The incidence and nature of prescribing and medication administration errors in paediatric inpatients

OBJECTIVES: To determine the incidence and nature of prescribing and medication administration errors in paediatric inpatients. DESIGN: Prospective review of drug charts to identify prescribing errors and prospective observation of nurses preparing and administering drugs to identify medication administration errors. In addition, incident reports were collected for each ward studied. PARTICIPANTS: Paediatric patients admitted to hospitals and nurses administering medications to these patients. SETTING: 11 wards (prescribing errors) and 10 wards (medication administration errors) across five hospitals (one specialist children's teaching hospital, one nonteaching hospital and three teaching hospitals) in the London area (UK). MAIN OUTCOME MEASURES: Number, types and incidence of prescribing and medication administration errors, using practitioner-based definitions. RESULTS: 391 prescribing errors were identified, giving an overall prescribing error rate of 13.2% of medication orders (95% CI 12.0 to 14.5). There was great variation in prescribing error rates between wards. Incomplete prescriptions were the most common type of prescribing error, and dosing errors the third most common. 429 medication administration errors were identified; giving an overall incidence of 19.1% (95% CI 17.5% to 20.7%) erroneous administrations. Errors in drug preparation were the most common, followed by incorrect rates of intravenous administration. CONCLUSIONS: Prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group. The causes and extent of these errors need to be explored locally and improvement strategies pursued.