Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review

Abstract

IntroductionChildren admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.ObjectiveThe objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units.Data SourcesSeven electronic databases were searched between January 2000 and March 2019.Study SelectionQuantitative studies that examined medication errors/preventable adverse drug events using direct observation, medication chart review, or a mixture of methods in children ≤ 18 years of age admitted to paediatric or neonatal intensive care units were included.Data ExtractionData on study design, detection method used, rates and types of medication errors/preventable adverse drug events, and medication classes involved were extracted.ResultsThirty-five unique studies were identified for inclusion. In paediatric intensive care units, the median rate of medication errors was 14.6 per 100 medication orders (interquartile range 5.7–48.8%, n = 3) and between 6.4 and 9.1 per 1000 patient-days (n = 2). In neonatal intensive care units, medication error rates ranged from 4 to 35.1 per 1000 patient-days (n = 2) and from 5.5 to 77.9 per 100 medication orders (n = 2). In both settings, prescribing and medication administration errors were found to be the most common medication errors, with dosing errors the most frequently reported error subtype. Preventable adverse drug event rates were reported in three paediatric intensive care unit studies as 2.3 per 100 patients (n = 1) and 21–29 per 1000 patient-days (n = 2). In neonatal intensive care units, preventable adverse drug event rates from three studies were 0.86 per 1000 doses (n = 1) and 0.47–14.38 per 1000 patient-days (n = 2). Anti-infective agents were commonly involved with medication errors/preventable adverse drug events in both settings.ConclusionsMedication errors occur frequently in critically ill children admitted to paediatric and neonatal intensive care units and may lead to patient harm. Important targets such as dosing errors and anti-infective medications were identified to guide the development of remedial interventions.Electronic supplementary materialThe online version of this article (10.1007/s40264-019-00856-9) contains supplementary material, which is available to authorized users.

Medication Discrepancies Involving Hospitalized Children At A High-Complexity Public Hospital

“…Antimicrobials were the drugs most commonly involved in UDs of children in the three transitions analyzed in this study. Alghamdi et al, (2019) [18] reported that antimicrobials were the drugs most frequently involved in potential adverse events and medication errors. The high rate of antimicrobial use in children can be explained by the high prevalence of infectious diseases in this population [33,34].…”

“…Any discrepancies found between the patients' medication list and prescriptions were classified as follows [18]:…”

Use of Electronic Health Records to Identify Exposure-Response Relationships in Critically Ill Children: An Example of Midazolam and Delirium

“…We identified all children <18 years of age admitted to the pediatric intensive care unit (PICU) or pediatric cardiac intensive care unit (PCICU) at Duke University during a 2year period who were administered midazolam via bolus or continuous infusion to facilitate mechanical ventilation and who had !1 Cornell Assessment of Pediatric Delirium (CAPD) score at any time after the initiation of midazolam. We defined dates of inclusion based on the following changes in institutional protocols: (1) in October 2014, after extensive nursing training, Duke University began screening critically ill children for delirium twice daily per standard of care with the CAPD tool; and (2) a new sedation protocol that limited midazolam use in the PICU. Throughout the entire study period, the PICU maintained a standard protocol for use of the CAPD.…”

Comparison of Accuracy and Speed in Computer-Assisted Versus Conventional Methods for Pediatric Drug Dose Calculation: A Scenario-Based Randomized Controlled Trial

“…Children are especially vulnerable to medication errors, particularly dosing errors resulting from inaccurate weight measurements or incorrect weight-dependent calculations. 1 - 4 Moreover, the emergency department is one area of health care most prone to medication errors in prescribing, transcription, administration, and monitoring. 5 - 7 Studies have identified prescribing errors in 10% to 30% of the charts 8 , 9 and a higher rate of errors among residents with less experience, with an especially high rate of errors at the beginning of the academic year.…”