Children given wrong drug doses

Children given wrong drug doses Hospital doctors make mistakes in more than one in 10 prescriptions they write for children according to a new study


Sarah Boseley The Guardian, Tuesday 19 January 2010 Article historyHospital doctors make mistakes in more than one in 10 prescriptions they write for children, far more than was previously thought, according to an authoritative study published today.

Errors were made in 13.2% of prescriptions written for children, according to the study covering five London hospitals and carried out by the School of Pharmacy, University of London. Even more mistakes were made by nurses who had to administer drugs, a task often entailing mixing up a solution to be injected. The study found that almost one in five drugs (19.1%) were wrongly administered.

Most of the mistakes were picked up by pharmacists who cross-checked the prescriptions, and most of the errors that did get through led to no long-term harm, though some could have been lethal.

Ian Wong, a professor and one of the authors of the study, reported in Archives of Disease in Childhood, said one child was prescribed a dose of anti-convulsants, for epilepsy, that was 10 times higher than it should have been.

Wong said of the incident: "It was over the weekend so the pharmacist wasn't around and nobody checked the prescription. On the Monday the pharmacist noticed straight away and stopped the treatment." Fortunately, the child had received only one dose.

The biggest problem in prescribing is that drugs used in hospitals have never been tested on children. They are not licensed for that use and are not in doses appropriate for children. Doctors are required to make a calculation for the dose based on the weight of each child.

Often the doctors on the children's wards are juniors, who could have just completed time on an adult medical ward or even surgical ward. "Sometimes they write exactly the same dose as they would in adults," said Wong, who added that doctors on their first day in a paediatric ward were permitted to write a prescription for a child.

The high rate of administration errors had much to do with drugs being far more often for injection to children rather than administered in tablet form, he said.

"All these things take a lot of time to do and you need to do the calculation absolutely right," said Wong.

He and his colleagues recommend that pharmacists should make up the injections, leaving nurses more time to care for patients. The study found that errors occurred in the prescription of many different drugs, but the biggest problems seemed to be with painkillers and anti-epileptics. The report noted another child who had a lucky escape when a prescription for morphine that was four times too high a dose was spotted in time.

Researchers visited and observed 11 paediatric wards. On some occasions they intervened on the wards to stop children being given the wrong dose.

That factor made the study more accurate than other surveys that relied on reports of errors after the event, said Wong.

The only two previous observational studies were much smaller and estimated prescribing errors at between 1.2% and 5.1%. During the study period pharmacists reviewed almost 3,000 prescriptions intended for 444 children.

In all 391 prescribing errors were made, giving an overall rate of 13.2% (one in eight), and ranging from 5% to 31.5%, depending on the ward. Incomplete prescriptions were the most common mistakes, followed by dosing errors.

The authors recommend that electronic prescribing systems be widely introduced. Computers can be used to check calculations and alert doctors to possible errors, although the authors point out that they are not foolproof and that paediatric systems are not yet readily available. In the meantime doctors should be vigilant when writing prescriptions, they said.
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article appeared on p8 of the UK news section of the Guardian on Tuesday 19 January 2010. It was published on guardian.co.uk at 00.05 GMT on Tuesday 19 January 2010.

http://www.guardian.co.uk/society/2010/jan/19/children-given-wrong-prescriptions-hospital