title: Prescribing errors in adult congenital heart disease patients admitted to a pediatric cardiovascular intensive care unit.
abstract: BACKGROUND
  Adults with congenital heart disease (CHD) are often cared for at pediatric hospitals. There are no data describing the incidence or type of medication prescribing errors in adult patients admitted to a pediatric cardiovascular intensive care unit (CVICU).
  
  
  METHODS
  A review of patients >18 years of age admitted to the pediatric CVICU at our institution from 2009 to 2011 occurred. A comparator group <18 years of age but >70 kg (a typical adult weight) was identified. Medication prescribing errors were determined according to a commonly used adult drug reference. An independent panel consisting of a physician specializing in the care of adult CHD patients, a nurse, and a pharmacist evaluated all errors. Medication prescribing orders were classified as appropriate, underdose, overdose, or nonstandard (dosing per weight instead of standard adult dosing), and severity of error was classified.
  
  
  RESULTS
  Eighty-five adult (74 patients) and 33 pediatric admissions (32 patients) met study criteria (mean age 27.5 ± 9.4 years, 53% male vs. 14.9 ± 1.8 years, 63% male). A cardiothoracic surgical procedure occurred in 81.4% of admissions. Adult admissions weighed less than pediatric admissions (72.8 ± 22.4 kg vs. 85.6 ± 14.9 kg, P < .01) but hospital length of stay was similar. (Adult 6 days [range 1-216 days]; pediatric 5 days [Range 2-123 days], P = .52.) A total of 112 prescribing errors were identified and they occurred less often in adults (42.4% of admissions vs. 66.7% of admissions, P = .02). Adults had a lower mean number of errors (0.7 errors per adult admission vs. 1.7 errors per pediatric admission, P < .01). Prescribing errors occurred most commonly with antimicrobials (n = 27). Underdosing was the most common category of prescribing error. Most prescribing errors were determined to have not caused harm to the patient.
  
  
  CONCLUSIONS
  Prescribing errors occur frequently in adult patients admitted to a pediatric CVICU but occur more often in pediatric patients of adult weight.
authors.affiliation: Department of Pharmacy, Texas Children's Hospital, Houston, Tex, USA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Echeta
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Paul
authors.initials: P
authors.lastname: Checchia
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Benton
authors.forename: Leda
authors.initials: L
authors.lastname: Klouda
authors.forename: Fred H
authors.initials: FH
authors.lastname: Rodriguez
authors.forename: Wayne
authors.initials: W
authors.lastname: Franklin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001835:Body Weight; D054796:Drug Dosage Calculations; D062787:Drug Overdose / Q000209:etiology* / Q000517:prevention & control; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D015278:Intensive Care Units, Pediatric; D008297:Male; D010343:Patient Admission; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D055815:Young Adult
keywords: Adult Congenital Heart Disease; Intensive Care; Medication Errors