Posted: October 27th, 2023

Pediatric Medication Safety in the Emergency Department

Pediatric Medication Safety in the Emergency Department

Pediatric patients who receive emergency care are at high risk of medication errors for various reasons, such as weight-based dosing, lack of standardized concentrations, and time pressure. Medication errors can lead to adverse drug events (ADEs), which are harmful and potentially life-threatening outcomes of drug therapy. ADEs can result in increased morbidity, mortality, length of stay, and health care costs. Therefore, it is essential to implement strategies to improve medication safety in the emergency department (ED) setting.

Some of the best practices to reduce medication errors and ADEs in pediatric EDs include:

– Using kilogram-only weight-based dosing: This eliminates the need for conversions between different units of measurement and reduces the risk of calculation errors. The patient’s weight should be measured and documented in kilograms at the time of ED arrival and verified before each medication order.
– Optimizing computerized physician order entry (CPOE) by using clinical decision support (CDS): CPOE systems can help prevent errors by providing alerts, reminders, and guidance for medication ordering, dosing, and administration. CDS tools can also provide evidence-based recommendations, drug information, and dosing calculators. However, CPOE and CDS systems should be designed and implemented carefully to avoid alert fatigue, workarounds, and unintended consequences.
– Developing a standard formulary for pediatric patients while limiting variability of medication concentrations: A standard formulary can help reduce the complexity and variability of medication choices and ensure the availability of appropriate formulations and doses for pediatric patients. The number of different concentrations of the same medication should be minimized to avoid confusion and errors. Ideally, only one concentration of each high-risk medication should be available in the ED.
– Using pharmacist support within EDs: Pharmacists can play a vital role in improving medication safety by reviewing medication orders, verifying doses, providing drug information, preparing and dispensing medications, monitoring for adverse effects, and educating patients and caregivers. Pharmacists can also participate in quality improvement initiatives, policy development, and staff training related to medication safety.
– Enhancing training of medical professionals: Medical professionals who work in pediatric EDs should receive adequate education and training on pediatric pharmacology, dosing, administration, and monitoring. They should also be familiar with the common sources and types of medication errors and ADEs in pediatric EDs and how to prevent, detect, and manage them. Simulation-based training, feedback, and competency assessment can help improve knowledge and skills related to medication safety.
– Systematizing the dispensing and administration of medications within the ED: Medication dispensing and administration processes should be standardized and streamlined to reduce errors and delays. Medications should be labeled clearly and accurately with the patient’s name, drug name, dose, route, frequency, and expiration date. Medications should be stored securely and organized by drug class or indication. Barcode scanning, smart pumps, automated dispensing cabinets, and other technologies can help ensure the correct medication is given to the correct patient at the correct time.
– Addressing challenges for home medication administration before discharge: Before discharging pediatric patients from the ED, medical professionals should provide clear and concise instructions on how to administer medications at home. They should also counsel patients and caregivers on the indications, benefits, risks, side effects, interactions, and storage of medications. They should use teach-back methods to verify understanding and provide written materials or other aids as needed. They should also encourage patients and caregivers to ask questions and seek help if they encounter any problems or concerns.

By following these best practices, pediatric EDs can improve medication safety and reduce the occurrence and impact of ADEs among their patients. Medication safety is a shared responsibility that requires collaboration among medical professionals, patients, caregivers, health care organizations, regulators, researchers, and other stakeholders.

Works Cited

American Academy of Pediatrics et al. “Pediatric Medication Safety in the Emergency Department.” Pediatrics 141.3 (2018): e20174066. https://doi.org/10.1542/peds.2017-4066

Centers for Disease Control and Prevention. “Adverse Drug Events in Children.” https://www.cdc.gov/medicationsafety/parents_childrenadversedrugevents.html

Hohenhaus SM et al. “Pediatric medication safety in the emergency department.” Journal of Emergency Nursing 34.4 (2008): 308-313. https://doi.org/10.1016/j.jen.2007.06.019