Pediatric Medication Safety in the Emergency Department

Abstract

Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weightbased dosing, optimizing computerized physician order entry using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.

Antibiotic Prescribing Errors in Patients Discharged From the Pediatric Emergency Department

“…The common finding of underdosing of antibiotics suggests that further education on treatment regimens for specific disease states, as well as review of appropriate pediatric-specific dosing, is necessary. Pediatric-specific physician education is recommended by the American Academy of Pediatrics and has been shown to significantly decrease medication errors in the PED in multiple investigations 11,22–24 . This could be accomplished through the implementation of medical resident training sessions during orientation that are focused on pediatric medication dosing and even repeated on a smaller scale at the start of their PED rotations.…”

“…In addition to in-person trainings, leveraging technology to encourage guideline-based dosing algorithms within CPOE would allow physicians to have quick access to appropriate dosing regimens. The use of recommended dosing regimens outlined in CPOE has been shown to significantly decrease prescribing errors 11,25 . Combining this method with an optimal utilization of the institution's on-site pharmacy may also help to decrease both incomplete prescriptions and dosing errors.…”

“…Recently, however, there has been an increased interest in exploring the incidence of medication errors in those patients discharged from PEDs, with investigators identifying medication error rates between 4.3% and 22.7% of all outpatient prescriptions written on discharge 8,10 . The American Academy of Pediatrics policy statement on pediatric medication safety in the PED states that pharmacist coverage in the PED, formulary standardization, computerized physician order entry (CPOE), and training physicians in pediatric medication safety would improve medication prescribing errors in the ED 11 . However, to optimally target any of these interventions among the vast number of medication classes written on discharge from PEDs, a more detailed identification of the medication orders at highest risk for errors is warranted.…”