A 1999 Institute of Medicine report estimated that 44,000 to 98,000 people die each year due at least in part to medical error. Medication errors are common even among hospitalized children, concludes a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063).
The researchers found that errors occurred in 5.7 percent of medication orders during the care of 1,120 pediatric patients admitted to two urban teaching hospitals in 1999. In addition, the rate of potential adverse drug events (ADEs)—errors caught before medication was administered to a child—was three times the rate of potential ADEs found in a similar study of hospitalized adults. There were 26 actual ADEs, of which 5 (19 percent) were deemed preventable.
Physicians at both hospitals still handwrote orders, and copies of their orders were sent to the pharmacy. Physician reviewers judged that computerized physician order entry and decision support (with automatic checks on patient drug allergies, drug dosage, and drug-drug interaction) could have prevented 93 percent of potential ADEs. Also, ward-based clinical pharmacists participating in ward rounds could have prevented 94 percent of potential ADEs. As the authors point out, 79 percent of potential ADEs occurred at the stage of drug ordering, and 34 percent involved incorrect dosing. They examined clinical staff reports, medication order sheets, medication administration records, and patient charts to identify medication errors, potential ADEs, and ADEs.
The authors emphasize that medication administration is even more problematic in children than adults for several reasons. Weight-based dosing is needed for virtually all pediatric drugs, and pharmacists often must dilute stock solutions. Young children do not have the communication skills to warn clinicians about potential mistakes in administering medications or about adverse effects that they experience. Finally, children, especially neonates, may have more limited internal reserves than adults with which to buffer errors.
See "Medication errors and adverse drug events in pediatric inpatients," by Rainu Kaushal, M.D., M.P.H., David W. Bates, M.D., M.Sc., Christopher Landrigan, M.D., M.P.H., and others, in the April 25, 2001, Journal of the American Medical Association 285(16), pp. 2114-2120.
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