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Published on: November 9, 2016
Medication errors among acutely ill and injured children treated in rural emergency departments
James P Marcin1, Madan Dharmar, Meyng Cho
1Department of Pediatrics, University of California-Davis, Sacramento, CA 95817, USA. jpmarcin@ucdavis.edu
Insights
Medication errors are common in rural emergency departments for critically ill children. While many errors occurred, none resulted in patient harm in this northern California study.
Area of Science:
- Pediatric Emergency Medicine
- Patient Safety
- Pharmacovigilance
Background:
- Medication errors pose a significant risk to patient safety, particularly in vulnerable pediatric populations.
- Rural emergency departments (EDs) may face unique challenges in medication management due to resource limitations.
- Understanding medication error patterns in these settings is crucial for targeted interventions.
Purpose of the Study:
- To determine the incidence, nature, and consequences of medication errors in acutely ill and injured children treated in rural EDs.
- To specifically identify physician-related medication errors and their characteristics.
- To assess the impact of these errors on patient outcomes.
Main Methods:
- A retrospective review of medical records was conducted for critically ill children in four northern California rural EDs (January 2000 - June 2003).
- Pediatric pharmacists utilized a standardized data collection instrument to identify and classify medication errors.
- Errors were categorized based on potential for harm, absence of harm, or actual harm caused.
Main Results:
- A medication error incidence of 39.0% was observed among 177 eligible children, with 84 total errors identified.
- Physician-related medication errors occurred in 11.9% of patients, totaling 24 errors.
- Of the 69 patients experiencing medication errors, 15.9% had errors with the potential to cause harm, while 85.5% caused no harm.
Conclusions:
- A high incidence of medication errors, including physician-related errors, was found in critically ill children in rural northern California EDs.
- Despite the frequency of errors, no instances of patient harm were documented in this study.
- These findings highlight the need for continued vigilance and potential system improvements in pediatric medication safety in rural healthcare settings.
Study Objective:
We identify the incidence, nature, and consequences of medication errors among acutely ill and injured children receiving care in a sample of rural emergency departments (EDs).
Methods:
Two pediatric pharmacists applied a medication error data collection instrument to the medical records of all critically ill children (highest triage category) treated in 4 northern California rural EDs between January 2000 and June 2003. Physician-related medication errors were defined as those involving wrong dose, wrong or inappropriate medication for condition, wrong route, or wrong dosage form. Wrong dose was determined by preset criteria, with doses above or below 10% to 25% of correct dose considered errors, depending on class of medication. Medication errors were classified into categories A through I under 3 broader categories, including errors having the potential to cause harm (A), errors that cause no harm (B to D), and errors that cause harm to the patient (E to I).
Results:
Complete data were available from 177 (97.3%) of the 182 patients identified as having been triaged in the highest category during the study period. A total of 84 medication errors were identified among 69 patients, resulting in a medication error incidence of 39.0%. Twenty-four physician-related medication errors were identified among 21 patients, resulting in a physician-related medication error incidence of 11.9%. Among the 69 patients with medication errors, 11 had errors categorized as having the potential to cause harm (15.9%), and 58 had errors categorized as causing no harm (85.5%).
Conclusion:
We found a high incidence of medication errors and physician-related medication errors among the acutely ill and injured children presenting to rural EDs in northern California. None of the medication errors identified caused harm to the patients included in this study.
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