Assessment of Medication Dosing Errors in Pediatric Intensive Care Units: A Prospective Observational Study
DOI:
https://doi.org/10.64149/J.Ver.8.1s.364-372Keywords:
Medication Errors, Dosing Errors, Pediatric Intensive Care, Patient Safety, Polypharmacy, Cpoe, Clinical Pharmacist, Adverse Drug Events.Abstract
Background: Medication errors in pediatric intensive care units (PICUs) are a serious concern for patient safety, and dosing errors are the most common type of medication error, mainly because of weight-adjusted pharmacotherapy and polypharmacy practices. Although the level of awareness is increasing, the extent of dosing errors in PICUs has not been fully explored in the current scenario. Methods: This is a prospective observational study, and it was conducted for 18 months (January 2022 to June 2023) in three tertiary PICUs. Incidents of dosing errors were identified, grouped, and independently validated. Multivariate logistic regression analysis was employed to determine independent risk factors for the occurrence of errors. Results: In 487 patients (37,218 medication orders), 1,164 dosing errors were identified (31.3 errors per 100 prescriptions; 95% CI: 29.6-33.1). Overdosing (26.8%) and calculation errors (16.1%) were most frequent. Analgesics/sedatives and inotropes were the most error-prone drug classes. Independent risk factors were polypharmacy (≥10 medications/day) (aOR 5.14), absence of CPOE (aOR 4.01), weight < 5 kg (aOR 3.64), and absence of clinical pharmacist review (aOR 3.42). Patient-received errors were significantly linked to higher ICU mortality (20.4% vs. 11.3%; p=0.008) and longer ICU Conclusions: Medication dosing errors are frequent in PICUs and have significant implications for morbidity and mortality. There is an urgent need for multidisciplinary strategies such as the installation of CPOE systems, medication review by clinical pharmacists, and weight-based dosing calculators.
