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The role of advice in medication administration errors in the pediatric ambulatory setting
Claire Lemer1, David W Bates, Catherine Yoon
1Harkness-Health Foundation Fellow, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Inadequate medical advice contributes to pediatric medication administration errors. Young children and those on multiple medications are at highest risk for these preventable drug events.
Area of Science:
- Pediatric pharmacology
- Patient safety
- Health services research
Background:
- Adverse drug events (ADEs) during medication administration are common in pediatrics.
- Preventable ADEs are a significant concern in child healthcare.
- Limited data exist on the impact of professional advice on pediatric medication safety.
Purpose of the Study:
- To investigate the relationship between advice quality and quantity from healthcare professionals and medication administration errors in pediatric patients.
- To identify factors associated with medication administration errors in a pediatric cohort.
Main Methods:
- Prospective cohort study involving 1685 pediatric patients across 6 Boston-area practices.
- Data collection through parental interviews, duplicate prescription review, and chart review.
- Analysis included descriptive statistics and multivariable analysis to identify risk factors for medication administration errors.
Main Results:
- Advice quality and provision from both office-based providers and pharmacies were frequently assessed as poor.
- Healthcare providers often failed to provide necessary medication information to families.
- Medication administration errors were not reduced by the form or location of advice.
- Key risk factors identified were polypharmacy (taking multiple medications) and younger age (under 5 years).
Conclusions:
- Current methods of delivering medication advice to pediatric patients are inadequate in preventing administration errors.
- Children under five years old and those prescribed multiple medications face the highest risk of medication administration errors.
- Improved strategies for providing medication guidance are needed to enhance pediatric patient safety.
Background:
In the pediatric setting, adverse events occurring at the administration stage are the most common type of preventable adverse drug events. Few data are available on the effect of advice from medical professionals on medication safety.
Methods:
This is a prospective cohort study of 1685 pediatric patients, 6 office practices in the Boston area. Data were collected from parental interviews, review of duplicate prescriptions, and chart review. Incidents were stratified by type (medication error, near miss, or preventable adverse drug event) and stage of the medication process. Descriptive analysis was followed by a multivariable analysis to determine which factors influenced the occurrence of reported medication administration errors.
Results:
Advice from both office and pharmacy was assessed to be poor in quality and limited in provision. Health care providers most often failed to offer information. Fifty-seven percent of families who did not receive information were not presented with information, rather than refusing it. Multivariable analysis did not demonstrate that advice form or location reduced the rate of medication administration errors (errors occurring during delivery of the medication, usually in the home). However, taking more than 1 medication (odds ratio = 1.68; 95% confidence interval, 1.15-2.46) and age younger than 5 years (odds ratio = 2.35; 95% confidence interval, 1.05-5.28) were correlated with risk of a medication administration error.
Conclusions:
Inadequate advice was provided. The current approach for delivering advice does not prevent against medication administration errors. Those at highest risk of such errors are the youngest children and those on multiple medications.
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Factual:
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