Medication errors in paediatric outpatients

Abstract

Background Medication errors are common in many settings and have important ramifications. Although there is growing research on rates and characteristics of medication errors in adult ambulatory settings, less is known about the paediatric ambulatory setting. Objective To assess medication error rates in paediatric patients in ambulatory settings. Methods The authors conducted a prospective cohort study of paediatric patients in six outpatient offices in Massachusetts. Data were collected using duplicate prescription review, two parental surveys and chart review. A research nurse classified all medication errors by stage and type of error. Results The authors identified 1205 medication errors with minimal potential for harm (rate: 68% of patients, 95% CI 64 to 72%; 53% of Rx, 95% CI 50 to 56%) and 464 potentially harmful medication errors (ie, near misses) (rate: 26% of patients, 95% CI 24 to 28%; 21% of Rx, 95% CI 19 to 22%). Overall, 94% of the medication errors with minimal potential for harm and 60% of the near misses occurred at the prescribing stage. The most common types of errors were inappropriate abbreviations followed by dosing errors. The most frequent cause of errors was illegibility. Conclusion With paper prescribing, half the prescriptions had medication errors, and one in five had a potentially harmful error. These rates are very high. Interventions targeting the ordering and administration stages have the greatest potential benefit. BACKGROUND

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

“…This was done because reviewer discrepancies often exist in determining whether a medication error is truly an error. 28 …”

Safety Incidents in the Primary Care Office Setting

“…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] …”

Evaluation of prescribing medication errors in a pediatric outpatient pharmacy

“…Most of the detected MEs were related to prescribing error (improper dosing [8%], inappropriate frequency [3%], dosage strength [3%], and inappropriate abbreviation used 20%), while in Pharmacopeia MEDMARX database, the prescribing error rate was reported to be around 8% in an outpatient pediatric clinics due to illegible handwriting, improper dose, and confused drug name. [10,11] Despite that children are considered high-risk group for MEs, and health-care provider is aware about the extent of the harm of possible drug events in all settings, there is still gap in the current evidence about the exact extent of the problem in an outpatient setting. Walsh KE et al in 2008, reported that 18.8% of the reviewed outpatient pediatric oncology prescriptions associated with ME, especially prescribing error (64%), and around 41% of the patients were harmed or injured.…”