High rate of drug errors during treatment of children in hospital

Mistakes are being made in a high number of drug treatments given to children in hospital, either when prescribing or administering the medicines, new study has revealed.
Although most of the mistakes were unlikely to cause serious harm, a small number of cases were potentially fatal, prompting the study’s authors to call for more effective strategies to curb the error rate.

The authors base their findings on data collected for a period of two consecutive weeks from each of the 11 wards in five hospitals in London in 2004 and 2005. The hospitals included one specialist children’s hospital, three general teaching hospitals and one non-teaching general hospital.
At the time, 23 hospitals in London admitted children as patients. The prescribing errors were picked up by pharmacists reviewing the drug charts for ten wards; the administration errors were picked up by an experienced observer watching how nurses gave drugs to children on 11 wards.
During the study period, pharmacists reviewed almost 3,000 prescriptions intended for 444 children. In all, 391 prescribing errors were made, giving an overall rate of 13.2 per cent, and ranging from 5 per cent to 31.5 per cent, depending on the ward.
Of these, an incomplete prescription was the most common mistake made, with dosing errors the third most common type of mistake. One in four prescribing errors involved the use of abbreviations.
The observer watched 161 nurses of different grades preparing and administering 1,554 doses of medicine to 265 children.
In all, 429 administration errors were picked up, equating to an overall error rate of one in four, and ranging from almost one in ten to almost one in three, depending on the ward.
Mistakes in drug preparation were the most common, accounting for just under 21 per cent of the total. The second most common category, accounting for almost one in five, was an incorrect rate of intravenous administration.
Almost one in ten errors involved mistakes in dosing, and on five occasions, the observer intervened to prevent the patient suffering the consequences.
Of all the mistakes picked up, only one – a prescribing error – was reported to the risk-management department at the hospital concerned.
Although the study involved only five hospitals in London, the authors pointed out that it includes different types of hospital and ward. “The results are therefore likely to be generalisable to other UK clinical environments,” the authors said.
Online edition of Archives of Disease in Childhood, available at: http://press.psprings.co.uk/adc/january/ac158485.pdf