Abstract
BackgroundProblems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety.MethodsNine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted.ResultsIn all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8–29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7–13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9–13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4–23). Administration technique errors represented 53% (IQR 52.7–67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1–46) of prescribed medication; 70.3% (Range 50–78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors.ConclusionsChildren are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.
Highlights
Problems arising from medicines usage are recognised as a key patient safety issue
Drug Related Problem (DRP) are a composite classification of events including safety (expressed as medication errors (MEs)), effectiveness (defined as adverse drug reactions (ADRs)) and necessity Outcomes of DRPs are operationalised as adverse drug events (ADEs)
[21] Walsh’s model describes a process whereby prescribers documented medication orders into the medical note, and nurses transcribed these into an administration record, reflecting the medication system in the United States at the time; in the United Kingdom (UK) medication orders are predominantly prescribed onto charts that serve as both prescription and administration record [22]
Summary
Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. 850,000 patients in the National Health Service (NHS) in England experience an adverse event during their hospital stay, costing the NHS an additional £2bn per year [2]. A recent United Kingdom (UK)-focussed literature review of primary and secondary healthcare settings estimated that there were approximately 237 million medication errors every year in the NHS, 66 million of which are likely to be clinically significant and 29% were estimated to occur in secondary care settings [4]. DRPs are a composite classification of events including safety (expressed as medication errors (MEs)), effectiveness (defined as adverse drug reactions (ADRs)) and necessity (described as unnecessary drug use.) Outcomes of DRPs are operationalised as adverse drug events (ADEs). ADEs are events related to medication that result in an adverse outcome, and many are preventable [9]. Many published studies have used these terms interchangeably, which can complicate the direct comparison of ADR studies
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