‘Unnoticed previously,’ hospital medication errors are more common in older children
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Key takeaways:
- The error rate among children aged older than 12 years was 20.9 per 100 orders.
- Clinicians are more careful with young children perhaps because they see greater harm stemming from errors, a researcher suggested.
Medication errors in hospitalized children were more common among older age groups, according to research published in The Journal of Pediatrics.
The Australia-based investigation began with an intent to examine how the introduction of an electronic medication management system affected prescribing and administration errors at the main pediatric hospitals in New South Wales, according to one of the study authors.
“We adjusted for age and noticed that error rates appeared to be higher in older children,” Tim Badgery-Parker, PhD, a biostatistician at the Australian Institute of Health Innovation at Macquarie University, told Healio. “This was surprising to some clinicians as more errors were expected in younger children, so we decided to explore the association in more detail using the existing data for both prescribing errors and medication administration errors.”
Badgery-Parker explained that this was “a relatively unexplored aspect of quality of care.”
The researchers analyzed prescribing errors in nine wards of a tertiary pediatric hospital and five wards of another tertiary pediatric hospital between April 22 to July 10, 2016, June 20 to Sept. 20, 2017, and June 20 to Sept. 30, 2020. At the nine-ward hospital, they also examined medication administration errors.
They found that the crude error rate for the entire sample of 68,781 orders for 8,691 pediatric patients was 18.6 (95% CI, 18.3-19) per 100 orders. Specifically for patients aged younger than 1 year, the crude error rate was 16 per 100 orders (95% CI, 15.2-16.9, compared with 20.9 (95% CI, 20.3-21.6) per 100 orders for patients aged 12 years and older.
Medication errors increased nonlinearly with patient age (P = 0.01), showing little association from ages 0 to 3 years and then increasing with age until around 10 years, and remaining constant through the teenage years.
Administration errors increased with patient age as well, with no association from 0 to around 8 years and then a steady rise with increasing age (P = 0.03). The researchers explained that associations differed by route — they were linear for oral medication and U-shaped for IV injections, but there was no association for IV infusions.
The study showed that the four most frequent error types across all age groups were wrong dose — which was the most common type of error — wrong frequency, duplicated drug therapy and wrong route.
“Nobody wants to make mistakes in patient care,” Badgery-Parker said. “Our results suggest that errors are more common among older than younger children, so clinicians might want to be aware of this when prescribing for an older child and perhaps check the order again before signing it.”
Badgery-Parker said medication errors should be examined in neonatal ICUs (NICUs) and pediatric ICUs (PICUs) next.
“Those children have quite different medical needs, and the association we observed may not apply to NICU/PICU,” Badgery-Parker said.
He added that although the study found an association between patient age and medication errors, it cannot explain why this observed pattern occurs.
“To reduce medication errors, we need to understand the contributing factors,” Badgery-Parker said. “A lot of research has been and is still being done in this area. This age association is one factor that appears to have been unnoticed previously. It might result from differences in the conditions being treated or the medications used in different age groups. Possibly clinicians are more careful with very young children as they see greater risk of error or harm. Studies that uncover why error rates are different for younger and older children can lead to insights that will help target interventions to reduce errors for all children.”
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