Article Text

Download PDFPDF

PO-0331 The Effects Of Increased Awareness On Medication Error Disclosures
  1. L Fernandez-Restrepo,
  2. J Ruiz,
  3. MS Son,
  4. R Taylor
  1. Pediatric Critical Care, The University of Texas Health Science at San Antonio, San Antonio, USA


Background Communicating medication errors is a crucial part of patient care. Children are exposed up to three times the rate of potentially dangerous adverse drug events. A previous evaluation of disclosure of medication errors identified barriers in communicating these errors.

Methods Two presentations on medication errors and how to improve their communication with patient/family were presented to the PICU team. A Medication Error Data Entry Form was used to collect the number and type of medication errors (only type C through I require immediate notification to the MD). Communication to family was documented in a separate form.

Results Thirty-four medication errors were recorded over a 4-month period (2 months before and 2 months after education). Fifty-three percent were type A errors (circumstances or events that have the capacity to cause error) while the remaining were type C (an error occurred that reached the patient but did not cause patient harm) (Table 1).

While the fellows did not participate in the communication of errors to patient/family before education, they did in 60% of the notifications afterwards. The two barriers to communication were “family was not available” (43%) and "error did not cause side effects" (57%).

Conclusion This study demonstrates that despite the effort to increase awareness of medication errors disclosure there was not an improvement in communicating of medication errors to the patient/family. A more systematic and aggressive approach to education on communication may be required to properly address and improve the disclosure of medication errors.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.