Characteristics of Reported Pediatric Medication Errors in Northern Ireland and Use in Quality Improvement

Abstract

BackgroundTo protect children from harm, clinicians, educators, and patient safety champions need information to direct improvement efforts. Critical incident data, often disregarded as a source of evidence because under-reporting makes them an inaccurate measure of error rates, could provide this. AimOur aim was to identify key targets for pediatric healthcare quality improvement. The objective was to evaluate the types, characteristics, and areas of risk within reported medication errors in pediatric patients. MethodsRetrospective study of a large regional dataset of 1522 pediatric medication errors reported from secondary care between 2011 and 2015, including all hospitals and community pediatric settings in Northern Ireland. Characteristics included: error severity; patient age; drug involved; error type; and area of practice. Two academic pediatricians, a senior medicines governance pharmacist, a Reader in Pharmacy Practice, and a Professor of Medical Education analysed the data. Validity checks included comparing the findings against key published literature and discussion by a practitioner panel representing five multidisciplinary stakeholder groups. ResultsNeonates, particularly in intensive care, were implicated in 19% of all errors. The medications most represented in risk were antimicrobials, paracetamol, vaccines, and intravenous fluids. The error types most implicated were dosing errors (32%) and omissions (21%). ConclusionsIncident reports identified neonates, a shortlist of drugs, and specific error types, associated with modifiable behaviours, as priority improvement targets. These findings direct further study and inform intervention development, such as specific training in calculations to prevent dosing errors. Involving experienced practitioners both endorsed the findings and engaged the practice community into their future implementation. The utility of incident reports to direct improvement efforts may offset limitations in their representativeness. Key points Critical incident reports can support medication safety by providing information on characteristics and nature of errors  Discussion with stakeholders and review of selected literature can offset incidents' lack of representativeness and support their validity  In pediatric medication safety, factors associated with risk of error included neonatal care, dosing and timely administration, and use of common drugs such as antimicrobials, paracetamol, IV fluids and vaccines

Patterns of medication errors involving pediatric population reported to the French Medication Error Guichet

“…33 Recent estimates also highlight this issue, whereby administration errors accounted between 42.5% and 54% of pediatric medication errors. 14,15 Of interest, Kaushal et al found that harmful errors occurred most commonly at the drug administration stage by parents. 34 Interventional studies in hospital medication administration errors explored barcode medicine administration, electronic prescribing, education and training, use of smart pumps, and standard concentration.…”

“…10 Patterns of medication errors in pediatrics are understudied in the hospital and community settings. 14,15 Besides, using information from studies conducted on adults may be of limited value, since medication errors most likely differ between the two populations. 16,17 Exploring specific patterns of medication errors in pediatrics compared with adults could enhance our understanding of this complex problem in pediatrics and inform targeted efforts to enhance patient safety.…”

A Mixed-Methods Analysis of Medication Safety Incidents Reported in Neonatal and Children’s Intensive Care

“…safety guidance and research that aimed to reduce medication errors and related adverse drug events across different healthcare settings [5,9,[17][18][19].…”

“…Medication-related safety incidents are commonly reported as the most frequent incident type in hospitals and may be more likely to cause harm in children than in adults [1,2]. The risk of experiencing these incidents may be greater for neonates and children admitted to intensive care units (ICUs) than for those on general wards because of factors such as the use of medicines associated with a high risk of harm, complicated and severe illnesses, complex weightbased dosing calculations, and heavy staff workload [3][4][5]. In addition, neonates and children admitted to ICUs may be pre-verbal or sedated, and this will affect their ability to prevent errors themselves [6].…”

“…The NRLS is a good example of reporting systems that include the checklist of WHO Draft Guidelines for Adverse Event Reporting and Learning Systems [ 15 , 16 ] and gather necessary information about incidents to enable success analysis and results dissemination with recommendations for safety improvements in healthcare systems. Incident reports submitted to the NRLS have been a source of information for those creating national patient safety alerts, rapid response reports, and medication safety guidance and research that aimed to reduce medication errors and related adverse drug events across different healthcare settings [ 5 , 9 , 17 – 19 ].…”