Pretoria teaching hospital rife with paediatric medication errors

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RANeonatalThe incidence of medication errors in the neonatal intensive care unit and paediatric wards at a Pretoria teaching hospital was higher than values reported elsewhere globally, with one in three resulting in ‘some level of harm’,  found a study published in the SA Journal of Child Health.

The Times.reports that pharmacists who spent 16 weeks in the four paediatric wards at Dr George Mukhari Academic Hospital in Ga-Rankuwa, outside Pretoria, detected 663 medication errors – an average of 2.9 per patient.

The biggest category of errors involved incorrect dosing, followed by omission of medication and medicine being given at the wrong time. A total of 106 errors were made in the hospital’s 55-bed neonatal intensive care unit.

In one in three patients the error resulted in “some level of harm”, said pharmacists who conducted the research, reported in the SA Journal of Child Health. But none suffered permanent harm or died.

Recommendations by lead researcher Archele Truter, from the pharmacy department at Sefako Makgatho Health Sciences University adjoining the hospital, include assigning a pharmacist to the paediatric wards, improving training for doctors and nurses and introducing a digital database of medication errors.

Truter and colleagues Natalie Schellack and Johanna Meyer had to intervene to prevent some errors during their observations.

“Examples.included the doctor being asked to change the high dose of 1g paracetamol prescribed for a two-year-old to the recommended 180mg and the nurse being stopped before administering 12 drops of tilidine to a one-year-old instead of two drops as prescribed.”

And Truter said because her team could not observe the wards around the clock – they worked for up to seven hours a day, five days a week – many errors probably went undetected.

The mistakes were equally split between prescribing doctors (47%) and administering nurses (51%). Only 2% were due to the pharmacy.

Anti-infective drugs – including antibiotics, antifungals and antivirals – accounted for 43% of errors and painkillers for 25%.

“The paediatric orthopaedic ward had the highest risk for medication errors. Reasons for this included the high number of analgesics prescribed for post-operative pain relief,” said Truter.

She said the error rate at George Mukhari was higher than that reported in similar studies elsewhere. Global research had found that the presence of clinical pharmacists in paediatric wards could cut the number of errors in half.

Abstract
Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied.

Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medication errors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) and paediatric wards.

Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients’medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered by the nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medication error checklist was used to collect the data.

Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients had one or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequent type of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of these medication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives(43%) and analgesics (25%) had the most errors.In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%)patients the medication error resulted in some level of harm.

Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reported elsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem in paediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventive measures among the multidisciplinary team.


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