PMID: 18425151Apr 22, 2008Paper

Preventable medication-related events in hospitalised children in New Zealand

The New Zealand Medical Journal
Desireé L Kunac, David M Reith

Abstract

To evaluate the frequency and characteristics of preventable medication-related events in hospitalised children, to determine the yield of several methods for identifying them and to recommend priorities for prevention. A prospective observational cohort study was conducted over a 12-week period on the paediatric wards at a university-affiliated urban general hospital in New Zealand. For all admissions of greater than 24 hours, medication-related events were identified using a multifaceted approach and subsequently classified independently by three reviewers (using a standardised reviewer form) by event type, type of error, stage of the medication process, and preventability. There were 495 eligible study patients, who had 520 admissions and 3037 patient days of admission, during which 3160 medication orders were written. Of 761 medication-related events reported during the study period, 630 (83.3%) were identified by chart review; 111 (14.6%) by a voluntary staff quality improvement reporting system; 16 (2.1%) by interview of parents; and 4 (0.53%) events via the concurrent routine hospital-incident reporting system. Excluding duplicate reports and practice-related issues, a total of 696 study patient-specific events were incl...Continue Reading

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