Country kids at risk for drug errors in the ER

NEW YORK (Reuters Health) - A study conducted in northern California hints that medication errors are common among acutely ill and injured children treated in rural emergency departments. These medication errors can be associated with significant illness and even death.

This study demonstrates that acutely ill and injured children receiving care in rural emergency departments are at "very high risk of experiencing a medication error," Dr. James P. Marcin, of the University of California, Davis, told Reuters Health.

"Rural emergency department are less experienced in treating critically ill children and have fewer resources, less training, and less expertise than larger children's hospitals," the researcher added. And many rural hospitals do not have a pharmacist available at all hours.

Marcin and colleagues studied medication errors among acutely ill and injured children receiving care in four northern California rural emergency departments.

Examples of medication errors include giving the wrong dose, wrong medication for the condition, wrong route of administration, or wrong dosage form. Depending on the class of medication, doses above or below 10 to 25 percent of the correct dose were considered errors.

The investigators identified a total of 84 medication errors among 69 of 177 children younger than age 17 who were included in analyses. This resulted in a medication error incidence of 39 percent.

There were 24 doctor-related medication errors among 21 patients, for a physician-related medication error incidence of 12 percent. Among the 69 patients with medication errors, 11 had errors that were categorized as having the potential to cause harm, and 58 had errors categorized as causing no harm.

"There needs to be a 'systems-based' solution, such as systems that standardize medication dosing for different age-weight children, telemedicine, which provides access to specialists that are not otherwise available, or computerized medication delivery systems so that these error rates can be reduced," Marcin said.

SOURCE: Annals of Emergency Medicine, October 2007.