Medication errors related to high-alert medications in a paediatric university hospital - a cross-sectional study
Sini Kuitunen1,2, Mari Saksa3, Justiina Tuomisto4
1HUS Pharmacy, HUS Helsinki University Hospital, Helsinki, Finland. sini.kuitunen@helsinki.fi.
Insights
Medication errors involving high-alert drugs are common in children, affecting one-third of reported errors. These errors are more likely to cause patient harm and have higher risk classifications.
Area of Science:
- Pediatric pharmacology
- Patient safety
- Medication error analysis
Background:
- Paediatric patients are susceptible to medication errors.
- Limited research exists on high-alert medication errors in children.
- This study addresses this gap by investigating such errors.
Purpose of the Study:
- To determine the prevalence and nature of medication errors involving high-alert medications in a paediatric hospital.
- To assess if high-alert medications are more associated with severe patient harm and higher error risk classifications compared to other drugs.
Main Methods:
- A cross-sectional study of self-reported medication errors from 2018-2020 in a paediatric university hospital.
- Descriptive quantitative analysis of medication error reports involving high-alert medications.
- Crosstabulation and Pearson Chi-Square tests to compare harm and risk classifications.
Main Results:
- Approximately one-third (34.8%) of reported errors involved high-alert medications.
- Common high-alert medication subgroups included blood substitutes, antineoplastic agents, and analgesics.
- Errors involving high-alert medications were more likely to result in patient harm and higher risk classifications (IV-V).
Conclusions:
- Preventive risk management should prioritize high-alert medications in paediatric settings.
- Focus should be on intravenous drugs (e.g., parenteral nutrition, concentrated electrolytes) and off-label medication use.
- Further research is needed on root causes and safeguard effectiveness for high-alert medication errors.
Background:
Paediatric patients are prone to medication errors, and only a few studies have explored errors in high-alert medications in children. The present study aimed to investigate the prevalence and nature of medication errors involving high-alert medications and whether high-alert medications are more likely associated with severe patient harm and higher error risk classification compared to other drugs.
Methods:
This study was a cross-sectional report of self-reported medication errors in a paediatric university hospital in 2018-2020. Medication error reports involving high-alert medications were investigated by descriptive quantitative analysis to identify the prevalence of different drugs, Anatomical Therapeutic Chemical groups, administration routes, and the most severe medication errors. Crosstabulation and Pearson Chi-Square (χ2) tests were used to compare the likelihood of more severe consequences to the patient and higher error risk classification between medication errors involving high-alert medications and other drugs.
Results:
Among the reported errors (n = 2,132), approximately one-third (34.8%, n = 743) involved high-alert medications (n = 872). The most common Anatomical Therapeutic Chemical subgroups were blood substitutes and perfusion solutions (B05; n = 345/872, 40%), antineoplastic agents (L01; n = 139/872, 16%), and analgesics (N02; n = 98/872, 11%). The majority of high-alert medications were administered intravenously (n = 636/872, 73%). Moreover, IV preparations were administered via off-label routes (n = 52/872, 6%), such as oral, inhalation and intranasal routes. Any degree of harm (minor, moderate or severe) to the patient and the highest risk classifications (IV-V) were more likely to be associated with medication errors involving high-alert medications (n = 743) when compared to reports involving other drugs (n = 1,389).
Conclusions:
Preventive risk management should be targeted on high-alert medications in paediatric hospital settings. In these actions, the use of intravenous drugs, such as parenteral nutrition, concentrated electrolytes, analgesics and antineoplastic agents, and off-label use of medications should be prioritised. Further research on the root causes of medication errors involving high-alert medications and the effectiveness of safeguards is warranted.
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