Errors by paediatric residents in calculating drug doses

Area of Science:

• Medical Education
• Pediatric Pharmacology
• Patient Safety

Background:

• Drug dosage calculation errors in pediatric patients can lead to severe morbidity and mortality, particularly with narrow therapeutic index agents.
• Previous institutional studies identified potentially life-threatening prescription errors made by trainees.
• Impaired calculation skills may contribute to prescribing errors in pediatric residents.

Purpose of the Study:

• To determine if impaired calculation skills, as assessed by written tests, explain the incidence of prescribing errors by pediatric trainees.
• To evaluate the prevalence of calculation errors among pediatric residents under test conditions.

Main Methods:

• Two anonymous written tests involving drug dose calculations were administered to pediatric residents in 1993 and 1995.
• Tests simulated bedside calculations and included participants from a tertiary pediatric hospital.
• Data were analyzed to correlate training year with error rates and identify significant error patterns.

Main Results:

• A significant proportion of pediatric residents made at least one calculation error in both test years.
• No clear correlation was found between the length of training (0-4 years) and the likelihood of error.
• Seven residents committed tenfold errors, significantly more than their peers, and were predominantly in their first two years of residency.

Conclusions:

• A substantial number of pediatric trainees exhibit calculation errors even under optimal testing conditions.
• Tenfold errors, which pose a significant risk to pediatric patients, are committed by a subset of trainees.
• Mandatory assessment of calculation skills and subsequent remedial interventions are crucial to prevent medication errors in pediatric care.