Enhancing Safe Medication Use for Pediatric Patients in the Emergency Department

Abstract

INTRODUCTION

A Canadian study assessing the incidence of medication errors in a pediatric emergency department found prescribing errors in 10.1% of charts reviewed and administration errors in 3.9%.1 The authors cited earlier work by others indicating that preventable errors are significantly more common in the emergency department than in other hospital departments.2,3 This heightened risk in the emergency department is thought to result from the need for medications to be given urgently, which means that many drugs are kept in ward stock. In addition, there is generally no pharmacist review of medication orders originating in the emergency department; patients seen in the emergency department may have only a brief, focused encounter with the physician and nurse before medications are ordered and given; a complete medical and drug history may not be available; physicians and nurses are often caring for several patients at the same time in an environment where interruptions are common; and use of high-alert drugs is common.1,4,5 The authors suggested that of the approximately 50 000 children seen annually in their emergency department, 5000 may be subjected to a medication error, and half of these errors might be clinically significant. Adding to these identified risks for emergency departments in pediatric specialty hospitals is the fact that many Canadian hospitals provide care to pediatric patients alongside adults in the emergency department, which greatly increases the risk of harm associated with an “incorrect patient” error. This risk of harm is compounded when a high-alert medication is involved, as is illustrated by the following case, in which an infant inadvertently received a dose of hydromorphone intended for an adult patient. This incident was highlighted in a recent ISMP Canada Safety Bulletin.6 The current article describes findings from an analysis of the incident and suggests opportunities for pharmacist intervention in the emergency department to reduce the likelihood of medication errors.