This document discusses medication errors in pediatrics. It defines key terms like adverse drug reactions, side effects, and prescribing errors. Medication errors are common in pediatrics due to dosing challenges from weight-based calculations and off-label use. Common causes of errors include human factors like fatigue, workplace issues like distractions, and drug factors like confusing labels. Preventing errors involves standardized processes, clear communication, limiting verbal orders, confirming patient identity, and involving pharmacists. Nursing students and faculty have specific responsibilities when administering medications to ensure safety. The goal is to establish best practices to minimize harmful medication errors in children.

1. MEDICATION ERRORS IN
PEDIATRICS
HATEMS. EL-DABBAKEH, BSN, MPH, Dr.PH-
Epidemiology
NOTES, CAUSES, ANDPREVENTION

2. Key Definitions (1)
Adverse drug reaction (ADR)
 A noxious and unintended response to a medicine that occurs at normal
therapeutic doses used in humans forprophylaxis, diagnosis, ortherapy of
disease, orforthe modification of physiologic function
 The word “effect” is used interchangeably with “reaction.”
Side effect
 Any unintended effect of a pharmaceutical product occurring at normal
therapeutic doses and is related to its pharmacological properties. Such
effects may be well-known and even expected and require little orno
change in patient management.
Serious adverse effect
 Any untoward medical occurrence that occurs at any dose and results in
death, requires hospital admission orprolonged hospital stay, results in
persistent orsignificant disability, oris life threatening

3. Key Definitions (2)
Prescribing error
 Incorrect medicine ordering by a prescriber
Medication error
 Administration of a medicine or dose that differs from the
written order
Negligence
 Medical decision making or care below the accepted
standards of practice

4. Medication Errors in General
4
Definition: An errorin prescribing, dispensing,
oradministering a medication
 Data suggests medication errors are seen at a higherrate in the ED
than otherareas of the hospital
 Medication errors positively correlate with inexperience, and with
stress/fatigue
 Sedation and resuscitation are especially vulnerable to errors
 It is suspected that medication errors are underreported

5. Medication Errors (1)
 Administration of medicine ordose that differs
fromwritten order
 Medicine prescribed but not given
 Administration of a medicine not prescribed
 Medicine given to the wrong patient
 Wrong medicine orIV fluid administered
 Wrong dose orstrength given
 Wrong dosage formgiven

6. Medication Errors (2)
 Medicine given forwrong duration
 Wrong preparation of a dose (e.g., incorrect
dilution)
 Incorrect administration technique (e.g., unsterile
injection)
 Medicine given to a patient with known allergy
 Wrong route of administration used
 Wrong time orfrequency of administration

7. Causes of Medication Errors
 Human factors
 Heavy staff workload and fatigue
 Inexperience, lackof training, poorhandwriting, and oral
orders
 Workplace factors
 Poorlighting, noise, interruptions, excessive workload
 Pharmaceutical factors
 Excessive prescribing
 Confusing medicine nomenclature, packaging, orlabeling
 Increased numberorquantity of medicines perpatient
 Frequency and complexity of calculations needed to prescribe,
dispense, oradministera medicine
 Lackof effective policies and procedures

8. Dosing Errors in Children
8
 Current research shows that, in pediatrics, dosing errors are the most
common type of medication error due to:
 Lackof standard doses formany drugs (often off label) used in
children
 Individual doses based on age, weight orbody surface area require
calculations that are prone to failure (even in ideal settings)
 Tenfold errors are common dosing errors, and are often associated
with highertoxicity than othertypes of dosing errors
 Failure to correctly estimate a child’s weight continues to be a
common problem
CASE: Jose Martinez was a 2-month-old who exhibited early
signs of CHF. His physician ordered IV Digoxin®
overan
extended length of stay. However, due to a decimal point
error, Jose received a dose that was 10 times what was
intended. Josedied.

9. Medication Errors in the
ED
9
A recent study involving medication administration in a
simulated pediatric emergency scenario revealed numerous
opportunities fornursing performance improvement:
a. Communication – 45% orders were not verbally repeated back
b. Converting Dose –14.2% converted incorrectly (convert mg
into ml)
c. Selecting medication – 7.3% wrong vials selected
d. Dilution & reconstitution – 40% Ceftriaxone not properly
constituted
e. Measuring Dose – 32.7% measured doses ≠ to intended dose

10. Medicine Ordering orPrescribing
Transcribing
Dispensing
Administering
Monitoring
MEDICATION
ERROR
When Medication Errors Occur(1)

11. Preventing Medication Errors (1)
 Establish consensus group of physicians, nurses, and
pharmacists to select best practices
 Introduce a punishment-free system to collect and
record information about medication-related errors
 Develop written procedures with guidelines and
checklists forIV fluids and high-riskmedicines (e.g.,
insulin, heparin, narcotics)

12. Preventing Medication Errors (2)
 Require legible handwriting and complete spelling of
medicine name
 Use standardized notation
 Doses given in mg, mcg, g
 Leading zero used forvalues < 1 and no trailing zero (e.g., 0.2
mg instead .2 mg; 2 mg instead of 2.0 mg)
 Write route of administration on all orders
 Write out directions completely (e.g., “daily” not “QD” or
“OD”)

13. Preventing Medication Errors (3)
 Limit use of telephone and oral orders to emergency
situations
 Confirm identity of patients before administering
medication
 Use standard administration times forhospitalized
patients
 Forlookalike and sound alike names, establish a policy
requiring that prescribers write both brand and generic
names
 Use pharmacy staff to help prevent errors

14. Nursing Student Responsibility (1)
Follow all Hospital’s or department’s policies
and procedures especially those related to
Patient Safety.

15. Nursing Student Responsibility (2)
 Nursing students do not take verbal/telephone
orders fromphysicians
 Nursing students do not administerany
chemotherapy agents (oral orIV)
 Nursing students do not give IV push medications
EVER!
 Nursing students do not administernarcotics,
paralytics, orvasopressors via pump ordrip
 Nursing students may not independently program
any infusion pumps

16. 1. Student must give medication under the direct supervision of
a nursing instructor unless supervision has been prearranged
with the instructor and the RN/BSN caring for your patient.
2. When giving a scheduled med late you must document the
actual time given.
3. If a scheduled med is not given you must document not given
and document the reason why..
4. You must have medications cosigned by an instructor or the
RN/BSN caring for the child
Medication administration
documentation (students)

17. Faculty Responsibility…
 Directly supervise the administration of medications. When the student
has demonstrated adequate knowledge and good technique, s/he may give
medications (except IV meds) with staff nurse availability. This must be
pre-arranged between the faculty and staff BSN.
 All student medication administration is to be directly supervised by
clinical faculty or staff nurse. The supervising BSN (faculty or staff BSN)
will co-sign the MAR.
 RN/BSN reviews and co-signs documentation and medication
administration. Writes “I agree/concur with above documentation” and/or
add any additional documentation. (Note: LPNs may not co-sign RN/BSN
student nurse medication administration documentation).

18. Some hints from the wise
 Always check name band prior to giving any
medications.
 Always check to see that ordered dose is
appropriate based on weight.
 Always look up medications unfamiliar to
you before leaving the medication room.

19. Wow, that is a lot of to
do’s and not to do’s…
but ultimately keeping
kids safe is ourgoal!

20. 20
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
- Johann von Goethe

21. Thank
s!
Medication errors in Pediatrics
Presented by HATEMS. EL-DABBAKEH, BSN, MPH, Dr.PH-
Epidemiology