Medication Errors in Children

Medication mistakes are caused by human error and are largely preventable. They can occur at any stage of the medication process, from selection and ordering of drugs, to transcribing the order, to formulating the drug and dispensing it, to its administration and monitoring. Though not always fatal or even injurious, medication errors kill as many as 98,000 hospitalized patients per year. When the victims are children, the fact that their deaths could have been prevented becomes even more heartbreaking.

Most pediatric drug errors result from incorrect dosing. At one Seattle children’s hospital, for example, overdosing caused the deaths of three children over a period of just a few years: a 12 year-old from a fatal dose of the painkiller Fentanyl, another 12 year-old from an overdose of codeine, and an 8 month-old from a fatal dose of calcium chloride.

Why Are Children More at Risk?

Adverse drug events (ADE’s), those medication errors which cause harm, occur 3 times more often in children than in adults. Children and adolescents are at greater risk of injury from medication mistakes because their organ systems are immature and vary in their ability to process drugs and excrete them. The kidneys, livers and immune systems of children and teenagers are still developing, so even the smallest increase in drug dosage can have serious consequences.

Medication error risks are often highest for those least able to overcome them: premature infants. Furthermore, because children are less able to communicate their feelings, it is sometimes difficult to diagnose their problems or to know when a symptom or complication due to a drug error has developed. In a recent study of 12 children’s hospitals across the United States, medication errors were detected in 11.1% of patients. Many of these mistakes were determined to be preventable.

Calculating the Right Dosage

Adult medications come in standardized prepackaged doses. Calculating the right dosage for a child involves mathematical skill and can be quite challenging. In the past, pediatricians calculated children’s dosages by determining a fraction of the adult dose. A more refined calculation method is based on the child’s weight or body surface area (height and weight).

Errors in computing percentages, fractions, ratios and decimals are distressingly common. Plus, children’s medications come in different formulations, such as drops, liquids and chewables, which increases the chance for dosing errors. Mistakes in pediatric dosage calculation could be reduced if medications were manufactured specifically for children, with standardized dosing instructions and clear labeling and packaging.

Further Prevention Strategies

Some medications, notably opioid painkillers, antibiotics and antifungals, seem to be more frequently associated with pediatric adverse drug events. A more effective system of monitoring children’s medication would focus on specific drugs, events and procedures that potentially trigger harm.

Experts also recommend the use of computerized physician order entry (CPOE) to avoid mistakes caused by illegible handwriting and misplaced decimal points. Currently, only about 10 percent of hospitals make use of computerized prescribing. The Journal of the American Medical Association (JAMA) reports that 94 percent of children’s medication errors could be prevented by staffing pediatric wards with clinical pharmacists. These professionals have the expertise to review medication orders for appropriateness and safety as well as incorrect doses. In addition, since nurses play the most significant role in administering medications, clinical pharmacists could assist them in calculating the correct dosages.

As the smallest and youngest victims of medication error, children are in need of the best protection we can offer. If your child has been injured due to medication error, the attorneys at the Orlow firm are available to provide knowledgeable and compassionate assistance.