Children: Reducing risk
Reports of medication errors are more common in infants and children. In general, the same types of medication errors occur as in adults such as the wrong doses or frequencies being used, doses being missed etc. However, the consequences of such errors are likely to be more severe. Factors that contribute to medication errors are numerous but the panel below highlights some of the more common pitfalls.Common reasons for medication errors in children
- Incorrect use of information resources (e.g. doses described in terms of total daily dose [t.d.d] being prescribed three times a day)
- Lack of familiarity with drug (e.g. in hospitals, errors are more likely to occur in clinical areas where children are treated alongside adults such as in emergency departments or theatres)
- Use of unlicensed/'off-label' drugs due to lack of clinical information/experience
- Lack of licensed paediatric dose units and/or the need to use adult formulations
- Complex calculations and dilutions
- Displacement volumes
- Extemporaneous preparation of oral liquids
To try to reduce the risk associated with different concentrations of medicines being available, and patients unknowingly being switched between different strengths resulting in under- or overdosing, the NPPG and RCPCH recommend use of a standard concentration oral liquid, where one exists. The BNF for Children includes this information in the relevant drug monographs in the ‘Prescribing and dispensing information’ section.
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It goes without saying that correct calculations are vital. Clues that would normally point to you having made an error in an adult, such as needing multiple injection ampoules, are not always present when prescribing or administering medicines for children. In a child it is quite possible to obtain a dose that is ten times too high from a single ampoule or tablet which has been marketed for adult use. You may like to refresh your calculation skills here.