Medication Errors in Children
Section snippets
Definitions for adverse drug events and medication errors
No consensus exists [12] on the definitions of medication error and ADE. A common definition for medication error is “an error in prescribing, dispensing, or administering a medication.” Some definitions require the end-result to be that the patient fails to receive the correct drug or the indicated proper drug dosage. This requirement, however, is limiting and does not include a wide range of errors that do not reach the patients. A recent consensus by an expert panel in the United Kingdom [13]
Types of errors
Numerous types of medication errors occur. For research purposes, the errors are subdivided and classified in different ways [14]. However, the classification is not universal. A logical way of differentiating among different types of errors is based on the process of drug administration, distinguishing among prescribing errors, dispensing errors, and administration errors. Each type may be further subdivided [15].
“Systems approach” versus “person approach”
Traditionally, the approach to tackling errors in medicine (including medication errors) focused on unsafe actions by individuals. It was assumed that errors were the result of careless behavior, negligence, or poor motivation. It was believed that the fault lay with the person who had made the error. This person was thus held responsible for the outcome, which in some cases could be dismal. He or she was blamed for wrongdoing, and disciplinary actions were often taken. When such an approach is
Determinants associated with an increased risk for medication errors
Although all health care professionals may err, and every patient may be exposed to medication errors, there are several characteristics of patients, health professionals, and services that have been associated with an increased risk for medication errors. Understanding such determinants is crucial to improving the system and preventing similar events.
Strategies to reduce medication errors
Efforts to reduce medication errors should take place at all levels [44]. Professional organizations, health maintenance organizations, drug companies, and regulatory bodies should lead such efforts on national and international levels. For inpatients, the hospital administration, physicians, pharmacy services, nursing staff, patients, and families should all take an active part in developing strategies for error reduction. For outpatients, the treating physician, family, and pharmacy should be
Detecting and identifying errors
Several methods of identifying and monitoring medication errors exist. Identifying errors and reporting them is an important part of any system of error prevention. When monitoring medication errors, it is important to identify potential errors, errors that reached the patients, and errors that were intercepted. Identifying near misses (ie, errors that were identified before reaching the patient) offers an opportunity to detect system failures before a catastrophe happens.
In a spontaneous,
Summary
Medication errors account for significant morbidity and mortality and are very common in pediatric practice. Errors are more common among the sickest and more vulnerable patients. Applying the “system approach” to medication errors enables hospitals and health organizations to detect and treat the source of preventable errors before they harm patients. Professionals and health organizations should adopt strategies that have been shown to reduce errors, such as CPOE, preprinted order forms, and
Acknowledgments
Supported in part by a grant from the Canadian Institutes for Health Research, Jonathan's Alert (Hospital for Sick Children), and by the Ivey Chair in Molecular Toxicology, The University of Western Ontario.
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