Medication errors in Pediatrics
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This document discusses medication errors in pediatrics. It defines key terms like adverse drug reactions, side effects, and prescribing errors. Medication errors are common in pediatrics due to dosing challenges from weight-based calculations and off-label use. Common causes of errors include human factors like fatigue, workplace issues like distractions, and drug factors like confusing labels. Preventing errors involves standardized processes, clear communication, limiting verbal orders, confirming patient identity, and involving pharmacists. Nursing students and faculty have specific responsibilities when administering medications to ensure safety. The goal is to establish best practices to minimize harmful medication errors in children.
Medication errors in Pediatrics
- 1. MEDICATION ERRORS IN PEDIATRICS HATEMS. EL-DABBAKEH, BSN, MPH, Dr.PH- Epidemiology NOTES, CAUSES, ANDPREVENTION
- 2. Key Definitions (1) Adverse drug reaction (ADR) A noxious and unintended response to a medicine that occurs at normal therapeutic doses used in humans forprophylaxis, diagnosis, ortherapy of disease, orforthe modification of physiologic function The word “effect” is used interchangeably with “reaction.” Side effect Any unintended effect of a pharmaceutical product occurring at normal therapeutic doses and is related to its pharmacological properties. Such effects may be well-known and even expected and require little orno change in patient management. Serious adverse effect Any untoward medical occurrence that occurs at any dose and results in death, requires hospital admission orprolonged hospital stay, results in persistent orsignificant disability, oris life threatening
- 3. Key Definitions (2) Prescribing error Incorrect medicine ordering by a prescriber Medication error Administration of a medicine or dose that differs from the written order Negligence Medical decision making or care below the accepted standards of practice
- 4. Medication Errors in General 4 Definition: An errorin prescribing, dispensing, oradministering a medication Data suggests medication errors are seen at a higherrate in the ED than otherareas of the hospital Medication errors positively correlate with inexperience, and with stress/fatigue Sedation and resuscitation are especially vulnerable to errors It is suspected that medication errors are underreported
- 5. Medication Errors (1) Administration of medicine ordose that differs fromwritten order Medicine prescribed but not given Administration of a medicine not prescribed Medicine given to the wrong patient Wrong medicine orIV fluid administered Wrong dose orstrength given Wrong dosage formgiven
- 6. Medication Errors (2) Medicine given forwrong duration Wrong preparation of a dose (e.g., incorrect dilution) Incorrect administration technique (e.g., unsterile injection) Medicine given to a patient with known allergy Wrong route of administration used Wrong time orfrequency of administration
- 7. Causes of Medication Errors Human factors Heavy staff workload and fatigue Inexperience, lackof training, poorhandwriting, and oral orders Workplace factors Poorlighting, noise, interruptions, excessive workload Pharmaceutical factors Excessive prescribing Confusing medicine nomenclature, packaging, orlabeling Increased numberorquantity of medicines perpatient Frequency and complexity of calculations needed to prescribe, dispense, oradministera medicine Lackof effective policies and procedures
- 8. Dosing Errors in Children 8 Current research shows that, in pediatrics, dosing errors are the most common type of medication error due to: Lackof standard doses formany drugs (often off label) used in children Individual doses based on age, weight orbody surface area require calculations that are prone to failure (even in ideal settings) Tenfold errors are common dosing errors, and are often associated with highertoxicity than othertypes of dosing errors Failure to correctly estimate a child’s weight continues to be a common problem CASE: Jose Martinez was a 2-month-old who exhibited early signs of CHF. His physician ordered IV Digoxin® overan extended length of stay. However, due to a decimal point error, Jose received a dose that was 10 times what was intended. Josedied.
- 9. Medication Errors in the ED 9 A recent study involving medication administration in a simulated pediatric emergency scenario revealed numerous opportunities fornursing performance improvement: a. Communication – 45% orders were not verbally repeated back b. Converting Dose –14.2% converted incorrectly (convert mg into ml) c. Selecting medication – 7.3% wrong vials selected d. Dilution & reconstitution – 40% Ceftriaxone not properly constituted e. Measuring Dose – 32.7% measured doses ≠ to intended dose
- 10. Medicine Ordering orPrescribing Transcribing Dispensing Administering Monitoring MEDICATION ERROR When Medication Errors Occur(1)
- 11. Preventing Medication Errors (1) Establish consensus group of physicians, nurses, and pharmacists to select best practices Introduce a punishment-free system to collect and record information about medication-related errors Develop written procedures with guidelines and checklists forIV fluids and high-riskmedicines (e.g., insulin, heparin, narcotics)
- 12. Preventing Medication Errors (2) Require legible handwriting and complete spelling of medicine name Use standardized notation Doses given in mg, mcg, g Leading zero used forvalues < 1 and no trailing zero (e.g., 0.2 mg instead .2 mg; 2 mg instead of 2.0 mg) Write route of administration on all orders Write out directions completely (e.g., “daily” not “QD” or “OD”)
- 13. Preventing Medication Errors (3) Limit use of telephone and oral orders to emergency situations Confirm identity of patients before administering medication Use standard administration times forhospitalized patients Forlookalike and sound alike names, establish a policy requiring that prescribers write both brand and generic names Use pharmacy staff to help prevent errors
- 14. Nursing Student Responsibility (1) Follow all Hospital’s or department’s policies and procedures especially those related to Patient Safety.
- 15. Nursing Student Responsibility (2) Nursing students do not take verbal/telephone orders fromphysicians Nursing students do not administerany chemotherapy agents (oral orIV) Nursing students do not give IV push medications EVER! Nursing students do not administernarcotics, paralytics, orvasopressors via pump ordrip Nursing students may not independently program any infusion pumps
- 16. 1. Student must give medication under the direct supervision of a nursing instructor unless supervision has been prearranged with the instructor and the RN/BSN caring for your patient. 2. When giving a scheduled med late you must document the actual time given. 3. If a scheduled med is not given you must document not given and document the reason why.. 4. You must have medications cosigned by an instructor or the RN/BSN caring for the child Medication administration documentation (students)
- 17. Faculty Responsibility… Directly supervise the administration of medications. When the student has demonstrated adequate knowledge and good technique, s/he may give medications (except IV meds) with staff nurse availability. This must be pre-arranged between the faculty and staff BSN. All student medication administration is to be directly supervised by clinical faculty or staff nurse. The supervising BSN (faculty or staff BSN) will co-sign the MAR. RN/BSN reviews and co-signs documentation and medication administration. Writes “I agree/concur with above documentation” and/or add any additional documentation. (Note: LPNs may not co-sign RN/BSN student nurse medication administration documentation).
- 18. Some hints from the wise Always check name band prior to giving any medications. Always check to see that ordered dose is appropriate based on weight. Always look up medications unfamiliar to you before leaving the medication room.
- 19. Wow, that is a lot of to do’s and not to do’s… but ultimately keeping kids safe is ourgoal!
- 20. 20 “Knowing is not enough; we must apply. Willing is not enough; we must do.” - Johann von Goethe
- 21. Thank s! Medication errors in Pediatrics Presented by HATEMS. EL-DABBAKEH, BSN, MPH, Dr.PH- Epidemiology
Editor's Notes
- #11: Medication errors can be defined as any error in the medication use process. As outlined in the chart above, this includes medicine ordering, transcribing, dispensing, administering, or monitoring.