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Published on: November 9, 2016
Medication errors in paediatric outpatients
Rainu Kaushal1, Donald A Goldmann, Carol A Keohane
1Department of Medicine, Weill Medical College of Cornell University, New York 10065, USA. rak2007@med.cornell.edu
Insights
Pediatric medication errors are frequent, with half of prescriptions containing errors and one in five posing potential harm. Interventions should focus on prescribing and administration stages to improve patient safety.
Area of Science:
- Pediatric pharmacology
- Patient safety
- Health outcomes research
Background:
- Medication errors are prevalent in healthcare settings, with significant consequences.
- Research on medication errors in adult ambulatory care is growing, but less is known about pediatric ambulatory settings.
Purpose of the Study:
- To evaluate the rates of medication errors in pediatric patients within ambulatory care settings.
Main Methods:
- A prospective cohort study was conducted in six Massachusetts outpatient pediatric offices.
- Data collection involved duplicate prescription review, parental surveys, and chart reviews.
- A research nurse categorized medication errors by stage and type.
Main Results:
- 1205 medication errors with minimal harm (68% of patients) and 464 potentially harmful errors (26% of patients) were identified.
- The majority of errors (94% minimal harm, 60% potentially harmful) occurred during the prescribing stage.
- Common errors included inappropriate abbreviations and dosing issues, often caused by illegibility.
Conclusions:
- Paper prescribing leads to high rates of medication errors, with half of prescriptions affected and one-fifth having potentially harmful errors.
- Interventions aimed at the ordering and administration stages offer the greatest potential for reducing pediatric medication errors.
Background:
Medication errors are common in many settings and have important ramifications. Although there is growing research on rates and characteristics of medication errors in adult ambulatory settings, less is known about the paediatric ambulatory setting.
Objective:
To assess medication error rates in paediatric patients in ambulatory settings.
Methods:
The authors conducted a prospective cohort study of paediatric patients in six outpatient offices in Massachusetts. Data were collected using duplicate prescription review, two parental surveys and chart review. A research nurse classified all medication errors by stage and type of error.
Results:
The authors identified 1205 medication errors with minimal potential for harm (rate: 68% of patients, 95% CI 64 to 72%; 53% of Rx, 95% CI 50 to 56%) and 464 potentially harmful medication errors (ie, near misses) (rate: 26% of patients, 95% CI 24 to 28%; 21% of Rx, 95% CI 19 to 22%). Overall, 94% of the medication errors with minimal potential for harm and 60% of the near misses occurred at the prescribing stage. The most common types of errors were inappropriate abbreviations followed by dosing errors. The most frequent cause of errors was illegibility.
Conclusion:
With paper prescribing, half the prescriptions had medication errors, and one in five had a potentially harmful error. These rates are very high. Interventions targeting the ordering and administration stages have the greatest potential benefit.
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