Systematic Review of Medication Errors in Pediatric Patients

Maisoon Abdullah Ghaleb, BSc MSc; Nick Barber, PhD MRPharmS FRSM; Bryony D Franklin, PhD, MRPharmS; Vincent WS Yeung, BPharm PhD; Zahra F Khaki; Ian CK Wong, PhD MRPharmS ILTM (HE)

Disclosures

The Annals of Pharmacotherapy. 2006;40(10):1766-1776. 

In This Article

Abstract and Introduction

Objective: To systematically locate and review studies that have investigated the incidence of medication errors (MEs) in pediatric inpatients and identify common errors.
Methods: A systematic search of studies related to MEs in children was performed using the following databases: MEDLINE (1951-April 2006), EMBASE (1966-April 2006), Pharm-line (1978-April 2006), International Pharmaceutical Abstracts (1970-April 2006), Cumulative Index to Nursing and Allied Health Literature (1982-April 2006), and British Nursing Index (1994-April 2006). Studies of the incidence and nature of MEs in pediatrics were included. The title, abstract, or full article was reviewed for relevance; any study not related to MEs in children was excluded.
Results: Three methods were used to detect MEs in the studies reviewed: spontaneous reporting (n = 10), medication order or chart review (n = 14), or observation (n = 8). There was great variation in the definitions of ME used and the error rates reported. The most common type of ME was dosing error, often involving 10 times the actual dose required. Antibiotics and sedatives were the most common classes of drugs associated with MEs; these are probably among the most common drugs prescribed.
Conclusions: Interpretation of the literature was hindered by variation in definitions employed by different researchers, varying research methods and setting, and a lack of theory-based research. Overall, it would appear that our initial concern about MEs in pediatrics has been validated; however, we do not know the actual size of the problem. Further work to determine the incidence and causes of MEs in pediatrics is urgently needed, as well as evaluation of the best interventions to reduce them.

Medical error has received a great deal of attention in recent years. The phrase "medical error" is an umbrella term given to all errors that occur within the healthcare system including mishandled surgery, diagnostic errors, equipment failures, and medication errors (MEs). Medical error is a large problem in the UK and the US, in both primary and secondary care, and policy initiatives have been implemented to reduce it.[1,2,3,4,5]

MEs are probably one of the most common types of medical error. In the US, it has been estimated that MEs kill 7000 patients a year.[1] In UK hospitals, the incidence and consequences of MEs seem similar to those reported in the US: prescribing errors occur in 1.5% of prescriptions, and administration errors occur in 3-8% of nonintravenous doses given.[6,7]

Much of the research into MEs and their prevention has been performed in facilities that care primarily for adults. Information on the incidence of MEs in pediatrics is scarce. Pediatrics poses a unique set of risks, predominantly because of wide variation in body mass, which requires doses to be calculated individually based on patient age, weight or body surface area, and clinical condition. This increases the likelihood of errors, particularly dosing errors.[8] In addition, dosage formulations are often extemporaneously compounded to meet the need for small doses in these patients, and there is a lack of information on pediatric doses and indications.[9]

In a one week study of over 10 000 UK hospital beds, it was shown that the number of pharmacist interventions (most of which relate to prescribing errors) was higher in pediatric wards than in geriatric, medical, or surgical wards.[10] In addition, there is recent evidence from the US that potentially harmful MEs may be 3 times more common in the pediatric population than in adults.[11] This suggests that the epidemiologic characteristics of MEs may be different between adults and children.

The situation in the UK is not clear. It has been estimated that 1675 avoidable MEs occur each year in UK pediatric inpatients.[12] However, this figure is based on spontaneous reporting of MEs and is therefore likely to be a gross underestimate due to underreporting.

Our objectives were to review studies of the incidence of MEs in pediatric patients and to identify common types of error in this patient group.

The literature on MEs needs to be evaluated carefully, as there are several methodological issues that can markedly affect the interpretation of findings.[8] These issues, summarized by Wong et al.,[8] include the definition of ME used, the method by which MEs are detected, and the setting studied.

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