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Emergency Medicine

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Rural emergency departments have a high rate of medication errors with the potential to harm children

Over half (51 percent) of medications were prescribed in error to children treated at four rural California emergency departments (EDs), according to this study. Although 16 percent of these errors had the potential to cause harm, none of them caused significant harm. These errors are a concern, especially given that one in four children receives ED care in the United States each year. Prescribing medicine for children involves calculating the proper dose based on the child's weight. These calculations are a potential source of error, especially in the critical and fast-paced ED environment, notes James P. Marcin, M.D., M.P.H., of the University of California-Davis.

Dr. Marcin and colleagues examined medication errors made between January 2000 and June 2003 among critically ill children treated in four northern California rural EDs. Physician-related medication errors were defined as those involving the wrong dose, wrong or inappropriate medication for the condition, wrong route, or wrong dosage form.

Among the 177 children for whom complete data were available, a total of 84 medication errors were identified among 69 patients, resulting in a medication error rate of 39 percent. Also, 24 physician-related medication errors were identified among 21 patients, resulting in a physician-related medication error rate of 11.9 percent. Overall, half of the medications prescribed for children had errors. Some of these medication errors might be prevented by use of an ED pharmacist, computerized order entry systems with automated drug alerts, use of the Broselow tape (which estimates a child's weight based on height), preprinted medication order sheets, and telemedicine or telepharmacy.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13179).

See "Medication errors among acutely ill and injured children treated in rural emergency departments," by Dr. Marcin, Madan Dharmar, M.B.B.S., Meyng Cho, Pharm.D., and others, in the October 2007 Annals of Emergency Medicine 50(4), pp. 361-367.

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