Children More Vulnerable to Medical Mistakes
Hospitalized children are exposed to three times as many "potential" adverse drug events as adults, according to a study published in today's Journal of the American Medical Association. Researchers associated with Boston's Children's Hospital and Brigham and Women's Hospital undertook the study because while medical errors in the adult population are well-documented, "few epidemiological data are available regarding medication errors in the pediatric inpatient setting." Researchers reviewed 10,778 medication orders across six weeks in 1999 at Children's and Massachusetts General Hospital for Children, looking for medication errors, potential ADEs and actual ADEs. They defined medication errors as "errors in drug ordering, transcribing, dispensing, administering or monitoring"; potential ADEs as medication errors with "significant potential for injuring a patient"; and actual ADEs as "injuries that result from the use of a drug," which may or may not be associated with a medication error. The study found 616 medication errors (a rate of 5.7 per 100 orders), 115 potential ADEs (1.1 per 100 orders) and 26 actual ADEs. Of the 26 actual ADEs identified, five (19%) were associated with medication errors and thus considered "preventable." The researchers conclude that medication errors occur more often in adults compared with other age groups, and preventable error rates among children mirrored adult rates found in previous studies. However, the rate of potential ADEs was three times higher among children, and "significantly higher" among infants in the neonatal intensive care unit (NICU).
The authors note that 79% of potential ADEs occurred at the stage of drug ordering, while 34% involved incorrect dosing, 28% anti-infective drugs and 54% intravenous medications. Because pediatric dosages must account for neonatal weight, which can change frequently (especially in a NICU setting), there is a greater potential for error. The researchers contend that a computerized physician order entry system could have prevented 93% of the preventable and potential errors. However, they caution that such a system would have to be "sufficiently flexible" to respond to frequent weight and renal changes in infants. An alternative approach, the authors note, is the use of a full-time "ward-based clinical pharmacist," which could have prevented 94% of potential ADEs. The authors note "several" limitations of this study: Because they only evaluated two academic pediatric hospitals, results may not translate to non-academic facilities; furthermore, the study did not attempt to detect inappropriate drug choice as a cause of error (Kaushal et al, JAMA, 4/25).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.