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Interventions to Reduce Dosing Errors in Children

A Systematic Review of the Literature

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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 foundwere 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.

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Acknowledgements

Professor Wong’s post was funded by a UK Department of Health Public Health Career Scientist Award at the time this work was undertaken. This work was funded by the UK Department of Health Patient Safety Research Programme. Professor Wong has also received funding from the Medical Research Council, Department of Health, JAC and First DataBank for a study on electronic prescribing. These organisations have not had any input into the work conducted for this paper.

The authors have no conflicts of interest that are directly relevant to the content of this paper.

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Authors and Affiliations

  1. Academic Division of Child Health, Derbyshire Children’s Hospital, University of Nottingham, Nottingham, UK

    Sharon Conroy

  2. Centre for Paediatric Pharmacy Research, The School of Pharmacy, Institute of Child Health, University of London and Great Ormond Street Hospital for Children, London, WC1N 1AX, UK

    Dimah Sweis, Claire Planner, Vincent Yeung &  Ian C. K. Wong

  3. School of Nursing, University of Nottingham, Nottingham, UK

    Jacqueline Collier

  4. Royal College of Paediatrics and Child Health, London, UK

    Linda Haines

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  1. Sharon Conroy
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  2. Dimah Sweis
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  3. Claire Planner
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  4. Vincent Yeung
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  7. Ian C. K. Wong
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Correspondence to Ian C. K. Wong.

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Conroy, S., Sweis, D., Planner, C. et al. Interventions to Reduce Dosing Errors in Children. Drug-Safety 30, 1111–1125 (2007). https://doi.org/10.2165/00002018-200730120-00004

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