A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

Lorena Michele Brennan-Bourdon,José Luis Marco-Garbayo,Alan O Vázquez-Alvarez,Selene G Huerta-Olvera,Manuel Koninckx-Cañada,Jahaira Gallegos-Llamas

doi:10.1186/s12887-020-02442-w

Lorena Michele Brennan-Bourdon, José Luis Marco-Garbayo + Show 4 more

Open Access

https://doi.org/10.1186/s12887-020-02442-w

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Abstract

BackgroundMedication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital.MethodsA cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs.ResultsIn 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders.ConclusionClinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

Highlights

Medication Errors (MEs) are considered the most common type of error in pediatric critical care services
MEs are defined by the National Coordination Council for Medication Error Reporting and Prevention (NCC MERP) as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer” [2]
Study design A cross-sectional study was performed in a secondarytertiary public teaching hospital in western Mexico from March 2017 to November 2018 in the following pediatric critical care services: pediatric emergency care (PEC), neonatal intensive care unit (NICU), neonatal intermediate care unit (NIMCU), and pediatric intensive care unit (PICU)

Summary

Introduction

Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. MEs are defined by the National Coordination Council for Medication Error Reporting and Prevention (NCC MERP) as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer” [2]. These can occur in the following stages of the medication use process: prescribing, transcribing, dispensing, administration, or monitoring [3]. The medication error rate in children has been reported up to three times higher than in adult patients [15]

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