Skip to main content
Top
Published in: European Journal of Pediatrics 10/2015

01-10-2015 | Original Article

Analysis of medication prescribing errors in critically ill children

Authors: Corina Glanzmann, Bernhard Frey, Christoph R. Meier, Priska Vonbach

Published in: European Journal of Pediatrics | Issue 10/2015

Login to get access

Abstract

Medication prescribing errors (MPE) can result in serious consequences for patients. In order to reduce errors, we need to know more about the frequency, the type and the severity of such errors. We therefore performed a prospective observational study to determine the number and type of medication prescribing errors in critically ill children in a paediatric intensive care unit (PICU). Prescribing errors were prospectively identified by a clinical pharmacist. A total of 1129 medication orders were analysed. There were 151 prescribing errors, giving an overall error rate of 14 % (95 % CI 11 to 16). The medication groups with the highest proportion of MPEs were antihypertensives, antimycotics and drugs for nasal preparation with error rates of each 50 %, followed by antiasthmatic drugs (25 %), antibiotics (15 %) and analgesics (14 %). One hundred four errors (70 %) were classified as MPEs which required interventions and/or resulted in patient harm equivalent to 9 % of all medication orders (95 % CI 6.5 to 14.4). Forty-five MPEs (30 %) did not result in patient harm.
Conclusion: With a view to reduce MPEs and to improve patient safety, our data may help to prevent errors before they occur.
What is Known:
Prescribing errors may be the most frequent medication errors.
In paediatric populations, the incidence of prescribing errors is higher than in adults.
What is New:
Several risk factors for medication prescribing errors, such as medication groups, long PICU stay, and mechanical ventilation could be presented.
Analysing the combination of the most frequent prescribing errors and the severity of these errors.
Literature
1.
go back to reference Al-Jeraisy M, Alanazi M, Abolfotouh M (2011) Medication prescribing errors in a pediatric inpatients tertiary care setting in Saudi Arabia. BMC Res Notes 4:294PubMedCentralCrossRefPubMed Al-Jeraisy M, Alanazi M, Abolfotouh M (2011) Medication prescribing errors in a pediatric inpatients tertiary care setting in Saudi Arabia. BMC Res Notes 4:294PubMedCentralCrossRefPubMed
2.
go back to reference American Society of Hospital Pharmacists (1993) ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 50:305–314 American Society of Hospital Pharmacists (1993) ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 50:305–314
3.
go back to reference Blum KV, Abel SR, Urbanski CJ, Pierce JM (1988) Medication error prevention by pharmacists. Am J Hosp Pharm 45:1902–1903PubMed Blum KV, Abel SR, Urbanski CJ, Pierce JM (1988) Medication error prevention by pharmacists. Am J Hosp Pharm 45:1902–1903PubMed
4.
go back to reference Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH, Child Health Accountability Initiative et al (2004) Assessing medication prescribing errors in paediatric intensive care units. Pediatr Crit Care Med 5:124–132CrossRefPubMed Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH, Child Health Accountability Initiative et al (2004) Assessing medication prescribing errors in paediatric intensive care units. Pediatr Crit Care Med 5:124–132CrossRefPubMed
5.
go back to reference Conroy S, Sweis D, Planner C, Yeung V, Collier J, Haines L, Wong IC (2007) Interventions to reduce dosing errors in children: a systematic review of the literature. Drug Saf 30(12):1111–1125CrossRefPubMed Conroy S, Sweis D, Planner C, Yeung V, Collier J, Haines L, Wong IC (2007) Interventions to reduce dosing errors in children: a systematic review of the literature. Drug Saf 30(12):1111–1125CrossRefPubMed
8.
go back to reference Di Paolo ER, Stoetter H, Cotting J, Frey P, Gehri M, Beck-Popovic M, Tolsa JF, Fanconi S, Pannatier A et al (2006) Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly 136:218–222PubMed Di Paolo ER, Stoetter H, Cotting J, Frey P, Gehri M, Beck-Popovic M, Tolsa JF, Fanconi S, Pannatier A et al (2006) Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly 136:218–222PubMed
9.
go back to reference Dosage booklet Children’s Hospital Zurich (2009) Pharmazeutischer Dienst, 4. Auflage Dosage booklet Children’s Hospital Zurich (2009) Pharmazeutischer Dienst, 4. Auflage
10.
go back to reference Easton-Carter K, Chapman C, Briet J (2003) Emergency department attendances associated with drug-related problems in paediatrics. J Paediatr Child Health 39:124–129CrossRefPubMed Easton-Carter K, Chapman C, Briet J (2003) Emergency department attendances associated with drug-related problems in paediatrics. J Paediatr Child Health 39:124–129CrossRefPubMed
11.
go back to reference e-mediat (2010) Pharmavista—information of health care professionals. Version April 2010. e-mediat AG, Schönbühl, Switzerland e-mediat (2010) Pharmavista—information of health care professionals. Version April 2010. e-mediat AG, Schönbühl, Switzerland
