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Measurement of Ambulatory Medication Errors in Children: A Scoping Review
Lisa Rickey1,2, Katherine Auger3,4,5, Maria T Britto4,5
1Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Insights
This study reviewed measures for pediatric medication errors in outpatient settings. While many prescribing and home administration error measures exist, few assess dispensing or monitoring, and most reliable measures are resource-intensive.
Area of Science:
- Pediatric pharmacology
- Medication safety research
- Health services research
Background:
- Most pediatric medications are administered in ambulatory settings, where errors often go undetected.
- There is a lack of standardized measurement tools for ambulatory pediatric medication errors.
- This study addresses the need for reliable methods to track and reduce medication errors in children.
Purpose of the Study:
- To identify and categorize existing measures for ambulatory pediatric medication errors.
- To describe the data sources used for measuring these errors.
- To evaluate the reliability of identified measurement methods.
Main Methods:
- A comprehensive scoping review of published literature (since 1986) and grey literature was conducted.
- Databases searched included PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane.
- Studies measuring ambulatory medication errors in children aged 0-26 years were included and measures were classified by medication use phase and type.
Main Results:
- The review identified 21 distinct measures for medication errors across the medication use pathway.
- The majority of measures focused on prescribing errors (n=6) and home administration errors (n=4).
- Few measures addressed dispensing or monitoring errors, and only 31 studies assessed the reliability of their measurement methods.
Conclusions:
- While reliable measures exist, many are too resource-intensive for system- or population-level assessment.
- Some identified measures show potential for adoption in continuous quality improvement initiatives.
- Further development of practical, reliable measures is needed for ongoing monitoring of pediatric medication errors.
Background And Objectives:
Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability.
Methods:
We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type.
Results:
We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability.
Conclusions:
Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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