Note: some media coverage confuses an error in a prescription, which is very often identified before the drug is dispensed, with actually giving the wrong drug.
The Centre for Paediatric Pharmacy research is a collaboration between the School of Pharmacy and UCL ICH.
ARCHIVES OF DISEASE IN CHILDHOOD
High rate of drug errors during treatment of children in hospital
[The incidence and nature of prescribing and medication administration errors in paediatric inpatients Online First 2010; doi 10.1136.adc.2009.158485]
Mistakes are being made in a high number of drug treatments given to children in hospital, either when prescribing or administering the medicines, reveals research published ahead of print in the Archives of Disease in Childhood.
Although most of the mistakes were unlikely to cause serious harm, a small number of cases were potentially fatal, prompting the authors to call for more effective strategies to curb the error rate.
The authors base their findings on data collected for a period of two consecutive weeks from each of the 11 wards in five hospitals in London in 2004/5.
The hospitals included one specialist children's hospital, three general teaching hospitals, and one non-teaching general hospital. At the time, 23 hospitals in London admitted children as patients.
The prescribing errors were picked up by pharmacists reviewing the drug charts for 10 wards; the administration errors were picked up by an experienced observer watching how nurses gave drugs to children on 11 wards.
During the study period, pharmacists reviewed almost 3000 prescriptions intended for 444 children. In all, 391 prescribing errors were made, giving an overall rate of 13.2% (one in eight), and ranging from 5% to 31.5%, depending on the ward.
Of these, an incomplete prescription was the most common mistake made (41%), with dosing errors the third most common type of mistake (11%). One in four prescribing errors involved the use of abbreviations.
The observer watched 161 nurses of different grades preparing and administering 1554 doses of medicine to 265 children.
In all, 429 administration errors were picked up, equating to an overall error rate of one in four (19%), and ranging from almost one in 10 (9%) to almost one in three (31%), depending on the ward.
Mistakes in drug preparation were the most common, accounting for just under 21% of the total. The second most common category, accounting for almost one in five (19.8%), was an incorrect rate of intravenous administration.
Almost one in 10 errors involved mistakes in dosing, and on five occasions the observer intervened to prevent the patient suffering the consequences.
Of all the mistakes picked up, only one - a prescribing error - was reported to the risk management department at the hospital concerned.
Although the study involved only five hospitals in London, the authors point out that it includes different types of hospital and ward. "The results are therefore likely to be generalisable to other UK clinical environments," they say.
In the absence of a wide range of specially formulated drugs for children, most drug doses for them have to be calculated individually, based on the child's age, weight, body surface area and their clinical condition.
Many drugs given to children are also used unlicensed - not licensed for use in children - or off label - not licensed for that particular ailment - so potentially increasing the risk of error, say the authors.
Contacts:Dr Maisoon Ghaleb, Department of Practice and Policy, The School of Pharmacy, University of Hertfordshire, Hatfield, Herts, UK
Tel: +44 (0)1707 285 087; Mobile: +44 (0)7702 152 607
Email:
m.ghaleb@herts.ac.ukor
Professor Ian Wong, Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London & Institute of Child Health, UCL, London, UK
Tel (mobile): +44 (0)7931 566 028
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Notes for editors:
Archives of Disease in Childhood is one of more than 30 specialist titles published by BMJ Group.
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