12.
go back to reference Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Pérez-Sanz C, Duran-García E, Sanjurjo-Saez M et al (2012) Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child 97:564–568CrossRefPubMed Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Pérez-Sanz C, Duran-García E, Sanjurjo-Saez M et al (2012) Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child 97:564–568CrossRefPubMed
13.
go back to reference Folli HL, Poole RL, Benitz WE, Russo JC (1987) Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics 79:718–722PubMed Folli HL, Poole RL, Benitz WE, Russo JC (1987) Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics 79:718–722PubMed
14.
go back to reference Franklin BD, Birch S, Savage I, Wong I, Woloshynowych M, Jacklin A, Barber N (2009) Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions. Pharmacoepidemiol Drug Saf 18:992–999CrossRefPubMed Franklin BD, Birch S, Savage I, Wong I, Woloshynowych M, Jacklin A, Barber N (2009) Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions. Pharmacoepidemiol Drug Saf 18:992–999CrossRefPubMed
15.
go back to reference Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC (2006) Systematic review of medication errors in pediatric patients. Ann Pharmacother 40:1766–1776CrossRefPubMed Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC (2006) Systematic review of medication errors in pediatric patients. Ann Pharmacother 40:1766–1776CrossRefPubMed
16.
go back to reference Ghaleb MA, Barber N, Franklin BD, Wong IC (2010) The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 95:113–118CrossRefPubMed Ghaleb MA, Barber N, Franklin BD, Wong IC (2010) The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 95:113–118CrossRefPubMed
17.
go back to reference Jonville AP, Autret E, Bavoux F, Bertrand PP, Barbier P, Gauchez AS (1991) Characteristics of medication errors in pediatrics. DICP 25:1113–1118PubMed Jonville AP, Autret E, Bavoux F, Bertrand PP, Barbier P, Gauchez AS (1991) Characteristics of medication errors in pediatrics. DICP 25:1113–1118PubMed
18.
go back to reference Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA (2001) Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114–2120CrossRefPubMed Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA (2001) Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114–2120CrossRefPubMed
19.
go back to reference Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, Vroom MB, Smorenburg SM (2010) On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care 14:R174PubMedCentralCrossRefPubMed Klopotowska JE, Kuiper R, van Kan HJ, de Pont AC, Dijkgraaf MG, Lie-A-Huen L, Vroom MB, Smorenburg SM (2010) On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care 14:R174PubMedCentralCrossRefPubMed
20.
go back to reference Kozer E, Scolnik D, Macpherson A, Keays T, Shi K, Luk T, Koren G (2002) Variables associated with medication errors in pediatric emergency medicine. Pediatrics 110:737–742CrossRefPubMed Kozer E, Scolnik D, Macpherson A, Keays T, Shi K, Luk T, Koren G (2002) Variables associated with medication errors in pediatric emergency medicine. Pediatrics 110:737–742CrossRefPubMed
21.
go back to reference La B, Butt W (1992) Drug errors in intensive care. J Paediatr Child Health 28:309–311CrossRef La B, Butt W (1992) Drug errors in intensive care. J Paediatr Child Health 28:309–311CrossRef
22.
go back to reference Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, Hallisey R, Ives J, Laird N, Laffel G et al (1995) System analysis of adverse drug events. JAMA 274:35–43CrossRefPubMed Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, Hallisey R, Ives J, Laird N, Laffel G et al (1995) System analysis of adverse drug events. JAMA 274:35–43CrossRefPubMed
23.
go back to reference Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med 324:377–383CrossRefPubMed Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med 324:377–383CrossRefPubMed
24.
go back to reference Lesar TS, Briceland LL, Delcoure K, Parmalee JC, Masta-Gornic V, Pohl H (1990) Medication prescribing errors in a teaching hospital. JAMA 263:2329–2334CrossRefPubMed Lesar TS, Briceland LL, Delcoure K, Parmalee JC, Masta-Gornic V, Pohl H (1990) Medication prescribing errors in a teaching hospital. JAMA 263:2329–2334CrossRefPubMed
25.
go back to reference Lesar TS, Briceland L, Stein DS (1997) Factors related to errors in medications prescribing. JAMA 277:312–317CrossRefPubMed Lesar TS, Briceland L, Stein DS (1997) Factors related to errors in medications prescribing. JAMA 277:312–317CrossRefPubMed
26.
go back to reference Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ (2007) Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 16:116–126PubMedCentralCrossRefPubMed Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ (2007) Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 16:116–126PubMedCentralCrossRefPubMed
27.
go back to reference Nixon P, Dhillon S, et al (1996) Medication errors in paediatrics. Progress in Practice: UKCPA Autumn Symposium, pp 18–19 Nixon P, Dhillon S, et al (1996) Medication errors in paediatrics. Progress in Practice: UKCPA Autumn Symposium, pp 18–19
