pediatrics

INTRODUCTION

Many hospitals in Canada focus on caring for adults, yet also provide care for pediatric patients (neonates, infants, children, and adolescents). Pediatric patients tend to constitute a small proportion of patients in these hospitals. The relatively low number of pediatric patients often means limited availability of resources such as specialized staff, on-site pediatric-focused education, and staff dedicated to strategies for reducing pediatric medication errors. At the author’s hospital, the pediatric population represents about 7% of patients and 1% or 2% of medication orders. Scrutinizing these orders appropriately is difficult when they are interspersed with adult orders.

Differences in age, weight, clinical condition, and organ function within the pediatric population result in significant differences in required doses. Dosing errors represent the most common medication incidents for pediatric patients, and 10-fold dosing errors (either 10 times or 1/10th the correct dose), are commonly report- ed. Such errors may be even more extreme, as in the case of a 1000-fold dosing error that occurred at the author’s hospital. In that case, a prescription for morphine 10 mg (milligrams) to be given orally every 3 h, a common adult order, was processed without question and appeared on the medication administration record for a neonate. However, the order was supposed to be 10 pg (micrograms) to be given orally every 3 h, which was a weaning dose for a neonate who had been exposed to narcotics in utero. The medication error was detected by nursing staff just before the drug was administered. This example highlighted the requirement that pharmacists be able to differentiate orders for pediatric patients, to ensure appropriate dose-checking.
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At the author’s hospital, which has 16 beds for general pediatrics and 18 beds for neonatal intensive care, all medication orders are received in the pharmacy by fax transmission. The current computer system does not offer dose validation functions or alert the pharmacist to pediatric orders. Inability to readily identify pediatric orders and to note the weight and age of pediatric patients was contributing to dosing errors. In 2006, 20 medication errors involving pharmacy were reported for pediatric inpatients. The types of errors frequently identified and not reported on incident reports included incorrect instructions for reconstitution of drugs, as well as situations in which the dose and suggested volume did not match the reconstitution instructions. Because reconstitution instructions differ for neonatal, pediatric, and adult patients, this type of error could lead to significant overdoses. Although not captured on incident reports, these errors have the potential to cause harm and were being reported verbally by nursing staff to pharmacy staff up to 10 times a day. The frequency of these errors and a couple of potentially fatal near-misses led to a recognition that a method of highlighting pediatric orders was urgently needed.

To increase pharmacists’ ability to immediately identify pediatric orders, a trial of a dedicated fax machine for pediatric orders was proposed. The objective of the study reported here was to determine if the dedicated fax machine actually increased pharmacists’ scrutiny of pediatric orders. canadian pharmacy viagra