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Medication errors in the homes of children with chronic conditions
  1. Kathleen E Walsh1,2,
  2. Kathleen M Mazor2,3,
  3. Christopher J Stille1,2,
  4. Irma Torres4,
  5. Joann L Wagner2,
  6. Juliet Moretti2,
  7. Kevin Chysna2,
  8. Christy D Stine1,
  9. G Naheed Usmani1,
  10. Jerry H Gurwitz2,3
  1. 1Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
  2. 2Meyers Primary Care Institute, Worcester, Massachusetts, USA
  3. 3Department of Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
  4. 4UMass Memorial Medical Center, Worcester, Massachusetts, USA
  1. Correspondence to Dr Kathleen E Walsh, Benedict Second Floor, UMass Medical Center, 55 North Lake Avenue, Worcester, MA 01655, USA; walshk02{at}ummhc.org

Abstract

Background Children with chronic conditions often have complex medication regimens, usually administered at home by their parents.

Objective To describe the types of medication errors in the homes of children with chronic conditions.

Methods Our home visit methods include direct observation of administration, medication review and prescription dose checking. Parents of children with sickle cell disease and seizure disorders taking daily medications were recruited from paediatric subspecialty clinics from November 2007 to April 2009. Potential errors were reviewed by two physicians who made judgements about whether an error had occurred or not, and its severity.

Results On 52 home visits, the authors reviewed 280 medications and found 61 medication errors (95% CI 46 to 123), including 31 with a potential to injure the child and 9 which did injure the child. Injuries often occurred when parents failed to fill prescriptions or to change doses due to communication problems, leading to further testing or continued pain, inflammation, seizures, vitamin deficiencies or other injuries. Errors not previously reported in the literature included communication failures between two parents at home leading to administration errors and difficulty preparing the medication for administration. 95% of parents not using support tools (eg, alarms, reminders) for medication use at home had an error compared to 44% of those using supports (χ2=13.9, p=0.0002).

Conclusions Home visits detected previously undescribed types of outpatient errors which were common among children with sickle cell disease and seizure disorders. These should be targeted in future intervention development.

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Footnotes

  • Funding KEW was supported by a Robert Wood Johnson Physician Faculty Scholar award.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Massachusetts Medical School Human Subjects IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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