Nineteen per cent of paediatric inpatient medication orders were associated with administration errors and 13.2% had prescribing errors in five London hospitals
- Correspondence to Jason Hall
Stopford Building, Oxford Road, Manchester M13 9PT, UK;
It is known that errors in prescribing medications for hospital inpatients are relatively common1 (8.9% of prescribed items). In addition, it is estimated that around 1–2% of adult patients are harmed by medication errors.2 Much less is known about the prevalence of medication errors in paediatric prescribing in the UK, but a US study suggests the prevalence of medication errors could be higher for paediatric patients as many drugs are unlicensed or used off-label.3
Outline and results
This study took place in paediatric wards in five hospitals in the UK (one specialist children's hospital, three teaching hospitals and one non-teaching hospital). There were two parts to this study. The first part involved a prospective review of drug charts in 11 wards and the second part involved observations of nurses in 10 wards to identify medication administration errors.
Data for the first part of the study were collected every week day for a 2-week period. There were 391 (13.2%) prescribing errors. The most common types of prescribing error were incomplete prescriptions (41.2%), use of abbreviations (24.0%), incorrect dose (11.3%) and incorrect frequency (6.6%). There was a considerable variation between the wards regarding the rate of prescribing errors with the specialist children's hospital having the highest rate. Only one of these prescribing errors resulted in the submission of an incident report.
In the second part of the study, data were collected over a 2-week period (including weekends). There were 429 (19.1%) administration errors detected in this study. The most common type of errors were those involving drug preparation (20.7%), incorrect rates of intravenous administration (19.8%), incorrect time of dosing (18.7%), leaving drugs by patient's bed without checking they had been taken (10.0%) and incorrect dose (9.3%). No incident reports were submitted for any of these administration errors.
Prescribing and medication administration errors in paediatric wards are not uncommon.
Critique of method
In part one of this study, prescribing errors were detected by the ward pharmacist and reported to a data collector. However, the normal procedure in each of these wards involved prescription charts being reviewed by a ward pharmacist each week day. Errors were therefore identified during the process and not at the end of the process so it is not known whether any of these errors would have reached the patient.
In part two, the review of administration errors did not assess whether the prescription was appropriate but did assess whether there was deviation from the prescription or standard hospital policies and procedures. The results did provide examples of medication administration errors that could have resulted in harm to the patient but it is not possible to state the proportion of these administration errors that could have resulted in harm to the patient.
For both parts of the study it is worth noting that the classification of errors used differed from those used in many other studies and therefore it is not possible to compare these results with the results of other studies in adults and paediatrics. It is also not possible to state whether the wide variation in detection rates between wards was due to different error rates or differences in detection by the 10 pharmacists that participated in the study.
Conclusions and implications for practice
While the errors rates reported in this study are higher than those previously reported studies in children4 and adults,1 the authors acknowledge that differences in the classification of errors may help to explain some of the differences. Furthermore, it is also not known whether these prescribing and medication errors could have led to patient harm.
Prescribing and medication errors in paediatrics are potentially common, and all healthcare professionals must be vigilant to maximise patient safety. A culture of reporting such events should be encouraged to allow organisations and healthcare professionals to learn from prescribing and medication errors.