Child/Adolescent Health

Medication errors are made during care for half of the children seen at rural California emergency departments

Hospitalized children, whose medication needs to be calculated for their weight, suffer from three times as many medication errors as hospitalized adults. One-fourth of the U.S. pediatric population receives care in hospital emergency departments (EDs) each year, yet very little is known about the medication errors that occur among these children. However, a new study found that medication errors were made during the care of half of the critically ill and injured children who received medications at four rural EDs studied. In addition, 15 percent of these errors were due to erroneous physician orders, for example, wrong dose, wrong or inappropriate medication for the condition, wrong route, or wrong dosage form, but none of the errors was deemed to have caused significant harm.

Nevertheless, the results underscore the need to redesign care systems to decrease the likelihood of medication errors among pediatric ED patients, concludes James P. Marcin, M.D., M.P.H., of the University of California, Davis.

Dr. Marcin and colleagues identified the incidence, nature, and consequences of medication errors among all critically ill children treated at the four California rural EDs between January 2000 and June 2003. Among the 69 children with medication errors, 16 percent had errors that had the potential to cause harm; however, none of the errors harmed the children treated. Potential solutions to medication errors among children treated at rural EDs might be computerized medication order systems, even though it is difficult for rural hospitals to afford them due to financial constraints. Other possible solutions include use of the Broselow tape to assess children's body weight (based on the tape's height measurement) for drug dosage calculation, use of preprinted medication order sheets, and use of telemedicine or telepharmacy (since there are few pharmacists or doctors in rural areas).

The study was supported in part by the Agency for Healthcare Research and Quality (HS13179).

See "Medication errors among acutely ill and injured children treated in rural emergency departments," by Dr. Marcin, Madan Dharmar, M.B.B.S., Meyng Cho, Pharm.D., and others, in the April 2007 Annals of Emergency Medicine 50(4), pp. 361-367.

Editor's Note: Another AHRQ-supported study (HS11890 and HS14020) on a related topic found that pediatricians are willing to report errors to hospitals and disclose errors to patients' families. However, they believe that current error reporting systems are inadequate, and they struggle with error disclosure. For more details, see: Garbutt, J., Brownstein, D.R., Klein, R.J., and others (2007, February). "Reporting and disclosing medical errors." Archives of Pediatric and Adolescent Medicine 161, pp. 179-185.

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