Diana Phillips
October 23, 2014
Medication errors occurred in 696,937 nonhospitalized children 6 years of age and younger between 2002 and 2012, and more than a quarter of the episodes were documented in children younger than 1 year, according to a studypublished online October 20 in Pediatrics.
The number of incidents translates into a medication error occurring in children every 8 minutes, report Maxwell D. Smith, from the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.
Nearly 82% of the medication errors identified in the analysis of data from the National Poison Database System involved liquid formulations, whereas 14.9% involved tablets, capsules, and caplets, the authors note.
The most common medication errors involved analgesics, accounting for 25.2% of the episodes, followed by cough and cold medications in 24.6% of the cases, they write. However, they note that the number and rate of errors involving cough and cold medications decreased significantly from 2005 through 2012.
The most common explanation for medication errors was medication being inadvertently given twice (27.0%), followed by incorrect dosing (17.8%), confused units of measure (8.2%), and wrong medication (7.8%).
Most of the exposures were managed on-site at a nonhealthcare facility and did not result in serious medical outcomes, the authors report. Serious medical outcomes resulting from the medication errors occurred in 0.7% of the cases, including 25 deaths over the course of the study period. “The number of exposures with moderate or major medical outcomes or death decreased by 19.5% during the study period, from 497 cases in 2002 to 400 cases in 2012,” the authors write.
The medication errors follow a seasonal pattern, peaking during the winter months, the authors observe. “This is most likely attributable to the increased use of cough and cold preparations, analgesics, and other medications to treat viral illnesses among young children during that time of year.”
The reason for the significant increase in the rate of non–cough and cold medication errors during the study period could not be determined from the study data; “however, it may be associated with increasing use of analgesics and antihistamines among young children,” the authors hypothesize.
The increase in number and rate of medication errors with decreasing age “is of concern because the proportions of children who died or who were admitted to the [intensive care unit] were >2 times higher among children <1 year of age compared with older children,” the authors report. The reason for this pattern cannot be determined from the study data, “but it is likely multifactorial,” they write. “Older children are able to communicate better with caregivers, indicating whether they have already taken medication, and thereby avoiding taking medication twice.”
A larger proportion of medication errors associated with liquid formulations among children younger than 2 years of age was also observed. “These liquid medications may lead to medication errors not experienced with other formulations, such as confusing units of measure or an incorrect amount dispensed,” the authors suggest, adding that it is also possible parents may be more likely to call a primary care provider for medication errors involving a younger child than an older one.
On the basis of their findings, the authors call for increased efforts and the implementation of proven strategies to prevent medication errors among young children. “Priorities addressing medication errors include an educational campaign and the refining of dosing measures and instructions on medication packaging and labeling to reduce errors made by parents and child caregivers.”
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online October 20, 2014.Abstract