Medication errors in paediatric outpatient prescriptions of a teaching hospital in Nigeria

Proper and adequate pharmacovigilance is lacking in children's drug therapy, especially in developing countries. Therefore these children are at risk of developing adverse reactions to drugs as a result of medication errors. Having a better understanding of the types of error in a teaching hospital would be an important step toward quality improvement in children drug therapy.

This study was aimed at identifying the medication errors most frequently committed in the paediatric outpatient prescriptions at the Lagos State University Teaching Hospital, Ikeja and to suggest effective strategies for reducing these errors.

A total of 2,000 paediatric outpatient prescriptions randomly selected from five months prescriptions were studied. Information extracted from the prescription forms are age, sex and the drug prescription proper (adequacy of the dosage and duration of use; generic or trade name prescription; using abbreviation or acronym; prescribing injections in millilitres or milligram, syrup or suspensions in millilitres or milligram, tablets in unit numbers or milligram; and giving instructions on how to use the drugs in the case of drug-drug, drug-disease or drug-food interactions).

A total of 1944 prescriptions met the criteria for inclusion in the study. Antimalarials (89.9%), analgesics (66.4%), vitamin B complex (61.5%) and antibiotics (41.4%) were the most prescribed drugs. Errors identified are inadequate medication dosing duration; omission of age, dosage, and duration of drug use; improper dosaging and prescription of those drugs that could adversely interact. While paracetamol, 94.6% of the analgesics, was prescribed for an average of 3.2 +/- 0.6 days, antibiotics were prescribed for an average of 6.2 +/- 1.0 days. Duration of use was omitted in 24 (2.0%) and 12 (1.5%) prescriptions for paracetamol and antibiotics respectively. Errors of overdosaging and underdosaging were common to most of the commonly prescribed drugs. Underdosage and overdosage were associated with 2518 (38.0%) and 1247 (18.8%) drugs respectively. There was a significant difference in the dosage error made in the prescription of tablets in mg/kg and in unit number of tablets (/2 = 148.42) and in the prescription of syrups/suspensions in millilitre and in mg/kg (/2 = 95.58). Inadequate and omission of the duration of use of the drugs were observed in 1981(28.3%) and 61(0.9%) prescriptions respectively.

Children presenting to the LASUTH are at a greater risk of adverse drug reactions from overdosage prescriptions and are also facing the risk of treatment inadequacy and failure from underdosage prescriptions. Therefore a monitoring committee is urgently required to be put in place to review all paediatric prescriptions for appropriateness, adequacy and dosage accuracy using the patient's weight, age, and other appropriate indicator(s) before dispensing and/or refill for paediatric patients. Also rational drug prescription should form part of the monthly continuous medical education of the hospital with much focus on the paediatric doctors.