Elsevier

The Journal of Pediatrics

Volume 152, Issue 2, February 2008, Pages 225-231
The Journal of Pediatrics

Original article
Risk Factors in Preventable Adverse Drug Events in Pediatric Outpatients

https://doi.org/10.1016/j.jpeds.2007.09.054Get rights and content

Objective

To determine whether there are racial/ethnic, socioeconomic, parental linguistic, or parental educational disparities in children who experienced an adverse drug event (ADE) in the ambulatory setting.

Study design

We conducted a prospective cohort study of pediatric patients <21 years seen during 2-month study periods from July 2002 to April 2003 at 6 office practices in Boston. The primary outcome measure was ADEs. Descriptive analysis of patient characteristics and types of ADEs experienced was followed by multivariate analysis to determine risk factors associated with presence of a preventable ADE.

Results

A total of 1689 patients receiving 2155 prescriptions were analyzed via a survey and chart review. Overall, 242 children (14%) experienced an ADE, of which 55 (23%) had a preventable ADE and 186 (77%) had a non-preventable ADE. In multivariate analysis, children with multiple prescriptions (odds ratio, 1.46; 95% CI, 1.01-2.11) were at increased risk of having a preventable ADE, controlling for parental education, racial/ethnic, English proficiency, practice type, and duration of care.

Conclusions

Children with multiple prescriptions are at increased risk of having a preventable ADE. Further attention should be directed toward improved communication among healthcare providers and patients.

Section snippets

Definitions

Medication errors can be categorized as errors with little potential for harm (medication errors), errors with significant potential for harm (near misses), and errors with actual harm (preventable ADE).4, 17 One example of a preventable ADE would be delay in giving a child a necessary antibiotic for a serious infection, resulting in worsening symptoms requiring a visit to the emergency department for intravenous antibiotics. This complication could have been prevented had the parents given the

Population Characteristics

During the study period, 21,209 visits were made by 13,919 patients, 3838 of whom received a prescription. Of these, we studied 1689 patients who had both completed the 10-day survey and had a chart review (Table I).

Characteristics of the study group are marked in Table II. These 1689 patients were given 2155 prescriptions, for an average of 1.3 prescriptions per patient. The number of prescriptions at the index visit ranged from 1 to 7. Children who had a chronic illness were more likely to

Discussion

Relatively little research has described the risk factors for ADEs in the pediatric outpatient setting. In this study of 6 primary care practices, we found that 14% of patients experienced an ADE, of which approximately a quarter were preventable. Children with complex medication regimens were at increased risk of having a preventable ADE. We did not find any disparities in preventable ADEs in pediatric outpatients.

As expected, children with chronic illnesses had more medications prescribed,

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      On an annual basis, approximately 4.3 million people in the United States (U.S.) require medical care for an adverse drug event (Bourgeois, Shannon, Valim, & Mandl, 2010). Furthermore, 70% of adverse drug events are due to errors in medication administration (Zandieh et al., 2008) and pose significant safety concerns as they often result in patient harm. In addition to risks for patient harm, adverse drug events are costly.

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    Supported by the Agency for Healthcare research and Quality (P01-HS11534) and the Commonwealth Fund. Dr Zandieh is the recipient of APA (Ambulatory Pediatric Association) young investigator award.

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