Paediatric Senior House Officer Crumlin Hospital Children's Health Ireland at Crumlin Dublin 2, Ireland
Background: To identify the medication prescribing error rate and error types in critically unwell paediatric patients (Irish Children’s Triage System category 1 or 2 out of 5 (1= critical to 5= least critical)) in emergency department (ED) resuscitation bays.
Design/Methods: A retrospective review of electronic and paper records of prescribed medications and associated errors for patients in the ED resuscitation bays during August 2020. Medications were prescribed on paper charts and scanned to the ED electronic information system. A medication error was defined as any preventable event that could cause or lead to inappropriate medication use or patient harm. Each error was recorded on a data collection form. These errors were independently graded by a paediatric medication safety pharmacist utilising the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index. Patients without full clinical record availability were excluded from medication error analysis.
Results: There were 111 patients were in the resuscitation bays during the study period. Full records were not available for 17 patients. Medication error analysis was carried out on the remaining 94 patients. The mean age was 5.5 years (range 0 -16 years) and 60% were under 6 years old. The mean weight was 14kg (range 2.3 – 79.4 kg). Ultimately 65% were admitted to the hospital, 6% directly to intensive care. The top diagnostic group (ICD-10) was injury and poisoning at 27%. The total number of medication orders was 185 in 94 patients. Analgesics/ sedatives were the most commonly prescribed medications; followed by intravenous fluids, respiratory medicines, antibiotics and antiepileptics. In total 27 prescribing errors were identified giving an error rate (per order) of 14.6%. 18 (67%) of these errors were classified as ‘near miss’ and did not reach the patient. 9 (33%) of these errors reached the patient but did not cause harm. Seven different types of errors were identified. The most common errors found were incorrect dose (26%), incorrect units of measurement (18.5%) and incorrect or no route of administration (15%). Conclusion(s): A prescribing error rate (per order) of 14.6% existed in the care of the critically unwell in the paediatric ED resuscitation bays. No patient harm was identified in errors that reached the patient. This study illustrates the need to develop tailored safety measures to reduce the rate and type of medication errors within our practice.
Authors/Institutions: Esme Dunne, Children's Health Ireland at Crumlin, Dublin 2, , Ireland; Karen Lavelle, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland; Moninne Howlett, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland; Fiona Leonard, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland; Michael J. Barrett, Children's Health Ireland, Dublin, , Ireland