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Underreporting of medical errors affecting children is a significant problem, particularly among physicians

The majority of medical errors committed by physicians and nurses during the care of pediatric patients go unreported, according to a new study supported by the Agency for Healthcare Research and Quality (HS11590). Fewer than half of doctors and nurses surveyed completed incident reports on 80 percent or more of the errors that they committed, and about one-third reported less than 20 percent of their errors. Physicians and nurses were more likely to report serious errors and those that affected the patient as opposed to "close calls."

Virtually all respondents said they would likely report a 10-fold overdose of morphine leading to respiratory depression in a child. However, only 32 percent said they would report an event in which a supply of breast milk was inadvertently connected to an infant's central venous catheter but was discovered before any breast milk went into the catheter (a potentially fatal error).

No corrections can be made to reduce future errors (for example, making different types of connectors for breast milk supply and intravenous fluids) unless close calls are reported, explains James A. Taylor, M.D., of the University of Washington. Dr. Taylor and his colleagues analyzed responses to a survey by 140 randomly selected physicians and nurses at a large children's hospital about their use of incident reports to document medical errors and whether they would report certain hypothetical medical errors.

Overall, 35 percent of respondents had reported less than 20 percent of their perceived medical errors in the past year, and 33 percent had reported less than 40 percent of perceived errors committed by colleagues. Nurses were nearly three times as likely to report 80 percent or more of their own medical errors as physicians. Physicians and nurses commonly underreported errors due to uncertainty about what is considered an error (41 percent) and concerns about implicating others (37 percent). Respondents noted several changes that would lead to more error reporting. These ranged from education about which errors should be reported and regular feedback on reported errors to evidence of system changes because of error reports and an electronic format for reports.

Details are in "Use of incident reports by physicians and nurses to document medical errors in pediatric patients," by Dr. Taylor, Dena Brownstein, M.D., Dimitri A. Christakis, M.D., M.P.H., and others, in the September 2004 Pediatrics 114(3), pp. 729-735.

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