Preventing medication errors

While medication errors can happen to any patient at any age, the consequences can be far more serious when children are involved. Healthcare practitioners must consider a child's age, weight, how often the child must take the medicine, and a number of other factors to help ensure the safety of young patients.

Medications for children are usually dosed by weight in kilograms, which means that adult dosages are often diluted based on weight conversions from pounds to kilograms. Because weight calculations are recognized as a frequent problem in pediatric medication dosing, parents can help prevent errors by knowing their child's weight in kilograms and reconfirming with their child's doctor that their child is receiving the proper dosage.

Parents should also inform their child's health care ovider of any and all allergies and make sure the provider lists them on their child's medical chart. In the home, it is essential that parents identify their child's medication by size, shape, color, smell, and sight. If their child is old enough, parents can also teach them to become familiar with their medications.

Tips for Parents

To help combat the problem of pediatric medication errors, the United States Pharmacopeia (USP), a nonprofit public health organization that establishes standards for medicines and medical technologies, offers the following advice to help parents prevent such errors from happening to their children.

On admittance to the hospital, provide the healthcare practitioner (HCP) with an up-to-date list of all medicines (prescription and over-the-counter) and dietary supplements that your child is taking. This will help minimize medication errors and prevent drug interactions during your child's hospital stay.

Make sure your child's doctor is aware of any allergies your child may have. For life-threatening allergies, be sure that your child wears a MedicAlert bracelet at all times.

Remember, when changing pounds to kilograms, "for a dose to be true, divide pounds by 2.2." For purposes of preparing appropriate dosages of medicines, your child's weight in pounds must be divided by 2.2 for conversion into kilograms. Be aware of this calculation and/or your child's weight in kilograms, and reconfirm the correct dosage with your child's HCP if you have concerns.

Be sure that you are provided with verbal and written information about your child's medications, the common side effects, and the adverse reactions that should be reported to the HCP responsible for your child's care.

Pay close attention to how your child is feeling while in the hospital. Notify a HCP immediately if you notice any negative side effects from the administered medications, such as sudden difficulty in swallowing or breathing.

If your child is given a liquid medication to take after release from the hospital, be sure you are provided with, if required, instructions to ensure proper medication doses and an appropriate measuring device.

Be sure that your child's school has a list of any medical conditions or allergies your child may have in case of an emergency.

In addition to the above tips for parents, USP's Pediatric Expert Committee and the Safe Medication Use Expert Committee released recommendations for healthcare professionals to help prevent pediatric medication errors, which may be applied and adopted in various healthcare settings. The Pediatric Expert Committee and the Safe Medication Use Expert Committee comprise national experts representing medicine, nursing, and pharmacy and include representatives from academia and research, the U.S. Food and Drug Administration (FDA), and consumer interest groups.

"Recommendations as those issued by USP should help to alert both parents and healthcare providers of ways to prevent such serious medication errors," said Dr. Phil Walson, who is professor of pediatrics at the University of Cincinnati Children's Hospital Medical Center and a member of the American Academy of Pediatrics. "Parents and their children have the right to expect that healthcare providers will do everything possible to avoid such errors."

The recommendations accompanied an analysis, released in December, of medication errors captured in 2001 by MEDMARX, the anonymous, national reporting database operated by USP that were submitted by hospitals and health systems nationwide. Of the 105,603 errors documented by MEDMARX, 3,361 errors involved pediatric populations (birth-to-16 years). One hundred eighty-eight errors resulted in patient injury; two of the errors resulted in death. However, the majority of errors were corrected before causing harm to the patient.

Diane D. Cousins is vice president of the United States Pharmacopeia's Center for the Advancement of Patient Safety, a graduate of the Rutgers University College of Pharmacy, is a registered pharmacist.

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