title: Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients.
abstract: OBJECTIVE
  Medication errors in pediatric inpatients occur at similar rates as in adults but have 3 times the potential to cause harm. Error prevention strategies in this setting remain largely untested. The objective of this study was to classify the major types of medication errors in pediatric inpatients and to determine which strategies might most effectively prevent them.
  
  
  METHODS
  A prospective cohort study was conducted of 1020 patients who were admitted to 2 academic medical centers during a 6-week period in April and May 1999. Medication errors were characterized by subtype. Physician raters evaluated error prevention strategies and identified those that might be most effective in preventing errors.
  
  
  RESULTS
  Of 10 778 medication orders reviewed, 616 contained errors. Of these, 120 (19.5%) were classified as potentially harmful, including 115 potential adverse drug events (18.7%) and 5 preventable adverse drug events (0.8%). Most errors occurred at the ordering stage (74%) and involved errors in dosing (28%), route (18%), or frequency (9%). Three interventions might have prevented most potentially harmful errors: 1) computerized physician order entry with clinical decision support systems (76%); 2) ward-based clinical pharmacists (81%); and 3) improved communication among physicians, nurses, and pharmacists (86%). Interrater reliability of error prevention strategy assignment was good (agreement: 0.92; kappa: 0.82).
  
  
  CONCLUSIONS
  Of the assessed interventions, computerized physician order entry with clinical decision support systems; ward-based clinical pharmacists; and improved communication among physicians, nurses, and pharmacists had the greatest potential to reduce medication errors in pediatric inpatients. Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed.
authors.affiliation: Department of Medicine, Quality Improvement, and Risk Management, Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Fortescue
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: McKenna
authors.forename: Margaret D
authors.initials: MD
authors.lastname: Clapp
authors.forename: Frank
authors.initials: F
authors.lastname: Federico
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D016303:Clinical Pharmacy Information Systems / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D000075202:Contraindications; D011307:Drug Prescriptions / Q000145:classification / Q000706:statistics & numerical data; D004360:Drug Therapy, Computer-Assisted / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008508:Medication Errors / Q000145:classification / Q000517:prevention & control* / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000145:classification; D010607:Pharmacy Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D012308:Risk Management / Q000145:classification / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D000078329:Workforce
chemical_list: D004364:Pharmaceutical Preparations