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Medication Improvements Sought for Children Treated at ‘High-Risk’ EDs

Citing emergency care as high risk for children, a multidisciplinary panel estimates that the medication error rate in pediatric patients is three times the rate for adult patients in the emergency department (ED).

That’s according to a report published in Pediatrics advocating improvements in prescribing for children who present to EDs. To discuss those challenges, a multidisciplinary expert panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics (AAP) via its Committee on Pediatric Emergency Medicine. The panel consisted of emergency care providers, nurses, pharmacists, representatives from the electronic health record industry, patient safety organization leaders, hospital accreditation organization representatives, and parents of children who suffered adverse drug events (ADEs).

In the report, the panel listed the reasons it considers pediatric emergency care so risky for medication errors in children, including the factor that EDs treat medically complex patients who have multiple medications and who are unknown to staff.

Drug dispensation and prescribing also raised concerns; the panel found that many EDs lack standard pediatric drug dosing and formulations, struggle with weight-based dosing, and depend too much on spoken orders. In addition, few ED care teams include clinical pharmacists, the report notes.

Other issues include the hectic environment with frequent interruptions — with many inpatients being “boarded” while awaiting admission — and the use of information technology systems that lack pediatric safety features. Experiencing multiple transitions in care also was cited as a risk.

“In addition, the vast majority of pediatric patients seeking care in EDs are not seen in pediatric hospitals but rather in community hospitals, which may treat a low number of pediatric patients,” study authors point out.

In light of their concerns, panel members came up with a list of recommendations to improve ED medication safety, including:

  • using kilogram-only weight-based dosing.
  • optimizing computerized physician order entry by using clinical decision support.
  • developing a standard formulary for pediatric patients while limiting variability of medication concentrations.
  • using pharmacist support within EDs.
  • enhancing training of medical professionals.
  • systematizing the dispensing and administration of medications within the ED.
  • addressing challenges for home medication administration before discharge.

Noting that medication errors and ADEs often are preventable, panel members concluded that “strategies to improve medication safety are an essential component of an overall approach to providing quality care to children.”