Preventing medication errors in children

In Part I of this article, we present pediatricians with a thorough understanding of the causes and consequences of medication errors in our young patients. The second installment will review the methods we can and should adopt to improve the safety of pediatric drug therapy. We also will detail the rationale for the adoption of a universal standard drug dosing system for infants and children.

Hospital medication errors

According to the American Academy of Pediatrics (AAP), studies have shown that medication errors occur in up to 15% of orders written for pediatric patients.^4,5 Of interest is that the prescribing error rate of experienced attending pediatricians at medical centers is only exceeded by that of first-year interns. While medications errors occur throughout the hospital environment, they occur more frequently in areas of the hospital where the pediatric patient care is most complicated and the patients most vulnerable-in the NICU and the PICU, with an average error rate of 1 error for every 6.8 admissions. The emergency department (ED), where up to 25% of the pediatric patient population receives care each year, is another area where pediatric dosing errors are commonplace. In one large retrospective study of pediatric patients who received care at a tertiary medical center emergency room, significant medication errors were discovered in 10% of written orders. Fortunately, only a few of these errors actually reached the patient.⁶ In community hospital emergency departments unaccustomed to dealing with pediatric patients, medication errors may be much higher. A recent study looking at the pediatric medication error rates in the emergency departments of four rural hospitals in California found medication errors in 51% of pediatric patients who had medications ordered or administered.⁷

Most recently, a study developed to evaluate a trigger tool to detect adverse drug events in an inpatient pediatric population drawn from 12 children's hospitals across the United States identified an 11.1% rate of adverse drug events in pediatric patients, and demonstrated that 22% of those adverse drug events were preventable.⁸

While the above studies help to define the magnitude of the problem, we need to keep in mind that medication errors are grossly underreported by physicians, nurses, and pharmacists, with hospital incident reports only capturing a very small percentage of the total number of medication errors that actually occur.⁹