Data Norms in Child Health

A retrospective study of 79,000 ED encounters at a children’s hospital and two general hospitals. The intent of the study was to characterize the frequency of weight errors and to determine of the children’s hospital was any better at correcting errors than the general hospitals. The findings were that weight errors were uncommon (0.63% of all weights, as defined by the weight being a new extreme value on the growth chart) in the 3 EDs, but they led to identifiable weight-based medication-dosing errors with the potential to cause harm. The rates of error where similar across hospitals, and it looked like the children’s hospital was slightly better at intercepting errors once they were committed. Common weight errors included the weight in pounds being substituted for the weight in kilograms and decimal placement errors.

Hirata 2017 (Link) | PubMed 28976456 | Author Search

A study of pediatric inpatient safety reports. From the abstract: “From 6643 medication-related safety reports, 252 10-fold medication errors were identified at a mean reporting rate of 0.062 per 100 total patient days. Morphine was the most frequently reported medication, and opioids were the most frequently reported drug class. Twenty-two reports described patient harm. Intravenous formulations, paper ordering, and drug-delivery pumps were frequent error enablers. Errors of dose calculation, documentation of decimal points, and confusion with zeroes were frequent contributing causes to 10-fold medication error.”

[su_cite_pediatrics url_fragment = ‘129/5/916’ author = ‘Doherty’ year = ‘2012’] | PubMed 22473367 | Author Search