Reducing the Risk of Harm from Medication Errors in Children

Neuspiel, Daniel R.; Taylor, Melissa

doi:10.4137/hsi.s10454

Cited by 44 publications

(41 citation statements)

References 73 publications

(71 reference statements)

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“…Solutions, syrups, suspensions and emulsions also have advantages over solid dosage forms such as capsules and tablets, as the doses can be individualized using special measuring devices . Nevertheless, dosing errors and misinterpretation of written instructions among caregivers can result in adverse drug events and hospitalization . Parental non‐adherent behaviours have also been associated with life‐threatening therapeutic failures in childhood leukaemia, prevention of graft failure in transplant patient and other medical conditions .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…3 Nevertheless, dosing errors and misinterpretation of written instructions among caregivers can result in adverse drug events and hospitalization. [4][5][6][7][8][9][10] Parental non-adherent behaviours have also been associated with life-threatening therapeutic failures in childhood leukaemia, prevention of graft failure in transplant patient and other medical conditions. 11 Of further concern is the potential antimicrobial resistance attributable to inappropriate dosage and duration of antibiotic use in the household.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Using pictograms to assist caregivers in liquid medication administration: a systematic review

et al. 2015

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SUMMARYWhat is known and objective: It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. Methods: MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. Results and discussion: Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. What is new and conclusion: The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings. WHAT IS KNOWN AND OBJECTIVELiquids are often the preferred form of oral medication delivery for young children and infants. These formulations are usually combined with pleasant-tasting excipients and easier to swallow.

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Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Using pictograms to assist caregivers in liquid medication administration: a systematic review

et al. 2015

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“…Among critically ill patients, the frequency of ADEs is up to three times higher in patients admitted to pediatric hospitals than in adults because of complexities associated with weight-based dosing, custom medication formulations and the inability of children to communicate adverse effects(7). Additionally, children with chronic illnesses as well as those with medical complexity may be at special risk for medication errors (8, 9,25, 26). …”

Section: Introductionmentioning

confidence: 99%

“…Medication reconciliation has been defined as the process of creating the most accurate list of preadmission medications and comparing this against the admission, transfer and discharge orders, with the aim of providing the right medications at all transition points within the hospital (11). Although some pediatric studies support medication reconciliation as a means to reduce ADEs (12, 13), primarily through the reduction of medication discrepancies, a recent review suggests continued uncertainty regarding the frequency and nature of these discrepancies in pediatrics (8). …”

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

DeCourcey

Silverman

Chang

et al. 2017

Pediatric Critical Care Medicine

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Objectives Although medication reconciliation has become standard during hospital admission, rates of unintentional medication discrepancies during intensive care of pediatric patients with chronic disease are unknown. Such discrepancies are an important cause of adverse drug events in adults with chronic illness and are associated with unintentional discontinuation of chronic medications. We sought to determine the rate, type, timing and predictors of potentially harmful unintentional medication discrepancies in children and young adults with chronic disease. Design Prospective observational cohort study. Setting Patients discharged from the Intensive and Intermediate Care Units at a tertiary care children’s hospital from September 2013–May 2014. Patients Consecutive sample of 308 patients less than 25 years of age with chronic disease defined by prescription of at least one predetermined class of chronic medication prior to hospitalization. Measurements and Main Results The number of unintentional medication discrepancies with the potential for harm, as well as patient and medication-related factors predisposing patients to these errors were assessed. 2739 medication discrepancies were identified; 284 (10%) were unintentional and had the potential for harm (0.9 per patient). Of these, 128 (45%) were due to errors in taking the preadmission medication history, while 156 (55%) were due to errors reconciling the medication history with orders. Most events occurred on admission (66%) and were dosing errors (45%). In multivariable negative binomial regression analyses (adjusted rate ratios [95% CI]), each additional preadmission medication (1.07 [1.04–1.10]), chronic respiratory medications (1.51 [1.01–2.28]) and chronic non-invasive ventilation (1.53 [1.07–2.19]) were associated with increased risk of a discrepancy. Conclusion Unintentional medication discrepancies with the potential for harm are common among children and young adults with chronic disease during critical care admission due to both failure to obtain an accurate medication history and errors in reconciling the history with patient orders. The use of current medication reconciliation processes is insufficient to prevent errors in this high risk population.

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“…Children may be at special risk of adverse effects caused by medication errors due to size and physiological variability, limited communication ability and treatment by non-paediatric healthcare providers 2. The safe delivery of medications to patients requires a number of sequential steps to occur without error, beginning with prescription of the correct medication and proceeding through to the safe administration of the correct medication 3.…”

Section: Introductionmentioning

confidence: 99%

Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years

et al. 2015

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BackgroundDespite the widespread implementation of Tall Man lettering, little evidence exists regarding whether this technique has reduced drug errors due to look-alike sound-alike (LA-SA) drug names. This study evaluated rates of potential LA-SA drug errors in the drug management process through to the point of dispensing before and after implementation of Tall Man lettering in 2007.MethodsWe used detailed pharmacy data for paediatric inpatients (<21 years old) from 42 children's hospitals in 2004–2012. After prespecifying a set of 8 potential LA-SA drug error patterns we searched within each hospitalisation for the occurrence of one of these patterns for a total of 12 LA-SA drug pairs deemed highly relevant to paediatric inpatients. To assess for potential change of error rates before and after Tall Man lettering implementation, we performed segmented regression analyses for each of 11 LA-SA drug pairs (because 1 pair had no detected potential errors) and for the overall total errors of all 11 LA-SA drug pairs.ResultsAmong 1 676 700 hospitalisations, no statistically significant change was detected for either the intercept or the slope of LA-SA error rate for each of the 11 drug pairs or for the combined error rate. In a sensitivity analysis of the moving average of the potential error rate over the entire study period, no downward trend in potential LA-SA drug error rates was evident over any time period 2004 onwards.ConclusionsImplementation of Tall Man lettering in 2007 was not associated with a reduction in the potential LA-SA error rate. Whether Tall Man lettering is effective in clinical practice warrants further study.

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Reducing the Risk of Harm from Medication Errors in Children

Cited by 44 publications

References 73 publications

Using pictograms to assist caregivers in liquid medication administration: a systematic review

Using pictograms to assist caregivers in liquid medication administration: a systematic review

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years

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