Revisit the “5 Rights” to avoid medication errors

In the recent article in Contemporary Pediatrics titled, “Safety first: How to avoid prescribing errors,” Dr. Andrew Schuman describes initiatives designed to recognize common medication prescribing errors, and parent medication administration errors. He provides practical information identifying the 3 most common errors and recommendations to reduce pediatric medication errors and the adverse outcomes related to these errors. Dr. Schuman reports statistics from a systematic review that revealed that “27% of all pediatric medication orders result in a medication error.”¹ I highly recommend reading his article, and then reflecting on your current office- and hospital-based practices surrounding prescribing medications for children to determine areas to apply these best practice initiatives in your personal work settings.

Mastering medication administration

The title “Safety first” is a major goal for all pediatric healthcare providers. Nursing students intensely study the safety principles of medication administration. In fact, many colleges of nursing require mastery of content for it. Students memorize the “5 Rights” and implement them in their practices every day: 1) the right patient, 2) the right drug, 3) the right dose, 4) the right route, and 5) the right time. Student nurses are required to know detailed information about all the drugs they administer, including the purpose of the medication for the patient’s particular disorder or disease, its mechanism of action, the correct dose based on child’s age and weight, and the medication’s potential adverse effects. If a student does not know this information, the student is required to look it up before administering the medication. Students anticipate that a Clinical Instructor can approach them at any time, and ask for these details. They must be prepared to answer. The expectation for safety in administering medications remains a priority in practice as a Registered Nurse, as it should be.

Extending safe administration to the home

As pediatric nurse practitioners (PNPs), we prescribe medications for children of all ages, carrying forward our undergraduate education to incorporate the principles of safe prescribing practices. In addition, we must ensure safe administration practices by parents and caregivers responsible for administering the medications to the children at home.

I vividly recall an encounter early in my practice years ago when a grandmother came to the office with her 4 ill grandchildren, all of whom were in her care. Two of the children had fevers, and she had not given any antipyretic medication at home. Although the children were ill, they were opening drawers and being chaotic in the office. I asked the grandmother if she would give one of the children some acetaminophen. She replied, “Yes, I give it to her all the time at home.” I handed her the bottle and the medicine cup with instructions on the amount, turned around for one second to intercede in the chaos, turned back around, and, much to my surprise, saw her filling up the entire medicine cup with the acetaminophen!

The literal take-home message on medications

Questions to consider are: What policies and practices do you have in your office to ensure that the parents and caregivers are correctly administering the medications that you prescribe? What are the specific instructions and tools that you recommend parents use at home? What type of reminders do you employ for administering the medications at home? For instance, often, as soon as the child is back to normal, parents stop administering the antibiotic; or, as soon as the rash disappears, they stop the medication. Do you have someone call the parent to inquire about the child? What is reasonable? What is safe and effective practice by parents who care for their children at home? What recommendations do you provide to parents to prevent children and adolescents’ unsupervised access to medications in the home?

And finally, considering the data reported in Dr. Schuman’s article, that 27% of all medications ordered result in a medication error: What audits do you conduct in your own practice to ensure safe prescribing practices by all providers? If a problem is identified, do you design and implement a quality improvement project?

The questions are big ones because the stakes loom large. The administration fail-safes that you can devise and implement may save a child’s life.

REFERENCE

1. Rinke ML, Bundy DG, Velasquez CA, et al. Interventions to reduce pediatric medication errors: a systematic review. Pediatrics. 2014;134(2):338-360. Erratum in: Pediatrics. 2015;136(3):583.