Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis
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The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts.
Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions.
We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods.
We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates.
Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
Compliance with Ethical Standards
Conflict of interest
Peter Gates, Melissa Baysari, Madlen Gazarian, Magdalena Raban, Sophie Meyerson, and Johanna Westbrook have no conflicts of interest that are directly relevant to the content of this study.
Funding from a National Health and Medical Research Council Partnership Grant (APP1094878) was used to assist with this research. MZR is supported by a National Health and Medical Research Council Early Career Fellowship (APP1143941).
- 1.Pharmacovigilance Risk Assessment Committee. Good practice guide on recording, coding, reporting and assessment of medication errors. European Medicines Agency. 2015. http://www.ema.europa.eu/docs/en_GB/document_library/Regulatory_and_procedural_guideline/2015/11/WC500196979.pdf. Accessed 18 Jan 2018.
- 2.The Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.Google Scholar
- 3.World Health Organization. Reporting and learning systems for medication errors: The role of pharmacovigilance centers. 2014. http://apps.who.int/medicinedocs/documents/s21625en/s21625en.pdf. Accessed 3 Apr 2019.
- 7.Aspden P, Wolcott J, Bootman L, Cronenwelt L. Prevention medication errors: quality chasm series. Washington DC: The National Academic Press; 2007.Google Scholar
- 9.Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care. 2007;16(2):116–26. https://doi.org/10.1136/qshc.2006.019950.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Sutcliffe K, Stokes G, O’Mara A, Caird J, Hinds K, Bangpan M, et al. Paediatric medication error: a systematic review of the extent and nature of the problem in the UK and international interventions to address it. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2014. ISBN 978-1-907345-73-9.Google Scholar
- 23.Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. J Am Med Assoc. 2001;285(16):2114–20.Google Scholar
- 24.Koumpagioti D, Varounis C, Kletsiou E, Nteli C, Matziou V. Evaluation of the medication process in pediatric patients: a meta-analysis. J Pediatr. 2014;90(4):344–55.Google Scholar
- 27.Westbrook JI, Li L, Lehnbom EC, Baysari MT, Braithwaite J, Burke R, et al. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. Int J Qual Health Care J Int Soc Qual Health Care. 2015;27(1):1–9. https://doi.org/10.1093/intqhc/mzu098.CrossRefGoogle Scholar
- 41.Wells GA, Shea B, O’Connell DP, J., Welch V, Losos M. The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. 2017. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 7 Aug 2017.
- 42.Critical Appraisal Skills Programme. CASP Cohort Study Checklist. 2017. http://www.casp-uk.net/casp-tools-checklists. Accessed 5 Aug 2017.
- 44.Gates PJ, Meyerson SA, Baysari MT, Westbrook JI. The prevalence of dose errors among paediatric patients in hospital wards with and without health information technology: a systematic review and meta-analysis. Drug Saf. 2018;42(1):13–25.Google Scholar
- 45.Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clin Res ed). 2003;327(7414):557–60.Google Scholar
- 55.Kadmon G, Pinchover M, Weissbach A, Kogan Hazan S, Nahum E. Case not closed: prescription errors 12 years after computerized physician order entry implementation. J Pediatr. 2017;190(236–40):e2.Google Scholar
- 58.Kunac DL, Reith DM. Preventable medication-related events in hospitalised children in New Zealand. N Zeal Med J. 2008;121(1272):17–32.Google Scholar
- 63.Morriss FH Jr, Abramowitz PW, Nelson SP, Milavetz G, Michael SL, Gordon SN, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr. 2009;154(3):363.e1–368.e1. https://doi.org/10.1016/j.jpeds.2008.08.025.CrossRefGoogle Scholar
- 70.Zeleke A, Chanie T, Woldie M. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Int Arch Med. 2014;7(18):1–6.Google Scholar
- 72.Chedoe I, Molendijk H, Hospes W, Van Den Heuvel ER, Taxis K. The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed. 2012;97(6):F449–55. https://doi.org/10.1136/archdischild-2011-300989.CrossRefPubMedGoogle Scholar
- 73.Raja Lope RJ, Boo NY, Rohana J, Cheah FC. A quality assurance study on the administration of medication by nurses in a neonatal intensive care unit. Singap Med J. 2009;50(1):68–72.Google Scholar
- 77.Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH. Assessing medication prescribing errors in pediatric intensive care units. Pediatr Crit Care Med. 2004;5(2):124–32. https://doi.org/10.1097/01.pcc.0000112371.26138.e8.CrossRefPubMedGoogle Scholar
- 83.Barber N, Franklin BD, Cornford T, Klecun E, Savage I. Safer, faster, better? Evaluating electronic prescribing: report to the patient safety research programme. London: Policy Research Programme of the Department of Health; 2006.Google Scholar
- 88.Ozkan S, Kocaman G, Ozturk C. Effect of strategies for preventing medication administration errors in pediatric inpatients. Turk Pediatr Arsivi. 2013;48(4):299–302.Google Scholar
- 89.Sagy M. Optimizing patient care processes in a children’s hospital using Six Sigma. J Clin Outcomes Manag. 2009;16(9):411–4.Google Scholar
- 103.Feleke Y, Girma B. Medication administration errors involving paediatric in-patients in a hospital in Ethiopia. Trop J Pharm Res. 2010;9(4):401–7.Google Scholar
- 105.Khaemba CN. Incidence and determinants of medication errors among paediatric in-patients at Kisii level 5 hospital. Nairobi: University of Nairobi; 2014.Google Scholar
- 107.Nikhithasri P, Ramya M, Kishore P. Assessment of medication errors in pediatric inpatient department of a private hospital. Int J Curr Pharm Res. 2017;9(6):70–5.Google Scholar
- 112.Truter A, Schellack N, Meyer JC. Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa. SAJCH S Afr J Child Health. 2017;11(1):5–10.Google Scholar
- 115.American Society of Healthsystem Pharmacists. ASHP standard definition of a medication error. Am J Hosp Pharm. 1982;39(2):321.Google Scholar
- 120.Chedoe I, Molendijk HA, Dittrich STAM, Jansman FGA, Harting JW, Brouwers JRBJ, et al. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Drug Saf. 2007;30(6):503–13. https://doi.org/10.2165/00002018-200730060-00004.CrossRefPubMedGoogle Scholar
- 126.Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Qual Saf. 2017;26(9):734–42. https://doi.org/10.1136/bmjqs-2016-006123.CrossRefPubMedPubMedCentralGoogle Scholar
- 129.Westbrook JI, Reckmann M, Li L, Runciman WB, Burke R, Lo C, et al. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. PLoS Med. 2012;9(1):e1001164. https://doi.org/10.1371/journal.pmed.1001164.CrossRefPubMedPubMedCentralGoogle Scholar