title: Medication errors in pediatric emergencies: a systematic analysis.
abstract: BACKGROUND
  Errors in drug administration are among the commonest medical errors. Children are particularly at risk for such errors because of the need to calculate doses individually. Doses that are ten times the correct amount (1000% of the correct dose) are occasionally given and can be life-threatening. In a simulated resuscitation in a pediatric emergency room, an error of this type occurred for one of the 32 medications that were ordered. The highest error rates are to be expected in prehospital emergency medicine. In this review, we analyze the process of ordering medications and describe the potential interventions for lowering error rates that have been evaluated to date.
  
  
  METHODS
  Systematic literature review
  
  
  RESULTS
  We found 32 original publications that concerned the evaluation of interventions for lowering error rates in the ordering of medications for children. Error rates can be lowered by interventions that improve prescribers' knowledge of pediatric pharmacotherapy (courses, immediately accessible sources of information) and by aids to the cognitive process of ordering medication (calculators, computer programs, tables of doses by weight). They can also be lowered by raising awareness of the problem of erroneous medication ordering and by monitoring medication orders, as well as by structured communication and standardized, unambiguously labeled drug preparations. In the hospital setting, computer programs for medication orders with a built-in pediatric pharmacological database are highly recommended. In the prehospital setting, the "pediatric emergency ruler" enables accurate estimation of the patient's weight, provides age-appropriate dosage recommendations, and directly indicates the steps needed for calculation of the correct dose.
  
  
  CONCLUSIONS
  Children in medical emergency situations are at significant risk for medication errors. The measures described here can markedly lower the rate of dangerous errors.
authors.affiliation: Institute of Anesthesiology at Witten/Herdecke University, Department of Paediatric Anesthesia, Cologne Children's Hospital, Germany. kaufmannj@kliniken-koeln.de
authors.forename: Jost
authors.initials: J
authors.lastname: Kaufmann
authors.forename: Michael
authors.initials: M
authors.lastname: Laschat
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
mesh_terms: D000367:Age Factors; D001835:Body Weight; D002648:Child; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D004636:Emergency Service, Hospital; D005858:Germany; D006801:Humans; D008508:Medication Errors / Q000401:mortality / Q000517:prevention & control; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects; D058996:Quality Improvement; D012151:Resuscitation; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs