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Characteristics of Reported Pediatric Medication Errors in Northern Ireland and Use in Quality Improvement

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Abstract

Background

To protect children from harm, clinicians, educators, and patient safety champions need information to direct improvement efforts. Critical incident data could provide this but are often disregarded as a source of evidence because under-reporting makes them an inaccurate measure of error rates.

Objective

Our aim was to identify key targets for pediatric healthcare quality improvement. The objective was to evaluate the types, characteristics, and areas of risk within reported medication errors in pediatric patients.

Methods

We conducted a retrospective study of a large regional dataset of 1522 pediatric medication errors reported from secondary care between 2011 and 2015, including all hospitals and community pediatric settings in Northern Ireland. The following characteristics were included: error severity, patient age, drug involved, error type, and area of practice. Two academic pediatricians, a senior medicines governance pharmacist, a Reader in Pharmacy Practice, and a Professor of Medical Education analyzed the data. Validity checks included comparing the findings against key published literature and discussion by a practitioner panel representing five multidisciplinary stakeholder groups.

Results

Neonates, particularly in intensive care, were implicated in 19% of all errors. The medications most represented in risk were antimicrobials, paracetamol, vaccines, and intravenous fluids. The error types most implicated were dosing errors (32%) and omissions (21%).

Conclusions

Incident reports identified neonates, a shortlist of drugs, and specific error types, associated with modifiable behaviors, as priority improvement targets. These findings direct further study and inform intervention development, such as specific training in calculations to prevent dosing errors. Involving experienced practitioners both endorsed the findings and engaged the practice community in their future implementation. The utility of incident reports to direct improvement efforts may offset the limitations in their representativeness.

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Acknowledgements

The authors thank the Royal Belfast Hospital for Sick Children, whose Research Fellowship supported Richard Conn in conducting this work. We also thank Professor Karen Mattick for comments on a draft of this article.

Author information

Authors and Affiliations

  1. Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK

    Richard L. Conn & Tim Dornan

  2. Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK

    Mary P. Tully

  3. Centre for Experimental Medicine, Queen’s University Belfast, Belfast, UK

    Michael D. Shields

  4. Medicines Governance Team, Belfast Health and Social Care Trust, Belfast, UK

    Angela Carrington

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  1. Richard L. Conn
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Richard Conn and Angela Carrington. The first draft of the manuscript was written by Richard Conn. All authors commented on previous versions of the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Richard L. Conn.

Ethics declarations

Conflict of interest

Richard Conn, Mary Tully, Michael Shields, Angela Carrington, and Tim Dornan have no conflicts of interest that are relevant to the content of this article.

Availability of data and material

Data were obtained with full NHS Ethics and Trust Governance approval. Data were fully anonymized prior to being made available to the research team. As data contain narrative information about patients and hospital staff, we have not openly published the dataset; access to data is available on request.

Code availability

Not applicable.

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Ethics approval

The research was deemed eligible for Proportionate Review by the first available committee. It was approved by the Proportionate Review Subcommittee of the East Midlands—Nottingham 2 Research Ethics Committee (reference 15/EM/0353).

Consent to participate/consent for publication

As this study used aggregated, anonymized incident data only, individual consent from patients and practitioners described in reports was not sought.

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Conn, R.L., Tully, M.P., Shields, M.D. et al. Characteristics of Reported Pediatric Medication Errors in Northern Ireland and Use in Quality Improvement. Pediatr Drugs 22, 551–560 (2020). https://doi.org/10.1007/s40272-020-00407-1

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