From the Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana'a City, Yemen.
Saba University School of Medicine, Dutch Caribbean, Netherlands.
Pediatr Emerg Care. 2024 Jan 1;40(1):58-67. doi: 10.1097/PEC.0000000000003108.
This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to identify common types of medication errors, implicated medications, risk factors, and evaluate the effectiveness of interventions in preventing these errors.
A systematic review analyzed 6 primary studies with sample sizes ranging from 96 to 5000 pediatric patients in P-EDs. The review followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included observational studies and randomized controlled trials involving patients aged 18 years and younger. Comprehensive searches in biomedical databases were conducted, and conflicts in record screening were resolved by a third reviewer using systematic review software.
Medication errors in P-EDs are prevalent, ranging from 10% to 15%, with dosing errors being the most common, accounting for 39% to 49% of reported errors. These errors primarily stem from inaccurate weight estimations or dosage miscalculations. Inadequate dosing frequency and documentation also contribute significantly to medication errors. Commonly implicated medications include acetaminophen, analgesics, corticosteroids, antibiotics, bronchodilators, and intravenous fluids. Most errors are categorized as insignificant/mild (51.7% to 94.5%) or moderate (47.5%). Risk factors associated with medication errors in P-EDs include less experienced physicians, severely ill patients, and weekend/specific-hour ordering. Human factors such as noncompliance with procedures and communication failures further contribute to medication errors. Interventions such as health information technology solutions like ParentLink and electronic medical alert systems, as well as structured ordering systems, have shown promise in reducing these errors, although their effectiveness varies.
Overall, this systematic review provides valuable insights into the complexity of medication errors in the P-ED, emphasizes the need for targeted interventions, and offers recommendations to enhance medication safety and reduce preventable errors in this critical health care setting.
本系统评价旨在调查儿科急诊部（P-ED）中药物错误的发生率、可预防程度和严重程度。还旨在确定常见的药物错误类型、涉及的药物、风险因素，并评估干预措施预防这些错误的效果。
系统评价分析了 6 项初级研究，这些研究的样本量范围为 96 至 5000 名 P-ED 中的儿科患者。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，纳入了涉及年龄在 18 岁及以下患者的观察性研究和随机对照试验。在生物医学数据库中进行了全面搜索，并使用系统评价软件由第三位评审员解决记录筛选中的冲突。
P-ED 中的药物错误普遍存在，发生率为 10%至 15%，其中剂量错误最为常见，占报告错误的 39%至 49%。这些错误主要源于不准确的体重估计或剂量计算错误。剂量频率不足和记录不充分也对药物错误有重大影响。常见的涉及药物包括对乙酰氨基酚、镇痛药、皮质类固醇、抗生素、支气管扩张剂和静脉输液。大多数错误被归类为无足轻重/轻度（51.7%至 94.5%）或中度（47.5%）。与 P-ED 中药物错误相关的风险因素包括经验较少的医生、重病患者和周末/特定时间的医嘱。人为因素，如不遵守程序和沟通失败，进一步导致药物错误。健康信息技术解决方案（如 ParentLink）和电子医疗警报系统等干预措施以及结构化医嘱系统已显示出降低这些错误的潜力，尽管其效果有所不同。
总体而言，本系统评价提供了儿科急诊部药物错误复杂性的有价值见解，强调了有针对性的干预措施的必要性，并为加强该关键医疗保健环境中的药物安全性和减少可预防的错误提供了建议。
