Children's Health

Nurses can take steps to prevent pediatric medication errors associated with dosing and administration

Children are more likely to be harmed by a medication error than adults due to their immature physiology and developmental limitations that affect their ability to communicate and self-administer medications. Often pediatric medications need to be calculated based on a child's weight, prematurity status, and particular disease or health status, which can affect a drug's metabolism. The inability to calculate the correct therapeutic drug dose accounts for the majority of pediatric medication errors, explain Ronda G. Hughes, Ph.D., M.H.S., R.N., and Elizabeth A. Edgerton, M.D., M.P.H., of the Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, in a recent article.

Drs. Hughes and Edgerton suggest several practical steps that nurses should take to improve pediatric medication safety. They recommend that nurses:

1. Report medication errors; this is the first step in understanding how to avoid future errors.
2. Know the medication before administering it, since lack of drug knowledge accounts for 15 percent of errors in medication administration.
3. Double-check drugs prescribed for an off-label use and be particularly cautious when administering high-alert medications such as corticosteroids, bronchodilators, insulin, and cardiac drugs.
4. Confirm patient information, such as weight in kilograms, before administering medications.
5. Double-check orders and collaborate with other clinicians to verify information, especially for illegible or verbal orders and discrepancies between standard drug protocols and the patient's order.
6. Minimize distractions during medication administration.
7. Communicate with parents and families and involve them in patient care, and improve communication among clinicians during transitions and handoffs from one setting or shift to another.
8. Educate parents and family members about medication administration when the child is discharged home.

For more information, see "Reducing pediatric medication errors," by Drs. Hughes and Edgerton, in the May 2005 American Journal of Nursing 105(5), pp. 36-42. Reprints (AHRQ Publication No. 05-R052) are available from the AHRQ Publications Clearinghouse.

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