescribing and medication errors remain common in pediatric hospital wards

Results from a study showed an overall prescribing error rate of 13.2% and an overall medication administration error rate of 19.1% in the pediatric wards of five London hospitals — calling attention to the need for improvement strategies.

From 2004 to 2005, researchers in the United Kingdom conducted a prospective review of drug charts from one specialist children’s teaching hospital, one nonteaching hospital and three nonspecialist teaching hospitals. They monitored 11 pediatric wards for prescribing errors and 10 pediatric wards for medication administration errors during a period of two consecutive weeks each.

The researchers defined prescribing errors as occurring when part of the prescribing process decreased a child’s chance of receiving timely and effective treatment or increased risk for harm to the child. They also characterized medication administration errors as any deviations from prescriptions or incorrect preparation or administration of medications.

Overall, they observed 444 pediatric patients and 2,955 medication orders. Results revealed 391 prescribing errors, with rates ranging from 5% (95% CI, 2.2%-7.8%) in one ward to 31.5% (95% CI, 24.3%-38.6%) in another. Incomplete prescriptions and dosing errors comprised the majority of prescribing errors.

The researchers also found 429 medication administration errors, varying between 9.0% (95% CI, 5.5%-12.5%) to 31.3% (95% CI, 25.4%-37.1%) across the wards. Data indicated that errors in drug preparation (20.7%), incorrect rates of IV administration (19.8%) and dosing errors (9.3%) were responsible for most medication administration errors.

In five cases, the researchers intervened because the dosing error would have had serious repercussions for the child. They also noted that only one prescribing error was reported to a hospital’s risk management department whereas none of the medication administration errors were reported.

They indicated that strategies to reduce errors, such as the development of electronic prescribing systems, are essential. They also wrote that clinicians “should be vigilant in writing prescriptions; nurses and pharmacists should be vigilant in checking prescriptions before dispensing and administering medications to children.”

Ghaleb MA. Arch Dis Child. 2010;doi:10.1136/adc.2009.158485.

This study by Ghaleb and colleagues provides additional data about the important implications associated with medication use in pediatrics. Dosing errors were shown to be a common cause of medication errors in this study, as has been demonstrated in other studies. Because several steps are often required when determining a pediatric patient-specific medication dose, the potential for error is increased.

Doses ordered without patient weight stated or weight not specified as pounds or kilograms are several examples that can introduce error to drug dosing. Many of these medication errors are not difficult to prevent, and electronic prescribing systems can be helpful. Monitoring and identifying medication errors are essential and should not be used primarily to assign individual blame, but to highlight alterations in system-wide practice patterns that may reduce these errors.

– Edward Bell, PharmD
Infectious Diseases in Children Editorial Board