Medication errors in a pediatric emergency department

Selbst, Steven M.; Fein, Joel A.; Osterhoudt, Kevin C.; Ho, Weng Hoe

doi:10.1097/00006565-199902000-00001

Cited by 112 publications

(79 citation statements)

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“…48,49 Pediatric medication incidents (including their extent and methods to reduce them) have been extensively explored in the hospital setting, but less so in family practice. 43,47,[50][51][52][53][54] Our findings emphasize the importance of verification procedures and support barcode scanning of medications during dispensing and using generic medication names (rather than brand names) to reduce mistakes from inattention or distraction and communication errors. [55][56][57] …”

Section: Discussionsupporting

confidence: 57%

Safety Incidents in the Primary Care Office Setting

et al. 2015

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Section: Discussionsupporting

confidence: 57%

Safety Incidents in the Primary Care Office Setting

et al. 2015

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“…It is known that one of the most comment errors in pediatric emergencies is incorrect dosing due to inaccurate weight estimations. 20 The Pediatric Advanced Life Support (PALS) guidelines recommend a dose of 0.01 mg/kg of adrenalin when indicated by intravenous or intraosseous infusion. 1 Our study showed that children from Ontario are at risk of underdosing, which may adversely affect the success of resuscitation of these children.…”

Section: Discussionmentioning

confidence: 99%

Ontario children have outgrown the Broselow tape

Milne

Yasin

Knight

et al. 2012

CJEM

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Objective: The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a wellestablished length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. Methods: Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated. Results: A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r 5 0.95577, p , 0.0001), the BT underestimated the actual weight by 1.62 kg (7.1% 6 16.9% SD, 95% CI 226.0-40.2). The BT had an $ 10% PE 43.7% of the time. Conclusions: Although the BT remains an effective method for estimating pediatric weight, it was not accurate and tended to underestimate the weight of Ontario children. Until more accurate measurement tools for emergency departments are developed, physicians should be aware of this discrepancy. RÉ SUMÉObjectif: L'é chelle de Broselow (Broselow Tape [ Bien que les poids estimé s à l'aide de l'é chelle de Broselow aient é té corré lé s avec les poids ré els (r 5 0,95577, p , 0,0001), l'é chelle de Broselow a sous-estimé le poids ré el de 1,62 kg (7,1 % 6 16,9 % é cart-type, IC à 95 %: 26,0 à 40,2). L'é chelle de Broselow avait un $ 10 % PE 43,7 % du temps. Conclusions: Bien que l'é chelle de Broselow reste une mé thode efficace d'estimation du poids en pé diatrie, elle ne s'est pas montré e exacte et tend à sous-estimer le poids des enfants en Ontario. Tant que l'on n'aura pas dé veloppé d'outil de mesure plus pré cis pour les services d'urgence, les mé decins doivent ê tre conscients de cette divergence.

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“…It is unclear whether the present findings are attributable to the observed admission densities or the increased human-error rates during evening hours, as reported in both medical and nonmedical fields. [30][31][32][33] Nevertheless, it is possible to assess prospectively whether changes in the structure of care, process of care, or a combination thereof could negate the observed differences in mortality rates between daytime and nighttime admissions to the PICU.…”

Section: Discussionmentioning

confidence: 99%

Association Between Evening Admissions and Higher Mortality Rates in the Pediatric Intensive Care Unit

2004

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ABSTRACT. Background. Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population.Objective. To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs.Design/Methods. We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score.Patients. T o improve the quality of care, discrepancies in health care delivery and their effects on patient outcomes must be identified. Recent research has demonstrated that, among large patient cohorts, differences in time of admission are associated with differences in patient outcomes. Bell and Redelmeier 1 identified a significantly higher mortality rate among adult patients admitted on the weekend, compared with similar patients admitted on weekdays. Barnett et al, 2 in a study of Ͼ150 000 adult patients admitted to 38 intensive care units (ICUs), demonstrated both a higher risk-adjusted odds of in-hospital death and a longer ICU length of stay for patients admitted on the weekend, compared with patients admitted on weekdays. Similarly, neonatal mortality rates were shown to be slightly higher among infants born on weekends and during evening hours, compared with those born on weekdays and during daytime hours, respectively. [3][4][5][6][7][8] Whether an association exists between patient outcomes and time of admission in the pediatric patient population is unknown.To address this question, the Pediatric Intensive Care Unit Evaluations (PICUEs) database, representing a cohort of 34 993 pediatric ICU (PICU) patients from 15 institutions in the United States, was analyzed. 9 The objectives of this study were to compare the risk-adjusted mortality rates for weekend admissions versus weekday admissions and the risk-adjusted mortality rates for evening admissions versus daytime admissions. METHODS PatientsData for analysis were obtained from the most current available PICUEs database, Research Dataset 20 -02. 9 This database contains patient-level data from 34 993 admissions to 15 PICUs in the United States. Details of the site-selection procedures for the 15 study sites, general data-collection methods, and other analyses of this data set have been published. 9,10 Briefly, a minimum of 67 demographic, diagnostic physiologic, laboratory, and outcome data points were collected for all patients within 24 hours a...

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Medication errors in a pediatric emergency department

Cited by 112 publications

References 0 publications

Safety Incidents in the Primary Care Office Setting

Safety Incidents in the Primary Care Office Setting

Ontario children have outgrown the Broselow tape

Association Between Evening Admissions and Higher Mortality Rates in the Pediatric Intensive Care Unit

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