Study: 10% of children get wrong dosages in the ED

Ten percent of children treated in the emergency department (ED) may get the wrong dose of medicine or be administered medication at the incorrect frequency, according to a new study.

The highest risk was for children seen between 4 a.m. and 8 a.m., children with severe disease, and kids seen on weekends. Children in those groups were between 1.5 and 2.5 times more likely to experience a medication prescribing error, according to the study led by Eran Kozer, MD, at the Hospital for Sick Children in Toronto. Errors also were more likely when a medical resident or intern had ordered the medication (Pediatrics 2002; 110:737-742).

Kozer and colleagues report that between 44,000 and 98,000 people die each year in the United States as a result of medical errors. And prescribing errors, they note, occur most frequently in pediatric and EDs. The researchers evaluated medical records for 1,532 children treated in the ED of a pediatric hospital.

Two pediatricians independently decided whether a medication error had occurred and gave errors a numerical severity score.

Prescribing errors were identified in 10.1% of the charts. The most common types of prescribing errors were dosing errors, followed by drugs given with incorrect frequency. Kids seen between 4 a.m. and 8 a.m., and kids with severe disease were roughly 2.5 times more likely to have a prescribing error, the authors report. Those who went to the ED on a weekend were nearly 1.5 times likely to have a prescribing error.

Another study indicates that physicians sometimes make mistakes when noting the physical form a prescription medication should take — such as a tablet, liquid, or cream. However, these types of errors, known as dosage form errors, occur relatively often for hospitalized patients, and the rate at which they take place appears to have increased during the past five years (J Gen Int Med 2002; 17:579-587).

Inside the study

The results are based on a review of dosage form errors at one hospital during that five-year period. Timothy S. Lesar, MD, of the Albany Medical Center in Albany, NY, was the lead author of a study that found the rate of these errors increased from slightly higher than 0.6 for each 100 patients in 1996 to 1.3 per 100 patients in 2000. The findings are based on a review of all prescription errors stemming from mistakes in how the medication should be given.

During the study period at the 631-bed hospital, a total of 1,115 errors involving dosage form took place, 52 of which were considered to be potentially fatal or have serious effects. The most common types of errors involved those in which the prescriber did not specify that the drug needed to be given to the patient in a controlled release form, which ensures that the medication will exert its effects in the body over a protracted period.

Three of the instances of medication order errors, if not corrected, were considered to be potentially fatal or severe, while another 49 errors were classified as serious. More than half of the errors involved cardiovascular drugs.