A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

Abstract

Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

“…Nevertheless, in order to minimize this problem, volunteers were requested to insert the syringe to a maximum of about one-fourth of the syringe length. This allows for a better comparison with real practice as children may insert a variable portion of the syringe in the mouth, but probably not more than 1 4 of its length. The design of the specific syringe used in this study does not include a nozzle which could be the only part of the syringe to be inserted in the child's mouth.…”

“…Whenever measurements were performed using the oral syringe, volunteers deepened the device into the formulation to a maximum of approximately 1 4 of the syringe length and the amount on the outer side of the wall was included in the analysis.…”

“…Children are at greater risk of medication errors [1] because (a) doses are calculated based on a patient's age, weight or body surface area [2,3] and need readjustment as those parameters change; (b) inadequate availability of appropriate dosage forms and concentrations; (c) immaturity of defense systems, such as hepatic metabolism and other pharmacokinetic parameters that are markedly different from the adult population and may have a significant impact on pharmacological therapy. These factors must be considered to promote the correct and safe use of medicines in pediatrics [3].…”

“…Average weight (n = 40), standard deviation (SD) and 95% confidence interval (95% CI) for 2.5 and 5 mL of antibiotic A, measured with a double-dosing spoon and oral syringe 1. Student t-test for paired samples.…”

Determining Medication Errors in an Adult Intensive Care Unit

“…The potential of medication errors (MEs) to cause harm to patients and increase hospital and legal costs is a current concern for the global health system, as reflected in the World Health Organization’s third global challenge [ 1 ]. MEs are preventable events prone to occur at all stages of the medication process and are relatively frequent among hospitalized adult patients, with reported rates ranging from 5% to around 90% [ 2 , 3 , 4 , 5 , 6 ].…”