Interventions to Reduce Dosing Errors in Children

Abstract

Children are a particularly challenging group of patients when trying to ensure the safe use of medicines. The increased need for calculations, dilutions and manipulations of paediatric medicines, together with a need to dose on an individual patient basis using age, gestational age, weight and surface area, means that they are more prone to medication errors at each stage of the medicines management process. It is already known that dose calculation errors are the most common type of medication error in neonatal and paediatric patients. Interventions to reduce the risk of dose calculation errors are therefore urgently needed. A systematic literature review was conducted to identify published articles reporting interventions; 28 studies were found to be relevant. The main interventions found were computerised physician order entry (CPOE) and computer-aided prescribing. Most CPOE and computer-aided prescribing studies showed some degree of reduction in medication errors, with some claiming no errors occurring after implementation of the intervention. However, one study showed a significant increase in mortality after the implementation of CPOE. Further research is needed to investigate outcomes such as mortality and economics. Unit dose dispensing systems and educational/risk management programmes were also shown to reduce medication errors in children. Although it is suggested that 'smart' intravenous pumps can potentially reduce infusion errors in children, there is insufficient information to draw a conclusion because of a lack of research. Most interventions identified were US based, and since medicine management processes are currently different in different countries, there is a need to interpret the information carefully when considering implementing interventions elsewhere.

Safety Incidents in the Primary Care Office Setting

“…48,49 Pediatric medication incidents (including their extent and methods to reduce them) have been extensively explored in the hospital setting, but less so in family practice. 43,47,[50][51][52][53][54] Our findings emphasize the importance of verification procedures and support barcode scanning of medications during dispensing and using generic medication names (rather than brand names) to reduce mistakes from inattention or distraction and communication errors. [55][56][57] …”

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

“…All searches were conducted on November 22, 2011. Articles included in previous systematic reviews on pediatric medication errors [10][11][12][13][14][15][16][17][18][19][20] were also included in the full-text review to augment our previous review and to ensure all relevant articles published before 2005 were retrieved.…”

“…9 Previous systematic reviews on pediatric medication error epidemiology or specific pediatric medication error intervention subsets, [10][11][12][13][14][15][16][17][18][19][20] including 1 review by our group, 10 found appreciable variation in medication error definitions, populations, and outcomes, precluding true synthesis of data. All previous systematic reviews looking at interventions to reduce pediatric medication errors examined subsets of interventions only, [11][12][13][14][15][16][17][18] and all searches in epidemiologic or intervention reviews were performed before 2008, 10,11,[13][14][15][16][17][18] except 1 that examined nurse staffing interventions performed in 2010. 12 The large increase in quality improvement intervention publications in the 6 years after our previous review, 10,21 the lack of a systematic review looking at all interventions to reduce pediatric medication errors, and the hypothesis that newer publications might use consistent definitions and outcomes allowing quantitative data synthesis suggest an updated systematic review on interventions to reduce pediatric medication errors is warranted.…”

Erros de medicação em pediatria

“…Tal literatura divide-se em relatos de caso, principalmente relacionados à superdosagem de medicamentos, revisões de prontuários de uma ou mais instituições de saúde, e experiências de específicos locais de atendimento à saúde (20)(21)(22) . Estima-se que a probabilidade de ocorrência de erros com potencial para causar danos seja três vezes maior em crianças hospitalizadas, quando comparadas aos pacientes adultos (20,(23)(24) . A maior vulnerabilidade à ocorrência de erros de medicação em pediatria deve-se a vários fatores.…”

“…Estudos demonstram a dificuldade de enfermeiros, médi-cos e residentes de pediatria em realizar os diversos cálculos matemáticos, ocasionando o erro relacionado à dosagem de medicamentos, o mais freqüentemente observado em crianças, que se refere à prescrição ou à administração incorreta da dose de um fármaco (23,(26)(27) . A prescrição ou administração de uma dose 10 vezes superior ou inferior à adequada para a idade e peso da criança é particularmente comum e deveras perigosa (16) .…”