Variables Associated With Medication Errors in Pediatric Emergency Medicine

OBJECTIVE: Medication errors are a common cause of iatrogenic morbidity and mortality. The incidence of medication errors in pediatric emergency departments (EDs) has not been described. The objective of this study was to describe the incidence and type of drug errors in a pediatric ED and determine factors associated with risk of errors. METHODS: A retrospective cohort study was conducted of the charts of 1532 children who were treated in the ED of a pediatric tertiary care hospital during 12 randomly selected days from the summer of 2000. Two pediatricians, blinded to other study variables, independently decided whether a medication error occurred and ranked it according to a severity score. Disagreement was resolved by consensus. RESULTS: Prescribing errors were identified in 10.1% of the charts. The following variables were associated in univariate analysis with an increased proportion of errors: patients seen between 4 AM and 8 AM (odds ratio OR: 2.45; 95% confidence interval CI: 1.10-5.50), patients with severe disease (OR: 2.53; 95% CI: 1.18-5.41), medication ordered by a trainee (OR: 1.48; 95% CI: 1.03-2.11), and patients seen during weekends (OR: 1.48; 95% CI: 1.04-2.11). Among trainees, there was a higher rate of errors at the beginning of the academic year (OR: 1.67; 95% CI: 1.06-2.64). Logistic regression revealed increased risk for errors when a medication was ordered by a trainee (OR: 1.64; 95% CI: 1.06-2.52) and in seriously ill patients (OR: 1.55; 95% CI: 1.06-2.26). CONCLUSIONS: In the pediatric ED, trainees are more likely to commit prescribing errors, and the most seriously ill patients are more likely to be subjected to prescribing errors.