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Preventable errors with nonopioid analgesics and antiemetic drugs may increase burden in surgical pediatric patients
Jolanda Maaskant1, Diederik Bosman1, Petra van Rijn-Bikker2
1Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Medication errors in hospitalized children, particularly those undergoing surgery, often cause minor harm. Prevention efforts should target prescription and administration of nonopioid analgesics and antiemetics.
Area of Science:
- Pediatric patient safety
- Hospital medication management
- Adverse drug events
Background:
- Medication errors (MEs) pose significant risks to hospitalized patients, especially children, leading to discomfort, harm, and potentially death.
- Understanding the prevalence, types, and severity of harm from MEs is crucial for reducing their occurrence.
- Children are particularly vulnerable to harm from medication errors.
Purpose of the Study:
- To determine the prevalence of different types of medication errors in hospitalized children (birth to 18 years).
- To assess the severity of harm caused by medication errors in this population.
- To explore correlations between harmful MEs and patient/medication process characteristics.
Main Methods:
- A cross-sectional study involving 426 hospitalized children.
- Identification of MEs through clinical record review, direct observation, pharmacy log monitoring, and incident reports.
- Classification of MEs by error type, medication, and process stage; harm severity rated by pediatricians.
Main Results:
- 322 MEs identified, with 39 causing patient harm.
- Wrong timing was the most frequent cause of harmful events (41%).
- Surgical patients had a higher risk of harmful MEs (aOR 2.79). Harm was mostly minor (77%), with no permanent, life-threatening, or fatal outcomes.
- Nonopioid analgesics and antiemetics were involved in 67% of harmful MEs, primarily during prescription (28%) and administration (62%).
Conclusions:
- Hospitalized pediatric surgical patients are at increased risk for medication errors.
- While most harm was minor, the high prevalence of MEs warrants concern.
- Interventions should focus on preventing errors in the prescription and administration of nonopioid analgesics and antiemetics.
Introduction:
Many hospitalized patients are affected by medication errors (MEs) that may cause discomfort, harm, and even death. Especially, children are considered to be at high risk of experiencing harm due to MEs. More insight into the prevalence, type, and severity of harm caused by MEs could help reduce the frequency of these harmful events. The primary objectives of our study were to establish the prevalence of different types of MEs and the severity of harm caused by MEs in hospitalized children from birth to 18 years of age. In addition, we investigated correlations between harmful MEs and characteristics of the collected data from 426 hospitalized children admitted, and the medication process.
Methods:
In this cross-sectional study, we identified MEs by reviewing clinical records, making direct observations, monitoring pharmacy logs, and reviewing voluntary incident reports. Subsequently, the MEs were classified according to type of error, medication group and stage of the medication process. Pediatricians rated the severity of the observed harm.
Results:
We collected data from 426 hospitalized children admitted during August to October 2011. A total of 322 MEs were identified, of which 39 caused patient harm. Harmful events were mainly because of wrong time (41%). Pediatricians rated the observed harm as minor in 77% of the incidents and significant in 23%. None of the harmful MEs resulted in permanent harm or was considered life-threatening or fatal. Patients admitted for a surgical procedure were at higher risk for a harmful event compared with patients admitted for nonsurgical reasons (adjusted odds ratio 2.79, 95% confidence interval; 1.35-5.80). Nonopioid analgesics and antiemetic drugs accounted for 67% of the harmful MEs. Harmful MEs occurred most frequently during medication prescription (28%) and administration (62%).
Conclusion:
Surgical pediatric patients seem to be at high risk for harmful MEs. Although the harm was considered minor in most cases, it still caused discomfort for the patients, and the high prevalence is a source of concern. Interventions to prevent the MEs should focus on the prescription and administration of nonopioid analgesics and antiemetic drugs.
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