Medication errors often unnoticed in homes of children with chronic conditions

Potentially dangerous medication errors are common in the homes of children with chronic conditions and frequently go unnoticed, according to a study reported online in Archives of Disease in Childhood.

Medication errors in the inpatient setting have received substantial attention, but little information is available about errors that occur in the home, where most medicines are taken. In a prospective cohort study, researchers reviewed medical records and directly observed daily medication use in the homes of 52 children with sickle cell disease or seizure disorders.

A total of 280 medications were reviewed during the home visits. Sixty-one medication errors were observed. Of these errors, 31 had the potential to injure the child, and 9 did in fact result in injury. Several errors that caused injury occurred when parents either missed doses or did not fill prescriptions, resulting in persistence of the clinical problem being treated.

For children with sickle cell disease, the most frequent errors were missed doses and previously undescribed types of administration errors. For children with seizure disorders, administration errors, usually because of confusion about dose changes or use of expired medicines, were the most common.

Previously undescribed errors observed in this study included complex communication errors between parents and health care providers and between multiple caregivers at home. Physicians were not aware of 83% of the errors the researchers detected.

Ninety-five percent of children whose parents did not use support tools such as alarms or reminders to help with medication use at home had at least 1 medication error compared with 44% of those whose parents used supports. Use of support tools such as written instructions may help prevent medication errors at home, the researchers suggest. They note that many of the errors found in this study may occur in children with other chronic conditions and that further research on interventions to prevent mistakes at home is needed.

Walsh KE, Mazor KM, Stille CJ, et al. Medication errors in the homes of children with chronic conditions. Arch Dis Child. 2011. doi:10.1136/adc.2010.204479.