Common Errors of Drug Administration in Infants

Abstract

Drug administration errors are common in infants. Although the infant population has a high exposure to drugs, there are few data concerning pharmacokinetics or pharmacodynamics, or the influence of paediatric diseases on these processes. Children remain therapeutic orphans. Formulations are often suitable only for adults; in addition, the lack of maturation of drug elimination processes, alteration of body composition and influence of size render the calculation of drug doses complex in infants. The commonest drug administration error in infants is one of dose, and the commonest hospital site for this error is the intensive care unit. Drug errors are a consequence of system error, and preventive strategies are possible through system analysis. The goal of a zero drug error rate should be aggressively sought, with systems in place that aim to eliminate the effects of inevitable human error. This involves review of the entire system from drug manufacture to drug administration. The nuclear industry, telecommunications and air traffic control services all practise error reduction policies with zero error as a clear goal, not by finding fault in the individual, but by identifying faults in the system and building into that system mechanisms for picking up faults before they occur. Such policies could be adapted to medicine using interventions both specific (the production of formulations which are for children only and clearly labelled, regular audit by pharmacists, legible prescriptions, standardised dose tables) and general (paediatric drug trials, education programmes, nonpunitive error reporting) to reduce the number of errors made in giving medication to infants.

Drug formulations that require less than 0.1 mL of stock solution to prepare doses for infants and children

“…The clinical sequelae of errors occurring as a result of preparing doses from small volumes will be compounded by incomplete safety data, [6][7][8][9][10] errors in medication orders, 11 and errors in preparation 2,12-14 or administration. 15,16 Preparation-associated errors could be prevented if more accurate equipment were available to measure small volumes. They could also be avoided with predilution of commercially available solutions, either by means of a doubledilution technique for single doses or the creation of local "stock solutions" for multiple patients.…”

Flat-Fixed Dosing of Irinotecan

“…In addition, drug preparation and administration errors are very common for i.v. drugs (16), and are usually the result of systematic error (inaccuracy of the calculation algorithms) and inevitable convergence error, including use of inaccurate height and weight for BSA calculation (17).…”

Evidence‐based strategies for preventing drug administration errors during anaesthesia

“…Surveys of opinion of specified 'experts' [53,57]; reports of expert committees [55]; book chapters [56]; narrative reviews [52]; editorials, or articles expressing the viewpoint of one or more acknowledged experts in the field [62] …”