Medication Administration Errors Involving Paediatric In-Patients in a Hospital in Ethiopia

Y Feleke,B Girma

doi:10.4314/tjpr.v9i4.58942

Abstract

Purpose: To assess the type and frequency of medication administration errors (MAEs) in the paediatric ward of Jimma University Specialized Hospital (JUSH), Jimma, Oromia Region, southwestern Ethiopia. Methods: A prospective case-based observational study was performed. The required data were collected by observing the health professionals and attendants in charge of administering medications to in-patients in the three units of the paediatric ward of JUSH from February 18 to March 2, 2009. Results: A total of 196 (89.9 %) MAEs were identified from the 218 observations made. From these, 178 (90.8 %) occurred with intravenous (IV) bolus medications while 16 (8.2 %) of them pertained to oral medications. The most frequent of the MAEs observed was wrong time error with 55 errors or 28.1 % of the total, while 52 (26.5 %) were dose errors and 42 (21.4 %) were due to drugs omitted during drug administration. Furthermore, wrong administration technique errors and unauthorized drug errors were 41 (20.9 %) and 6 (3.1 %), respectively. The drug mostly associated with error was gentamicin with 29 errors (1.2 %). Conclusion: During the study, a high frequency of error was observed. There is a need to modify the way information is handled and shared by professionals as wrong time error was the most implicated error. Attention should also be given to IV medication administration with special emphasis on gentamicin, ampicillin, cloxacillin and crystalline penicillin.Keywords: Medication administration error, Omission error, Wrong dose, Wrong administration technique, Unauthorized drug.

Highlights

Patient’s age is the most important risk factor for medication administration errors (MAEs) [1]
As recent evidence from United States indicated, potentially harmful MAEs may be three times more common in the paediatric population than among adults; this suggests that the epidemiologic characteristics of the errors may be different between adults and children [2]
The results obtained reveal that MAEs are prevalent in the paediatric units of the hospital where the study took place

Summary

Introduction

Patient’s age is the most important risk factor for medication administration errors (MAEs) [1]. Children and adolescents are at a greater risk than adults for medication errors because they have immature physiology as well as developmental limitations that affect their responsibility to communicate and selfadminister medications Another important factor is that the great majority of medications are developed in concentrations appropriate for adults. Determining paediatric dosages can be complicated because of the need to calculate the child’s weight; those children who take such medications are at a greater risk of medication error than adults who don’t require such calculations [3] These errors are potentially dangerous as omission of one step or wrong calculation can result in a dose up to 10 times higher than necessary. This can cause serious injury, even death, especially when medication agents have a narrow therapeutic range [1]

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Results

Discussion

Conclusion