Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis

Gates, Peter; Baysari, Melissa T.; Gazarian, Madlen; Raban, Magdalena Z.; Meyerson, Sophie A.; Westbrook, Johanna I.

doi:10.1007/s40264-019-00850-1

Cited by 43 publications

(46 citation statements)

References 114 publications

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“…The results of this review offer some interesting contrasts with a similar recent review. Gates et al attempted to meta-analyse ME estimates across the global literature [68], and encountered the same definitional and methodological challenges encountered in this review. MPEs were more prevalent in critical care areas (25.9%; 95%CI 17.3–36.7) compared to general ward areas (14.7% (95%CI 6.1–31.6).…”

Section: Discussionmentioning

confidence: 99%

Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

et al. 2019

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BackgroundProblems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety.MethodsNine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted.ResultsIn all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8–29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7–13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9–13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4–23). Administration technique errors represented 53% (IQR 52.7–67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1–46) of prescribed medication; 70.3% (Range 50–78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.ConclusionsChildren are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.

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Section: Discussionmentioning

confidence: 99%

Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

et al. 2019

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“…Only a sample of medication administrations were observed during the study periods, and therefore dose omissions could not be included. As dose omissions have been reported in several studies as a common MAE type, 8 19 21 33 34 and also an error type that can be reduced by the introduction of an EMS, 19 we may have underestimated both the true frequency of MAEs at baseline and also the impact of the intervention.…”

Section: Discussionmentioning

confidence: 97%

Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study

Westbrook

Sunderland

Woods

et al. 2020

BMJ Health Care Inform

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BackgroundElectronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).ObjectiveTo assess changes in MAE rates and types associated with EMS implementation.MethodsThis was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.Results7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.ConclusionsImplementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.

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“…The high cumulative incidences could partly be explained by the power of triggers of finding additional events were the rate has been shown to be dependent on the error detection method in the ascending order of 1) incident reporting, 2) trigger tool and chart review and 3) direct observational methods. 15,16 Stockwell et al used a global assessment of pediatric patient safety trigger tool and reported 20% admissions with AE for teaching pediatric hospitals and 30% for critically ill children. 17 They also found hospital-acquired infections and intravenous line complications to be the most frequent occurring events but with low occurrence of untreated pain.…”

Section: Discussionmentioning

confidence: 99%

<p>Drug Use and Type of Adverse Drug Events–Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital</p>

Nydert

Unbeck

Härenstam

et al. 2020

DHPS

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The objectives of our study were to determine drug use, type and incidence of all adverse event associated with drug or drug-related processes (Adverse Drug Events, ADE) among pediatric inpatients in relation to hospital unit and length of stay. Patients and Methods: 600 pediatric (0-18 years) admissions at a Swedish university hospital during one year were included and stratified in blocks to 150 neonatal, surgical/ orthopedic, medicine and emergency-medicine unit admissions, respectively. Adverse events were identified from medical records using a pediatric trigger tool. All triggers identifying an adverse event related to drugs and drug-related devices were included. Data on drug use were extracted from the hospital drug-data warehouse. Results: In total, 17794 daily drug orders were administrated to 486 (81.0% exposed) admissions. Parental nutrition, potassium salts and morphine constituted half of all high-risk drugs prescribed. Two-thirds of intravenous irritating drug doses consisted of vancomycin, esomeprazole and meropenem. In 129 (21.5%) admissions, at least one ADE was identified, out of which 21 ADE were classified as more severe (National Coordinating Council Medication Error Reporting Prevention-Index, NCCMERP≥F). The ADE incidence was 47.4 (95% confidence interval: 39.4-57.3) per 1000 admission days and varied by unit category. In neonatal units, 56.9 (49.5-65.4) ADEs/1000 admission days were detected, in surgery/orthopedic 54.2 (40.3-72.8), in medicine 44.1 (33.1-58.7), and in emergency-medicine 14.3 (7.7-26.7) ADEs/1000 admission days were found. The most common types of ADEs were identified by triggers that were not directly aiming at drugs including insufficiently treated pain (incidence peaking already in the first days), skin, tissue or vascular harm (peaking at the end of the first week) and hospitalacquired infections (peaking in later admission days). Conclusion: Adverse drug events are common in pediatric patients. The incidence of ADEs and type of ADE varies by hospital unit and length of hospital stay.

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Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis

Cited by 43 publications

References 114 publications

Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review

Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study

<p>Drug Use and Type of Adverse Drug Events–Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital</p>

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