Take action to improve pediatric ED medication safety

The pediatric population is at high risk for medication errors in the emergency department (ED), with medication error rates three times higher in pediatric patients than in adult patients, according to a study in Annals of Emergency Medicine.

For this reason, the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine convened a multidisciplinary panel to identify areas of improvement for pediatric medication safety.

Medical errors are a leading cause of morbidity and mortality in the United States and medication errors are the most common type of error related to hospitalization. Medication errors in particular are common in this setting because the ED often sees medically complex patients who are on a number of medications and are relatively unknown to the ED staff.

This type of error can also be attributed to a lack of standard pediatric dosing and formulations, the frequency of verbal orders given in the ED, the fact that the ED is often hectic, and a lack of clinical pharmacists on the ED team. Matters are further complicated by the fact that many pediatric patients are treated in community hospitals that see fewer young patients rather than pediatric hospitals that specialize in this patient population, according to Annals of Emergency Medicine.

The multidisciplinary panel identified the following areas for improvement that may help reduce instances of pediatric prescribing errors in the ED:

• Developing medication dosage guidelines, formulas, labeling, and administration
• Employing dedicated ED pharmacists to monitor adverse drug events and provide medication information
• Providing dedicated pediatric medication safety education
• Using computerized physician order entry to aid in the calculation of medication calculations

Areas of improvement specific to pediatric medication administration include the following:

• Employing pharmacists and ED care providers working effectively as a team, and having policies to guide medication use
• Providing medication reference materials
• Standardizing the concentrations available for a given drug
• Using automated dispensing cabinets
• Using barcoded medication administration
• Using premixed intravenous preparations

Decreasing pediatric medication errors in the home can often start at the facility level. Staff must learn to recognize patients and families with language barriers or health literacy concerns to provide appropriate resources and education that can help reduce medication errors at home. Counseling patients and families can be instrumental in decreasing pediatric medication errors at home.