Introduction

One of the biggest hurdles to overcoming medication errors in children is that most healthcare providers are unaware of the magnitude of the problem. In most hospitals, the paediatric ward and ED generate the most medication errors. Accurate drug dose calculation and delivery in children can be challenging at the best of times, but in the stressful circumstances of a paediatric emergency or resuscitation it is even more difficult and susceptible to error. There is mounting evidence that mistakes in the process of medication prescription and administration are more common in adults than in children, and have a higher potential for harm than was previously realized. It is for this reason that it is useful for any doctor who is involved in the emergency management of children to have a knowledge of the nature of medication errors that occur in the ED, in order to develop a strategy to eliminate (or at least minimize) potential resultant harm to the patient. Merely encouraging ED staff (doctors and nurses) to be attentive to detail when dealing with medications is often fruitless, and disciplinary action against those making errors, when detected, is counter-productive. It requires a system designed to reduce medication-related harm to create a ‘culture of safety’ for paediatric patients in the ED.

Potential sources of medication errors

Doctors and nursing staff members who are not experienced in paediatric emergency medicine or the management of paediatric emergencies are especially at risk of making medication-related errors (see Table 2.1 for a breakdown of the types of errors that may lead to incorrect administration of a medication). Studies have shown that 10% to 15% of paediatric medication orders are erroneous, and that nearly one third of medication errors lead to harm in children. The potential for harm is higher in smaller children and infants and in the critically ill or injured, possibly because of the administration of multiple medications, limited time to double-check doses and altered pharmacokinetics and pharmacodynamics resulting from the physiological insults.

Table 2.1 Types of error that may be incurred in the administration of medications