Pediatric medication safety considerations for pharmacists in an adult hospital setting

Abstract

Purpose Risks and vulnerabilities of the medication-use process in nonpediatric institutions that also serve pediatric patients are reviewed, and guidance on risk mitigation strategies is provided. Summary There are many risks and vulnerabilities in the medication-use process as it relates to pharmacotherapy for pediatric patients admitted to adult institutions. Mitigation of these risks is critical and should encompass various available resources and strategies. Special emphasis should be placed on use of technology to improve overall safety. Available literature recommends optimization of technology and resource use, institutional support for pediatric pharmacists’ involvement in managing pediatric medication use, and provision of early exposure to pediatric patients in pharmacist training programs as additional methods of mitigating risks associated with pediatric medication use in adult institutions. Adult hospitals that provide care for pediatric patients should assess their processes in order to identify hospital-specific interventions to promote pediatric medication safety. Conclusion Pediatric medication safety frameworks in U.S. adult institutions vary widely. Treating pediatric patients involves risks in all areas of the medication-use process. Optimizing technology, utilizing external resources, supporting a pediatric pharmacist, and providing early-career exposure to pediatric patients are methods to mitigate risks in institutions that primarily serve adult patients.

Improving pediatric pharmacy services in a primarily adult emergency department

“…The pediatric population has unique healthcare needs and therefore can be particularly vulnerable to harm. 1,2 Pediatric patients experience a higher rate of medication errors than adults and may be subject to more adverse drug reactions as well. 1 The rate of medication errors in children may be as much as 3 times that in adults.…”

“…3 Factors contributing to this elevated risk include age-specific medication contraindications, need for personalized dosing strategies, nonpediatric providers, and a lack of pediatric safety alerts within information technology systems. 2,[4][5][6] When adverse medication events occur in children, they are associated with a higher rate of morbidity and mortality than in adults, likely owing to a lower tolerance for errors. 2 Children often receive initial disease management from adult acute care hospitals where pediatric resources may not be optimal.…”

“…2,[4][5][6] When adverse medication events occur in children, they are associated with a higher rate of morbidity and mortality than in adults, likely owing to a lower tolerance for errors. 2 Children often receive initial disease management from adult acute care hospitals where pediatric resources may not be optimal. 2 These frontline health systems typically provide care for both adults and children, but tend to be more adult oriented, which can negatively influence outcomes for pediatric patients.…”

“…2 Children often receive initial disease management from adult acute care hospitals where pediatric resources may not be optimal. 2 These frontline health systems typically provide care for both adults and children, but tend to be more adult oriented, which can negatively influence outcomes for pediatric patients. While pediatric patients often represent a minority of encounters in these primarily adult facilities, they still commonly receive care in the emergency department (ED).…”

Cross-sectional study on the drug utilization and evaluation indicator of antibiotics used in pediatric population

“…In contrast to adults who are mature in all aspects, in a healthy paediatric population, age directly affects the development status and physiological functions of organs; consequently, paediatric drug use cannot be accurately measured, off-label drug use behaviour [ 8 , 9 ] is inevitable, and a series of drug safety problems in serious cases occurs [ 10 ]. The medication error rate without injury amongst paediatric patients is three times higher than that amongst adults [ 11 ], and the medication error rates of causing injury and death in the former are 31 and 13 % higher than those in the latter [ 12 ]. Therefore, evaluating the rational use of antibiotics in paediatrics is a difficult problem.…”