Medication errors in paediatric patients : the role of the clinical pharmacist

Six electronic databases were searched and 153 studies which identified the number or the rate of paediatric medication errors were identified; mainly from the US. These studies were compared to identify factors responsible for the great variations seen in reported error rates (Chapter 2). The most important factors were the use of different denominators, different definitions of medication errors, and the use of different methods of data collection. To explore further the reasons for the wide ranges of error rate identified in Chapter 2, the studies that used the same denominators, methods, and error types were compared, yet showed a difference between the highest and lowest error rate of more than 50% (Chapter 3). Factors identified for the variation in error rates included differences in setting, drugs studied, participants, study design details and countries involved. To try to clarify the relationship between the method of data collection and results obtained (Chapter 3), the rates of specific types of medication errors reported by studies using different methods but the same denominator were compared. Conclusions were difficult to draw due to the heterogeneity of the current literature. Prescription errors are probably best studied using chart review and administration errors by direct observation. The relationship between the clarity of definitions and results was investigated in Chapter 3, in terms of how clearly the studies had defined errors and the degree to which the definition(s) used matched each study’s aim. Studies were too heterogeneous and unfortunately could not adequately be compared. Chapter 3 also explores the interventional tools reported. Of all studies, 59 used interventional tools and assessed their benefit. These included dosing supporting tools, electronic prescribing, education, health and safety strategies, clinical pharmacist services and pre-printed forms among others. Most studies reported that their interventions effectively reduced or prevented medication errors, despite in some cases not measuring errors before and after interventions and even in some studies where error rates increased. Chapter 3 also explores the UK studies. Very few studies occurred in the same setting and used both the same methodology and denominators to identify the rate of the same types of medication errors. It was difficult to draw firm conclusions but prescribing and administration errors seem to happen more often in paediatric units in general hospitals than in specialist children’s hospitals. Most studies were of prescribing errors with other types of error rarely studied in the UK. Four studies identified the time of day most associated with errors; three the time of day and days of the week most associated with errors; and one the days of the week most associated with errors (Chapter 3). However, given the diversity of definitions of times of day, shifts, and weekdays, it was impossible to draw conclusions regarding the temporal aspect of medication errors from these studies. A second systematic review was conducted to explore the current literature that examines the role of paediatric clinical pharmacists in reducing the rate of medication errors (Chapter 4). Twenty-five studies published until the end of July 2013 were identified that reported pharmacists’ activities in reducing or preventing medication errors. The most commonly intercepted types of errors were wrong dose, wrong drug and wrong route of administration. The most common types of pharmacists’ contributions were reactive information giving in response to other healthcare professionals’ queries, education of healthcare professionals and cost saving. Based on knowledge gained from the second systematic review, an observational study of the role of paediatric clinical pharmacists was conducted in two NHS Trusts in the UK (Chapter 5). By shadowing pharmacists, they were observed during their day-to-day work and their contributions to health care were documented, as well as the errors that they identified and addressed. Having ultimately shadowed 14 pharmacists over the course of 197 ward visits, clinical pharmacists were found to play an important role in improving the health care services provided to paediatric patients and are effective in averting different types of medication errors. Pharmacists intercepted errors in 8.4% of all prescriptions and the overall contribution rate of all prescriptions was 54.8%. The most common types of errors intercepted by pharmacists were omission errors (27.9%), wrong dose (24%) and illegible prescribing (19.2%). The most common types of contributions were annotating prescriptions with information (e.g. administration instructions) (19.2% of all prescriptions), drug history check (97% of all new patients) and allergy status checked (100% of all new patients). The acceptance rate of pharmacists’ recommendations by doctors was very high (99.5%).