Medication Errors and Adverse Drug Events in Pediatric Inpatients

AUTHORS:

Rainu Kaushal, MD,MPH; David W. Bates, MD,MSc; Christopher Landrigan, MD,MPH; Kathryn J. McKenna, MS,RN; Margaret D. Clapp, RPh; Frank Federico, RPh; Donald A. Goldmann, MD

CONTEXT:

Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting.

OBJECTIVES:

To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies.

DESIGN:

Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999.

MAIN OUTCOME MEASURE:

Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts.

RESULTS:

We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs.

CONCLUSIONS:

Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.

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