As research results emerge, we are beginning to understand the impact of medication errors on children. Several studies of pediatric inpatients found rates of medication error ranging from 4.5 to 5.7 errors per 100 medication orders, 4 rates similar to those found in studies of adult inpatients. 5 Horen and colleagues found that pediatric outpatients had three times the risk of an adverse drug reaction, compared with adult outpatients, especially when the medication was used for an “off-label” indication-a common practice in pediatrics. 6 While this study found significant error rates, the frequency of pediatric medication errors in ambulatory settings may be greater, because there are fewer checks and balances in place to prevent them. According to Miller and colleagues, “Pediatric patient safety in ambulatory care settings should be a high research and policy priority given the unique vulnerabilities of children, the glaring lack of current knowledge, and the disproportionate reliance on ambulatory care as compared to inpatient care.” How Drugs Are Administered to Pediatric Patients Essay
Medication errors take many forms, but they don’t all result in injury or death. Medication errors are defined as the preventable, inappropriate use of medications that may occur at any stage of the medication process, including ordering, transcribing orders, dispensing, administering, and monitoring. In some instances, medication errors result in an adverse drug event. Adverse drug events can also occur at any step in the medication process.5, 8, 9
TYPES OF MEDICATION ERRORS
Bates and colleagues, among others, have demonstrated the phases of the care process in which medication errors are most likely to occur.10 In pediatrics, the prescribing or ordering phase is associated with the most errors-usually dosing errors-followed by the administering phase.11 According to research recently published in AJN, “When respondents to [a] staff patient-safety survey were asked to identify which profession has primary responsibility for ensuring patient safety, 96% of nurses and more than 90% of physicians, administrators, and pharmacists assigned primary responsibility to nurses,” regardless of the factors that contributed to the error (see “An Error by Any Other Name,” June 2004).12 Therefore, nurses involved in the care of children must be well informed about their patients and the medications ordered.How Drugs Are Administered to Pediatric Patients Essay
Contrary to earlier research,13, 14 nurses play a significant role (specifically in medication administration) in pediatric medication errors. 5 Even though many errors are caught before a drug is administered,15 medication errors not caught or intercepted by nurses can result in an adverse event. Because nurses are the ones who predominantly administer medications to patients, they are often the last potential barrier between a medication error (such as the wrong medication given at the wrong time) and serious harm. Nurses have a responsibility to ensure that patients receive the right medication at the right time, and to monitor patients after they’re given or have taken the medication to observe possible adverse events.How Drugs Are Administered to Pediatric Patients Essay
THE UNIQUE NATURE OF MEDICATIONS FOR CHILDREN
Children and adolescents are at greater risk than adults for medication errors because they have an immature physiology as well as developmental limitations that affect their ability to communicate and self-administer medications. Another important factor is that the great majority of medications are developed in concentrations appropriate for adults; therefore, pediatric indications and dosage guidelines often aren’t included with a medication, necessitating weight-based dosing or dilution.16 That is, in order for many drugs to be used in children, safe dosages-which are fractions of those normally given to adults-must be calculated. Determining pediatric dosages can be complicated because of the need to calculate them according to the child’s weight; therefore, those children who take such medications are at greater risk for medication error than others who take medications that don’t require such calculations. If no calculation is required, the risk of an error decreases significantly.How Drugs Are Administered to Pediatric Patients Essay
Research has identified some of the children most vulnerable to medication errors, including those
* who are younger than two years.17
* who are in ICUs, especially neonatal ICUs.4, 18, 19
* who are in EDs, especially if seriously ill, between the hours of 4 AM and 8 AM or on weekends.20
* who are receiving chemotherapy.21
* who are receiving IV medication.21, 22
* whose weight hasn’t been documented.23
Many
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