The incidence and nature of prescribing and medication administration errors in paediatric inpatients
- 1The School of Pharmacy, University of Hertfordshire, Hatfield, UK
- 2Department of Practice and Policy, The School of Pharmacy, University of London, Mezzanine, BMA House, London, UK
- 3Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- 4Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London & Institute of Child Health, University College London, London, UK
- Dr Maisoon A Ghaleb, Department of Practice and Policy, The School of Pharmacy, University of Hertfordshire, Hatfield AL10 9AB, UK; m.ghaleb{at}herts.ac.uk
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Contributors MG: design, data collection, analysis and interpretation, and writing manuscript; NB: conception and design, interpretation of data and contribution to manuscript; BDF: conception and design, interpretation of data, contribution to manuscript; ICKW: conception and design, interpretation of data, contribution to manuscript and guarantor of the paper.
- Accepted 4 October 2009
- Published Online First 4 February 2010
Abstract
Objectives To determine the incidence and nature of prescribing and medication administration errors in paediatric inpatients.
Design Prospective review of drug charts to identify prescribing errors and prospective observation of nurses preparing and administering drugs to identify medication administration errors. In addition, incident reports were collected for each ward studied.
Participants Paediatric patients admitted to hospitals and nurses administering medications to these patients.
Setting 11 wards (prescribing errors) and 10 wards (medication administration errors) across five hospitals (one specialist children’s teaching hospital, one nonteaching hospital and three teaching hospitals) in the London area (UK).
Main outcome measures Number, types and incidence of prescribing and medication administration errors, using practitioner-based definitions.
Results 391 prescribing errors were identified, giving an overall prescribing error rate of 13.2% of medication orders (95% CI 12.0 to 14.5). There was great variation in prescribing error rates between wards. Incomplete prescriptions were the most common type of prescribing error, and dosing errors the third most common. 429 medication administration errors were identified; giving an overall incidence of 19.1% (95% CI 17.5% to 20.7%) erroneous administrations. Errors in drug preparation were the most common, followed by incorrect rates of intravenous administration.
Conclusions Prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group. The causes and extent of these errors need to be explored locally and improvement strategies pursued.
Footnotes
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Funding MG was partly funded by the UK Overseas Research Scholarship. ICKW was funded by a UK Department of Health National Public Health Career Scientist Award at the time of the study. NB, BDF and ICKW have received funding from the UK Medical Research Council and UK Department of Health in the research of medication errors and the use of technology in their reduction. NB and IW also received funding from the First Databank Ltd and JAC in the research of the use of technology in their reduction in medication errors in children. The Centre for Medication Safety and Service Quality is affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust, which is funded by the National Institute of Health Research.
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Competing interests None.
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Ethics approval Ethics approval was provided by a Multicentre Research Ethics Committee.
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Provenance and peer review Not commissioned; externally peer reviewed.
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Patient consent Not obtained.
