1. Gois Paixao, Maria Jose MSc, SPQ (Pediatrics), RN

Article Content


Medication errors are one of the most frequent causes of adverse events in hospitalized patients. Children are considered to be at a higher risk of experiencing an adverse drug event. Evidence has shown that potentially harmful medication errors in children are 3 times higher than in adults.


The most used definition of medication error is from the US National Coordinating Council for Medication Error Reporting and Prevention as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient or consumer."1


Reasons for the vulnerability of medication errors in children are pharmacological factors such as age-based variability in absorption, metabolism and excretion of drugs, and risk of overdosing; the need for dose calculations based on constant changes of weight and surface area; and the need for frequent unit conversion to reflect the very small dose required.



The aim of this study is to determine the effectiveness of interventions aimed at reducing medication errors and related harm in hospitalized children.



This review included randomized controlled trials, interrupted time series studies, and controlled before-after studies incorporating 5 different interventions aimed to reduce medication errors, namely, the introduction of a pharmacist as part of the clinical team, a computerized physician order entry, a barcode administration system, a professionally medication oriented check and control checklist, and a preprinted order sheet.2


Participants were healthcare professionals who were authorized to prescribe, dispense, or administer medication and who were involved in the provision of hospital care to children up to 18 years old. The included settings were pediatric medical wards, pediatric intensive care units, neonatal intensive care units, and pediatric emergency departments.


The primary outcomes measured the occurrence of medication errors as proportions of participants, admission days, prescriptions and administrations, the occurrence of potentially harmful medication errors, and the reduction of potential harm.



A total of 28 potentially eligible studies were selected for full-text reviewing. Seven studies met the inclusion criteria and were eligible for this review. The designs of the included studies were 2 randomized controlled trials, 3 controlled before-after studies, and 2 interrupted time series studies. The included studies were from Canada (2), United States (3), United Kingdom (1), and China (1).


The studies showed great clinical and methodological heterogeneity, resulting in the inability to aggregate data through meta-analyses. Some interventions showed a decrease in medication errors, but the results were not consistent, and none of the studies reported significant reduction in patient harm. Overall, the quality and strength of the evidence is low.



The evidence available about the effectiveness of interventions to reduce medication errors in pediatric hospitalized population were methodologically weak to produce recommendations that are evidence based. Therefore, the conclusions of this review are mostly centered toward recommendations for research.



The interventions studied in this review showed limitations both in volume and methodological quality. Although the 5 organizational interventions studied showed some decrease in medication errors, the results are not conclusive and the benefits for children remain unclear.


Medication errors can happen in every stage of the medication pathway: ordering/prescribing, transcribing and verifying, dispensing and delivering, and monitoring and reporting. In most settings, nurses may be involved in all steps that follow ordering/prescription so they are not only prone to medication errors but they can also intercept medication errors that occurred earlier in the chain of the medication process.


Actually, nurses are provided with the "rights" of medication administration and have the responsibility to control the environmental conditions conducive to safe medication practice. These human resources remain valid and fundamental to work concurrently with other organizational methods that technology has made accessible in order to reinforce the prevention of medication errors.




1. National Coordinating Council for Medication Error Reporting and Prevention. About medication errors: what is a medication error? Accessed November 2, 2016. [Context Link]


2. Maaskant JM, Vermeulen H, Apampa B, et al. Interventions for reducing medication errors in children in hospital. Cochrane Database Syst Rev. 2015;3:CD006208. [Context Link]