Medication Errors and Adverse Drug Events in Pediatric Inpatients
- Rainu Kaushal, MD, MPH;
- David W. Bates, MD, MSc;
- Christopher Landrigan, MD, MPH;
- Kathryn J. McKenna, MS, RN;
- Margaret D. Clapp, RPh;
- Frank Federico, RPh;
- Donald A. Goldmann, MD
- Author Affiliations: Departments of Medicine (Drs Kaushal, Landrigan, and Goldmann) and Quality Improvement and Risk Management (Ms McKenna), Children's Hospital, Boston, Mass; Division of General Internal Medicine, Brigham and Women's Hospital, Boston (Drs Kaushal and Bates); Pharmacy, Massachusetts General Hospital, Boston (Ms Clapp); and Risk Management Foundation, Cambridge, Mass (Mr Federico).
Abstract
Context Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting.
Objectives To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies.
Design, Setting, and Patients Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999.
Main Outcome Measures Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts.
Results We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs.
Conclusions Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.
