title: Preventable errors with nonopioid analgesics and antiemetic drugs may increase burden in surgical pediatric patients.
abstract: BACKGROUND
  Many hospitalized patients are affected by medication errors (MEs) that may cause discomfort, harm, and even death. Especially, children are considered to be at high risk of experiencing harm due to MEs. More insight into the prevalence, type, and severity of harm caused by MEs could help reduce the frequency of these harmful events. The primary objectives of our study were to establish the prevalence of different types of MEs and the severity of harm caused by MEs in hospitalized children from birth to 18 years of age. In addition, we investigated correlations between harmful MEs and characteristics of the collected data from 426 hospitalized children admitted, and the medication process.
  
  
  METHODS
  In this cross-sectional study, we identified MEs by reviewing clinical records, making direct observations, monitoring pharmacy logs, and reviewing voluntary incident reports. Subsequently, the MEs were classified according to type of error, medication group and stage of the medication process. Pediatricians rated the severity of the observed harm.
  
  
  RESULTS
  We collected data from 426 hospitalized children admitted during August to October 2011. A total of 322 MEs were identified, of which 39 caused patient harm. Harmful events were mainly because of wrong time (41%). Pediatricians rated the observed harm as minor in 77% of the incidents and significant in 23%. None of the harmful MEs resulted in permanent harm or was considered life-threatening or fatal. Patients admitted for a surgical procedure were at higher risk for a harmful event compared with patients admitted for nonsurgical reasons (adjusted odds ratio 2.79, 95% confidence interval; 1.35-5.80). Nonopioid analgesics and antiemetic drugs accounted for 67% of the harmful MEs. Harmful MEs occurred most frequently during medication prescription (28%) and administration (62%).
  
  
  CONCLUSIONS
  Surgical pediatric patients seem to be at high risk for harmful MEs. Although the harm was considered minor in most cases, it still caused discomfort for the patients, and the high prevalence is a source of concern. Interventions to prevent the MEs should focus on the prescription and administration of nonopioid analgesics and antiemetic drugs.
authors: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Jolanda
authors: J
authors: Maaskant
authors: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Diederik
authors: D
authors: Bosman
authors: Department of Clinical Pharmacy, Academic Medical Center, Amsterdam, The Netherlands.
authors: Petra
authors: P
authors: van Rijn-Bikker
authors: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Wim
authors: W
authors: van Aalderen
authors: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands.
authors: Hester
authors: H
authors: Vermeulen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative
chemical_list: D018712:Analgesics, Non-Narcotic; D000932:Antiemetics