Potential Medication Dosing Errors in Outpatient Pediatrics

McPhillips, Heather; Stille, Christopher J.; Smith, David; Hecht, Julia; Pearson, John; Stull, J. W.; DeBellis, Kristin R.; Andrade, Susan E.; Miller, Marlene R.; Kaushal, Rainu; Gurwitz, Jerry H.; Davis, Robert L.

doi:10.1016/j.jpeds.2005.07.043

Cited by 134 publications

(96 citation statements)

References 13 publications

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“…Doses .10% different from the recommended dose were considered errors. 13,25 When multiple references existed, including cancer treatment protocols, we considered the maximum and minimum dose referenced to represent the normal range. To be conservative in our estimates, giving as much credit as possible to prescribers, doses outside of normal limits that were considered clinically reasonable by physician reviewers (based on reviewers' experiences) were not considered errors.…”

Section: Demographic Characteristicsmentioning

confidence: 99%

Medication Errors in the Home: A Multisite Study of Children With Cancer

et al. 2013

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OBJECTIVE: As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer. METHODS: In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites. RESULTS: We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40–121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9–81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7–5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3–43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy. CONCLUSIONS: Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.

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Section: Demographic Characteristicsmentioning

confidence: 99%

Medication Errors in the Home: A Multisite Study of Children With Cancer

et al. 2013

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“…Among children, the rate of potentially dangerous medication errors is three times that of adults and outpatient wrong dose ordering errors are common [29,30]. Although the majority of pediatric medications are taken at home, data on parental medication errors are limited, and risks for children with chronic conditions, who use many medicines, may be great [31].…”

Section: Significance Of the Studymentioning

confidence: 99%

A Pictogram-Based Intervention to Reduce Parental Liquid Medication Errors: Health Literacy Approach

Tork¹

2013

AJNS

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Evidence suggests that parents and caregivers make frequent errors when administering liquid medications to children. These errors, which include inaccurate dosing as well as non-adherence to medication regimens, place children at risk for morbidity and mortality. The study aim to explore the effectiveness of pictogram based intervention in reducing caregivers' liquid medication errors as well as the extent to which health literacy impacts medication errors. Quasi-experimental study of caregivers (n=250) of young children (<6 years) enrolled at primary pediatric clinic in Zagazig University hospital. A total of 250 caregivers (121 standard medication counseling and 129 pictogram based intervention) were assessed for health literacy by means of the Newest Vital Sign measure; 84.4%% had low health literacy (Newest Vital Sign score 0-3). Pictogram based intervention recipients were less likely to make errors in knowledge related to medication storage (26.6% vs. 63.3%) dose frequency (20.2% vs. 25%), and preparation compared with caregivers of standard medication counseling recipients (12.8% vs. 31.7%). Pictogram was an efficient way to reduce the prevalence of caregivers' liquid medication errors.

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“…In this study, a dosing error was defined as the presence of a daily antibiotic dose that was 110% or more of the maximum recommended daily dose or below 90% of the minimum recommended daily dose. 19 Additionally, the appropriate dosing interval for the prescribed antibiotic was evaluated and compared with the recommend dosing interval provided by the up-to-date version of two pediatric drug references, the Harriet Lane Handbook (Custer J, Rau RE (eds (Figures 1 and 2). The pediatric standardized dosing table for oral and parenteral antibiotics was created by clinical pharmacists and received the approval of the antimicrobial subcommittee at this hospital.…”

Section: Methodsmentioning

confidence: 99%

The Impact of a Pediatric Antibiotic Standard Dosing Table on Dosing Errors

Aseeri

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The goal of this study was to compare the rate of dosing errors for antibiotic orders in pediatric patients before and after the implementation of an antibiotic standard dosing table with precalculated dosage for different weight ranges at a tertiary care hospital. METHODS A retrospective study of 300 antibiotic prescriptions for pediatric patients in three different settings (ambulatory care, inpatient, and emergency department) at a tertiary care hospital assessed the appropriateness of antibiotic dosing. The need for an antibiotic dosing standardization policy was identified after finding that more than 30% of patients experienced a dose variation of ±10% of the recommended daily dose. An antibiotic dosing standardization policy was implemented with an antibiotic standard dosing table for different weight ranges, and a hospital wide-education program was conducted to increase awareness of this new practice and its benefits. Three months after implementation, a random sampling of 300 antibiotic prescriptions collected from the same settings as the pre-intervention period was evaluated for compliance with the new policy and its effect on the number of antibiotic dosing errors. RESULTS Six hundred prescriptions were included in this study (300 in the pre-implementation phase and 300 in the post-implementation phase). Patient characteristics were similar in both groups in terms of sex, age, and weight. Physician compliance with the antibiotic dosing standardization policy after its implementation was 62%. The dosing standardization policy reduced the rate of dosing errors from 34.3% to 5.06% (p=0.0001), and weight documentation on the antibiotic prescription improved from 65.8% to 85.7% (p=0.0001). CONCLUSIONS Implementation of an antibiotic dosing standardization policy significantly reduced the incidence of dosing errors in antibiotics prescribed for pediatric patients in our hospital.INDEx TERMS antibiotic dosing, dose rounding, dosing errors, dosing standardization, medication safety, pediatrics J Pediatr Pharmacol Ther 2013;18(3):220-226

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Potential Medication Dosing Errors in Outpatient Pediatrics

Cited by 134 publications

References 13 publications

Medication Errors in the Home: A Multisite Study of Children With Cancer

Medication Errors in the Home: A Multisite Study of Children With Cancer

A Pictogram-Based Intervention to Reduce Parental Liquid Medication Errors: Health Literacy Approach

The Impact of a Pediatric Antibiotic Standard Dosing Table on Dosing Errors

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