Medication Errors in Pediatric Populations

Medication Errors in Pediatric Populations

Abstract

This paper looks at the systems currently in place in the medical field which helps to prevent medication errors in the pediatric population. It considers the entire healthcare team important to prevent medication errors. It will touch on the current flaws of systems and which medications are typically overdosed. This paper will consider why medication errors are more fatal in the pediatric population. Finally, it will also address specifically the nurse's role in proper administration of medication and tips for avoiding medication errors.

Medication Errors in Pediatric Populations

According to the Joint Commission, pediatric patients are at three times a higher risk for medication errors than adults ("Joint Commission," 2008) and not enough is being done to combat this problem. Nurses are the first line of defense for our children when it comes to medication errors. Unfortunately, there are barriers to eliminating medication errors that we, as nurses, must continue to be alert to. Using the six rights of medication administration is an important start to eliminating medication errors. These consist of the right medication, the right route, the right time, the right patient, the right dosage, and the proper documentation.

Also, understanding that it takes a team effort to mitigate medication errors, including the physician, the pharmacist and pharmacy techs, nursing staff, risk management, ancillary personnel (in the case of schools and non-medical facilities), and the parents of children patients. Medication errors can happen in any setting within the healthcare system, to include, in-patient, emergency, out-patient, long-term care, schools and in the home. An important step is identifying the more common types of medication errors, their causes and the steps to prevent those errors. Numerous studies national and internationally have been conducted to gain some insight into the causes of common medication errors. Some of the key interventions to preventing medication errors in pediatric patients include, weighing patients, double checks, clarifying orders, no blame reporting of errors, automation, and education.

The team element is often overlooked when a medication error is discovered. Fingers get pointed and typically the nurse is blamed for causing harm to the patient. "Nursing professionals must accept responsibility for reducing errors that occur during the administration of medication" (Tang, Sheu, Yu, Wei, & Chen, 2007, p. 448). But prior to a medication being given to a patient, four things must be completed properly by the healthcare team: prescription, transcription, dispensing, and administration (Tang et al., 2007). The pediatric patient's healthcare team, that directly influences medications, consists of physicians, pharmacists and pharmacy techs, nurses and order transcription staff, and the parents. Lack of accuracy in administering medications happens at home, with parents, as well as in schools. In some cases, it also consists of ancillary personnel like school secretaries; in the case of school nurses stretched thin and too many students that must receive medications. In one study, upwards of 60+% of school secretaries administered medications to chronically ill students 5 days a week with little or no training (Clay, Farris, McCarthy, Kelly, & Howarth, 2008). At any point along the way a member of that team can make a mistake.

One step in preventing medication errors in the hospital setting is to work closely with the risk management department. Pharmacies and risk management should collaborate in determining areas in which there could be potential for medication errors. Outside resources such as the Institute for Safe Medication Practices (ISMP) can be consulted to reduce errors. Risk managers can help coordinate with pharmacies and hospitals in setting up automated medication management systems, although the first priority is determining current systems and the types of errors that occur ("Joint Commission," 2008).

Another step in working with the team is the use of unit-based clinical pharmacists, which would make rounds with physicians and monitor drug dispensing, storage, and administration. This effectively puts a subject matter expert among the first line caregivers on the floor. Unit-based clinical pharmacists are a resource for both doctors and nurses to double check medications dosing, drug interaction, dose intervals, and routes of administration. They can also help to facilitate communication between the patient's healthcare team and the pharmacy (Kaushal, Bates, Abramson, Soukup, & Goldmann, 2008). In a study conducted by Kaushal et al. (2008), there was a 79% decrease of serious medication errors in the pediatric ICU when using a unit-based clinical pharmacist. They are more cost effective than implementing a computerized prescriber order entry (CPOE) system which has also has been shown to significantly decrease medication errors.

Physicians must be clear when ordering medications for their patients and they must be even more diligent with pediatric populations. Nurses must be willing to question even the most qualified professional. Mistakes can be made by anyone. Trust your instincts; if the order doesn't seem right, ask questions ("Will a drug," 2008). Accurate medication administration is a critical task, but administration of the wrong medication or the wrong dose is an omnipresent nursing problem. Many medication administration errors result from interrelated factors involving the healthcare team; the system (heavy workload and insufficient training), patients (complicated conditions), doctors (complex orders) and nurses (personal neglect, new staff, unfamiliarity with medication, unfamiliarity with patient). These are all issues that must be addressed if improvements are to be made. Two critical ways to reduce errors in medication administration are extending the training period for new staff and increasing nursing manpower. Nurses' should always report their errors, but only in a reprisal free atmosphere, for nurses, will medication errors be reported freely. Only then the learning opportunities that they present can be properly utilized (Tang et al., 2007).

The number one medication error in pediatric populations is giving the wrong dose. Risks specific to children include a wide variation in body surface area, body mass, and differing stages of organ system maturity. With such risks, as opposed