28.
go back to reference Patanwala AE, Hays DP, Sanders AB, Erstad BL (2011) Severity and probability of harm of medication errors intercepted by an emergency department pharmacist. Int J Pharm Pract 19:358–362CrossRefPubMed Patanwala AE, Hays DP, Sanders AB, Erstad BL (2011) Severity and probability of harm of medication errors intercepted by an emergency department pharmacist. Int J Pharm Pract 19:358–362CrossRefPubMed
29.
go back to reference Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R et al (1995) Incidence of adverse drug events and potential adverse drug events: implication for prevention. JAMA 274:29–34CrossRefPubMed Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R et al (1995) Incidence of adverse drug events and potential adverse drug events: implication for prevention. JAMA 274:29–34CrossRefPubMed
31.
go back to reference Potts AL, Barr FE, Gregory DF, Wright L, Patel NR (2004) Computerized physician order entry and medication errors in pediatric critical car unit. Pediatrics 113:59–63CrossRefPubMed Potts AL, Barr FE, Gregory DF, Wright L, Patel NR (2004) Computerized physician order entry and medication errors in pediatric critical car unit. Pediatrics 113:59–63CrossRefPubMed
32.
go back to reference Raju TN, Kecskes S, Thornton JP, Perry M, Feldman S (1998) Medication errors in neonatal and pediatric intensive care units. Lancet 2:374–376 Raju TN, Kecskes S, Thornton JP, Perry M, Feldman S (1998) Medication errors in neonatal and pediatric intensive care units. Lancet 2:374–376
33.
go back to reference Ross LM, Wallace J, Patron JY (2000) Medication errors in a pediatric teaching hospital in the UK: five years operational experience. Arch Dis Child 83:492–497PubMedCentralCrossRefPubMed Ross LM, Wallace J, Patron JY (2000) Medication errors in a pediatric teaching hospital in the UK: five years operational experience. Arch Dis Child 83:492–497PubMedCentralCrossRefPubMed
34.
go back to reference Shane R (2009) Current status of administration of medicines. Am J Health Syst Pharm 66:42–48CrossRef Shane R (2009) Current status of administration of medicines. Am J Health Syst Pharm 66:42–48CrossRef
35.
go back to reference Slater A, Shann F, McEniery J (2003) The ANPIC Registry diagnostic code: a system for coding reasons for admitting children to intensive care. Intensive Care Med 29:271–277PubMed Slater A, Shann F, McEniery J (2003) The ANPIC Registry diagnostic code: a system for coding reasons for admitting children to intensive care. Intensive Care Med 29:271–277PubMed
36.
go back to reference Slater A, Shann F, Pearson G (2003) PIM2: a revisec version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMed Slater A, Shann F, Pearson G (2003) PIM2: a revisec version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMed
37.
go back to reference Struck P, Pedersen K, Moodley P, Rasmussen M (2007) A pilot study of pharmacist-initiated interventions in drug therapy in an Australian paediatric hospital. EJHP Sci 4:105–112 Struck P, Pedersen K, Moodley P, Rasmussen M (2007) A pilot study of pharmacist-initiated interventions in drug therapy in an Australian paediatric hospital. EJHP Sci 4:105–112
39.
go back to reference Tritschler T, Frey B (2011) Is the number of drugs independently associated with mortality? Intensive Care Med 39:2060–2062CrossRef Tritschler T, Frey B (2011) Is the number of drugs independently associated with mortality? Intensive Care Med 39:2060–2062CrossRef
40.
go back to reference Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA (1989) Drug errors and incidents in a neonatal intensive care unit. Am J Dis Child 143:737–740CrossRefPubMed Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA (1989) Drug errors and incidents in a neonatal intensive care unit. Am J Dis Child 143:737–740CrossRefPubMed
41.
go back to reference Wilson DG, McArtney RG, Newcombe RG, McArtney RJ, Gracie J, Kirk CR, Stuart AG et al (1998) Medication errors in paediatric practice: insights form a continuous quality improvement approach. Eur J Pediatr 157:769–774CrossRefPubMed Wilson DG, McArtney RG, Newcombe RG, McArtney RJ, Gracie J, Kirk CR, Stuart AG et al (1998) Medication errors in paediatric practice: insights form a continuous quality improvement approach. Eur J Pediatr 157:769–774CrossRefPubMed
42.
go back to reference Wong IC, Ghaleb MA, Franklin BD, Barber N (2004) Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Saf 27:66–70 Wong IC, Ghaleb MA, Franklin BD, Barber N (2004) Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Saf 27:66–70
Metadata
Title
Analysis of medication prescribing errors in critically ill children
Authors
Corina Glanzmann
Bernhard Frey
Christoph R. Meier
Priska Vonbach
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 10/2015
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-015-2542-4

Other articles of this Issue 10/2015

European Journal of Pediatrics 10/2015 Go to the issue