ASSESSMENT OF MEDICATION ERRORS IN PEDIATRIC PRESCRIPTIONS, A PROSPECTIVE STUDY CONDUCTED IN 4 DIFFERENT GOV SECTOR HOSPITALS OF PAKISTAN.

1. The Assessment of Weight
Based Medication Errors in
Pediatric Prescriptions
PRESENTED BY:
SALMAN SHAH (078)
DEPARTMENT OF PHARMACY
Abbotabad

2. Introduction:
Pediatrics is the branch of medicine dealing with the development, diseases and disorders of children.
Infancy and childhood is a period of rapid growth and development. The various organs, body systems
and enzymes that handle drugs develop at different rates; hence, drug dosage, formulation, response to
drugs and adverse reactions vary throughout Childhood. For the purpose of proper drug dosing
childhood is divided into the following age groups1:
 Premature Newborns: <38 weeks gestational age
 Term Newborns: >38 weeks gestational age
 Neonate: 0 – 30 days of age
 Infant: 1 month – 2 years
 Young Child: 2 – 6 years
 Child: 6 – 12 years
 Adolescent: 12 – 17 years

3. Medication Errors
The United States National Coordinating Council for Medication Error Reporting and
Prevention defines a medication error as:
“Any preventable event that may cause or lead to inappropriate medication use or patient
harm while the medication is in the control of the health care professional, patient, or
consumer. Such events may be related to professional practice, health care products,
procedures, and systems, including prescribing, order communication, product labelling,
packaging, and nomenclature, compounding, dispensing, distribution, administration,
education, monitoring, and use” (WHO)
Drug doses for the pediatric population should be calculated according to their body
weights / body surface area while keeping there age in consideration as well. Thus
calculating a drug dose on the basis of their age only or from adult doses wouldn't be
appropriate & may cause therapeutic failure. Medication error result from administering a
drug through wrong route, in wrong dose, wrong frequency & wrong duration.
Such errors can be omitted by training the staff, using computer generated prescriptions or
by involving Pharmacists in the patient care process.2

4. Medication Errors
Globally medication errors are among the major health and economic concerns. Annually
44,000 people die from preventable medication errors.3
However not every medication error may result in clinical emergency but there are certain
narrow therapeutic drugs such as digoxin etc. of which a minor dose fluctuation may result
in a clinical emergency. Thus in order to avoid such errors trained personals are required to
monitor drug utilization process, Pharmacists are health care professionals that are specially
trained to identify and monitor drug related problems. Pharmacists can provide benefits to
both the institution and patients by detecting and preventing errors before their occurrence
and by ensuring cost effective therapy hence providing economic benefits to the institution.
A study in US analyzed that how clinical pharmacist identifies prescription errors in
pediatric ward, of which about 78% of potentially harmful prescribing errors were prevented
by pharmacists.4

5. Aims & Objectives
The purpose of this study was to assess & identify the medication errors in the pediatric
patient care system of Pakistan based on the negligence of weight based dosing in pediatric
population.
The purpose of the study is to point out the correctable or preventable errors that can be
rectified in the coming future by the health care professionals involved in the drug utilization
process.

6. Methodology:
Collection & Slection of Prescriptions/Cases:
A total of 200 prescriptions were collected from following healthcare setups;
1. HMC Peshawar
2. ATH Abbottabad
3. DHQ Haripur
4. Children Hospital Lahore
5. Private Clinics
These prescriptions were collected in such a way that 50 prescriptions came from each of the Peshawar,
Abbottabad, Haripur and Lahore cities.
One hundred and twenty prescriptions were randomly selected from these two hundred prescription for our
study, keeping in mind that same number of prescription (30) were from each of the above cities.
Recording Information of Prescription:
The following information relating to each drug prescribed (excluding nutritional prescribed if any) were noted and
tabulated.
1. Diagnosis or disease for which the drug was prescribed
2. Name, age and weight of the patient
3. Dose prescribed

