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Systematic literature review of hospital medication administration errors in children
Ahmed Ameer1, Soraya Dhillon1, Mark J Peters2
1Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Insights
Medication administration errors (MAEs) in children are common, occurring in 50% of reports and 29% of observed doses. Interventions like barcode scanning and electronic prescribing can help reduce these pediatric medication errors.
Area of Science:
- Pediatric medicine
- Patient safety
- Healthcare quality improvement
Background:
- Medication administration errors (MAEs) are a significant concern, particularly in pediatrics where weight-based dosing increases miscalculation risks.
- MAEs can occur at various stages, acting as a critical point for potential patient harm.
- Despite being preventable, MAEs in pediatric inpatient settings remain a documented issue.
Purpose of the Study:
- To systematically review and report medication administration errors (MAEs) in pediatric inpatients.
- To identify the prevalence and types of MAEs in children within hospital settings.
- To summarize interventions aimed at reducing pediatric MAEs.
Main Methods:
- A comprehensive literature search was conducted across twelve databases for studies published between January 2000 and February 2015.
- Search terms included "medication administration errors", "hospital", and "children".
- Study eligibility and quality were assessed by two independent reviewers, with handsearching of relevant publications.
Main Results:
- Forty-four studies were systematically reviewed, defining MAEs as deviations from prescribed doses, including omissions and incorrect timing.
- Hospital MAEs in children represented a mean of 50% of all reported medication errors and were identified in 29% of observed doses.
- Common MAEs involved preparation, infusion rate, dose, and timing. Five key interventions were identified: barcode medicine administration, electronic prescribing, education, smart pumps, and standard concentrations.
Conclusions:
- A wide variation exists in the reported prevalence of pediatric hospital MAEs, influenced by differing definitions and investigation methods.
- Medication administration errors are complex and multifaceted, requiring comprehensive strategies.
- Developing a robust set of safety measures is crucial for effective error reduction in pediatric practice.
Objective:
Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients.
Methods:
Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using "medication administration errors", "hospital", and "children" related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria.
Key Findings:
A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588). It was also identified in a mean of 29% of doses observed (n=8,894). The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration.
Conclusion:
This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to the definition and method used to investigate MAEs. The review also illustrated the complexity and multifaceted nature of MAEs. Therefore, there is a need to develop a set of safety measures to tackle these errors in pediatric practice.
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