Children at Greatest Risk for Drug Errors

Hospitalized children experience potentially dangerous medication errors three times as often as adults, according to a new study.

Nearly all potentially dangerous errors, however, could be prevented by computerized prescription systems that flag questionable doses, warn about allergic reactions and eliminate problems of illegible handwriting, according to the study in Wednesday’s Journal of the American Medical Assn.

The study is one of the few research efforts on medication errors in children.

“I think this study shows that wherever we systematically look for problems in patient safety, we do indeed find them,” said Gregg Meyer, a physician at the federal government’s Agency for Healthcare Research and Quality.

The rate of actual harm found was extremely small and similar to that found previously in studies of hospitalized adults. However, the rate of “near misses”--errors with the potential for harm--was about three times higher than in adults.

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The study is likely to further increase awareness of medication errors, which account for 10% to 20% of all medical mistakes.

In the study, Rainu Kaushal and her colleagues at Brigham and Women’s Hospital in Boston looked at all the drug orders on nine wards at two hospitals in Boston during a six-week period. Out of about 11,000 orders, 6% had an error. Often it was small and unlikely to cause harm, such as a doctor’s failure to date a prescription or a nurse’s dispensing of a nonessential medicine many hours late.

However, 1.3% of orders contained errors that could--or did--cause harm. About half of those were caught in time. Although most of the rest didn’t cause harm, five did, for a rate of one preventable “adverse event” per 2,000 orders. None was fatal.

Doctors have long known that children--especially infants--are especially vulnerable to medication errors. That is because pediatric doses or drugs are usually calculated based on a child’s weight. That fact introduces the possibility of fatal errors of arithmetic--the nightmare of harried pediatric residents.

The Boston researchers found the rate of potentially damaging mistakes was highest in newborns, where there is the most need for arithmetic and the least leeway for error.

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“Small babies and sick babies just can’t tolerate mistakes as well as an older, healthier child,” Kaushal said.

The study’s authors judged that about 90% of the mistakes could have been prevented by “physician order entry” computer systems, which entirely replace paper prescriptions and nursing orders.

Such systems require a doctor to provide specified dosing information before an order is accepted. If the patient is allergic to the ordered drug, an alarm flashes. If a dose is unusually high, or a patient’s test results suggest that a problem such as kidney disease may alter a drug’s effects, the doctor is told. If two drugs can interact, that information is provided and the doctor must acknowledge the warning.

Fewer than 10% of U.S. hospitals have physician order entry systems. Use of the systems is one of three health-care improvements being promoted by the Leapfrog Group, a consortium of Fortune 500 companies.

The other reforms being pushed by the organization are use of specially trained physicians in intensive care units and referral of complicated patients to hospitals with experience in their treatment.