7. PARAMETERS DESCRIPTION PERCENTAGE
AGE Infants (1Mo to
2Yrs)
Young children
(2-6Yrs)
Child (6-12Yrs)
Adolescence(12
-18Yrs)
54%
24.16%
18.33%
2.5%
GENDER Male
Female
60%
40%
WEIGHT Less than 10Kg
10-20Kg
20-30Kg
30-40Kg
58.33%
31.6%
5%
0.8%
TYPE OF
CLINICAL CARE
Gov. Hospitals
Private clinics
90%
10%
Table 1; Demographic data of the
patients illustrating %age of the age,
sex and weight of patients involved
in the study, with the %age of data
collecting centers.
Results:
A total of 120 pediatric prescriptions were
collected from different health care
settings based in different cities of
Pakistan. These prescriptions were
screened for dose based medication errors,
frequency of different classes of medicines
& the frequency of errors occurring in
each class of medicine prescribed. The
outcomes can be summarized & illustrated
best through the following tables:

8. Clinical Condition Percentage (%)
Fever 23.30%
Wheezing Cough 17.50%
Bronchiolitis 12.5%
Pneumonia 11.67%
Sepsis 5.83%
Abdominal Pain 3.30%
Fits 2.50%
Thalassemia 2.50%
Tuberculosis 2.50%
Meningitis 2.50%
Chronic Diarrhea 2.50%
AGE (Acute Gastroenteritis) 2.50%
Malaria 1.67%
Others 4.16%
Table 2; Percentages of clinical conditions encountered in the prescriptions:

9. Table 3; Percentages
of medicine classes
prescribed:
PRESCRIBED
MEDICATIONS
OVERALL
PERCENTAGE (%)
Antibiotics 35.5%
Antipyretic and analgesics 31%
Antihistamine 25%
Bronchodilators 7.7%
Nasal Decongestant 5.0%
Antiemetic 20%
Corticosteroids 5.5%
Tonics and vitamins 4.1%
Laxatives 9.0%
LK-antagonist* 2%
Topical nasal drops 0.4%
Topical eye drops 0.5%

10.  Table 4; Shows the medication error for
each medicine class based on the frequency
of prescribtion. A large percentage of errors
were in antibiotic doses and/or duration of
use. The findings of this study suggest that
prescribers miscalculated the proper
antibiotic doses that was over or under dosed
which can lead to significant clinical
outcomes.
Class of Medicines % Dose
Deviation
Antibiotics 52%
Antipyretics and Analgesics 45%
Antihistamines 30%
Bronchodilators 35%
Nasal decongestant 29.9%
Antiemetics 10%
Corticosteroids 9.9%
Topical nasal drops 0.2%
Topical eye drops 0.3%
Unsafe Drugs in Infants
<3months e.g. Albuterol
3.0%

11. Table 5; Pie chart depicting the percentage or portion of data collected from type of health
care facility:
Government Hospitals (Data %) Private Clinics (Data %)
90% 10%
90%
10%
Government
Hospitals (Data
%)
Private Clinics
(Data %)

12. Conclusion:
Thus from the data & results above it is evident that pediatric dosing error is common
in both governmental and private clinics. Pediatric dosing error may be in dose
calculation, duration of medication use or improper and inaccurate route of
administration. The results showed majority of the errors in dose calculations which is
very concerning in pediatric health care, therefore heath care institutions in Pakistan
should give more efforts for rational use of mediation in pediatrics and educate the
society to improve health care outcomes.

13. References:
 European Medicines Agency. Reflection Paper : Formulations of Choice for the Pediatric Population, London,
28 July 2006.
 Mohammed-Jawad, Noor & Abdulrahman, Noor & Jumaa, Samar. (2020). Assessment of dosing errors in
pediatric patients prescriptions in Basra City. 11. 73-76.
 Institute of Medicine: To err is human:building a safer health system, National Academies, Washington,DC,
Press: 2000.
 Otero P, Leyton A, Mariani G, Ceriani Cernadas JM: Medication errors in pediatric inpatients: prevalence and
results of a prevention program. Pediatrics 2008; 122(3):e737–e743.