Published: 5 March 2015

Publications

Preventing Paediatric Medication Errors

This article is more than five years old. Some content may no longer be current.

Prescriber Update 36(1): 14
March 2015

Medication errors are considered adverse events which can lead to adverse drug reactions. These errors can occur at any stage from prescription to dispensing to administration. Paediatric patients are an especially vulnerable group as these adverse events can result in more serious and severe outcomes than would occur with the same error in adults.

There are numerous factors which contribute to the risk of medication errors in paediatric patients. The nature of paediatric dosing lends itself to an increased risk of errors due to individualised dosing and varied strengths in available formulations. For example, different children in the same family are likely to require different doses with different strengths of the same drug. All healthcare professionals have opportunity to reduce medication administration errors in the paediatric population as errors can be detected and corrected at various stages before administration.

There are many points at which errors occur and can be prevented. The most vital stage is the point of administration as those who administer the medicines are the final barrier to protect a child from a medication error. Measuring devices such as oral syringes, droppers and medicine measuring cups can improve accurate and consistent doses at the time of administration. If those administrating medicines are well-informed and possess the correct tools, they are empowered to reduce the risk of an error.

Reducing errors is an ongoing process and particular vigilance is required with paediatric patients as they may not always be able to communicate symptoms which would indicate an adverse reaction.

These points to consider may be helpful in reducing medication errors in children.

Points to consider for paediatric medicines: All healthcare professionals

• Allergy status.
• History of adverse reactions.
• Other medications currently being administered/prescribed to prevent accidental additional doses.
• Current weight of the child at the time of drug administration. Weigh the child if uncertain.
• Confirm mg/kg basis of dose and calculation with child's current weight - it may be helpful to provide a written copy of the dose, calculation (and volume for liquid formulations) to be administered for the parent/carer who will administer the medication to the child.
• For children who weigh 40kg or more, check that the dose does not exceed an adult dose.
• Check if those who will administer the medicine have access to droppers/oral syringes or other measuring devices to facilitate accurate dose administration of liquid formulations.
• Check that parents/carers are clear on how to administer medicines and feel comfortable/confident with the procedure. Encourage them to discuss any concerns or uncertainty around administering medicines. Ask them to explain it to you (as they would explain to another carer such as a grandparent or babysitter).
• Report medication errors so measures can be taken to reduce the risk of these occurring in the future and to help prevent others from making similar mistakes.

Points to consider for paediatric medicines: Prescribers

• Provide specific instructions in the prescription on how to give each dose - avoid vague phrases such as "take as directed" or "when required".
• Include the maximum dose (or number of doses) in 24 hours.
• Ask about other medications currently being administered/prescribed to the child.
• Confirm current weight of the child. Weigh the child if uncertain.

Points to consider for paediatric medicines: Pharmacists

• Provide specific instructions on how to give each dose - avoid vague phrases such as "take as directed" or "when required".
• Double check the strength of formulation to be administered and double check the dose calculation.
• Include the volume to be administered for liquid formulations.
• Include the maximum dose (or number of doses) in 24 hours.
• Ask about other medications currently being administered/prescribed to the child.
• Confirm current weight of the child. Weigh the child if uncertain.
• Encourage those administering the medicine to use oral syringes or other measuring devices to facilitate accurate dose administration of liquid formulations.

Points to consider for paediatric medicines: At time of administration

• Check when the last/previous/most recent dose was administered and how many doses have been given in the previous 24 hours.
• Check the strength of the formulation.
• Check that the dose calculation of mg/kg x weight of child matches the volume to be administered (compare to written information provided).
• Check the measuring device to ensure the units match the volume to be administered.
• Monitor for adverse effects following administration of a medicine.