Incidence and determinants of medication errors Among paediatric in-patients at Kisii level 5 hospital.

Abstract

Background : Medication errors are any error in prescribing, d ispensing, administration, or monitoring of a drug and are an important cause of patient harm. They are also the single most preventable cause of patient harm yet when the y occur in paediatrics patients, they have a much higher risk of death compared to adults . Literature suggests that children experience medication errors up to three times more than adults do. Some studies indicate up to tenfold higher rate of medication errors in chil dren. Objective of the study: The main objective of the study was to determine th e incidence and factors associated with medication errors in paedia tric patients admitted Kisii level 5 Hospital Methodology: The study carried out between June and August 2014 was conducted in two parts; a descriptive cohort study that had a quanti tative approach and a cross sectional survey that was qualitative in nature. The quantit ative component entailed the prospective review of treatment sheets and files for medication related errors among children aged 0-5 years old admitted at the general paediatric ward a nd newborn unit at Kisii level 5 Hospital until discharge or up to a period of one month. Th e qualitative component included interviews of health care workers and caregivers al ongside focused group discussions to identify the medication error types and causes. De scriptive statistics was used to determine frequency, incidences, means, and standard deviatio ns. The relationships between predictor and outcome variables for dosing errors were comput ed using logistic regression (with significance set at p-value of 0.05 and 95% confide nce interval). Key themes identified in the interviews and focus group discussions were exp lored for potential causes of medication errors. Results: Out of 405 treatment sheets and files reviewed duri ng the study, 307 contained errors yielding an overall medication error rate of 75.8% with the total number of medication errors observed being 1023. These erro rs were classified into various categories as documentation errors 756 (73.9%) which were more frequent, followed by dosing errors (90, 8.8%), monitoring errors (88, 8.6%) and timing errors (58, 5.7%). The medication errors occurred more frequently in male children (1 64, 41.2%), children less than one year (186, 45.9%) and in those admitted to the general p aediatric ward (196, 48.4%). Logistic regression of dosing errors revealed that children receiving more than five medicines were 6.4 times likely to experience dosing errors (OR 6. 4; 95%CI: 2.7-15.1; P<0.001). Route of drug administration was a significant predictor of dosing errors with a 90% less risk of developing a dosing error for oral routes as compar ed to intravenous route (P <0.001). Various causes of medication error were identified and strategies to mitigate the occurrence of medication errors among the paediatric in-patien ts proposed. Conclusion: The incidence of medication errors was significantl y high with about 3.3 errors per prescription and larger studies would be approp riate to determine the extent of medication errors among children. Despite the fact that majority of errors observed were less likely to cause harm, some can be potentially fatal and therefore there is need for hospitals to have strategies of detecting and minim izing the errors.