Peer-reviewed article
Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review
Adam B. Sutherland, Denham L. Phipps, Stephen Tomlin, Darren Mark Ashcroft ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined studies from 1999-2019 about medication-related problems affecting children in UK hospitals. The review found that about one quarter of hospitalised children experience adverse drug reactions, with prescribing and administration errors being common throughout hospital care. Medication errors were frequently identified when patients were admitted to hospital or discharged, with many errors classified as potentially harmful. The authors conclude that medication safety is a significant patient safety issue for hospitalised children and that better understanding of paediatric medication systems is needed to prevent harm.
Key points
- Adverse drug reactions affected a median of 25.6% of hospitalised children, with 79.2% requiring withdrawal of medication
- Prescribing errors occurred in a median of 6.5% of cases, with dose errors accounting for 11.1% of prescribing errors
- Administration errors had a median prevalence of 16.3%, with 53% being administration technique errors
- Medicines reconciliation at hospital admission found errors affecting 43% of patients and 23% of prescribed medications, with 70.3% classified as potentially harmful
- Errors at hospital discharge affected 33% of patients and 19.7% of medicines
Limitations
This review only included UK-based studies and does not directly measure the clinical outcomes or harm resulting from medication errors; it cannot tell us the severity of harm experienced by affected children or the most effective interventions to prevent these errors.
Abstract
BACKGROUND: Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care. Hence, there is a need for an updated, focussed and critical review of the prevalence and nature of drug-related problems in hospitalised children in the UK, in order to support the development and targeting of interventions to improve medication safety. METHODS: Nine electronic databases (Medline, Embase, CINAHL, PsychInfo, IPA, Scopus, HMIC, BNI, The Cochrane library and clinical trial databases) were searched from January 1999 to April 2019. Studies were included if they were based in the UK, reported on the frequency of adverse drug reactions (ADRs), adverse drug events (ADEs) or medication errors (MEs) affecting hospitalised children. Quality appraisal of the studies was also conducted. RESULTS: In all, 26 studies were included. There were no studies which specifically reported prevalence of adverse drug events. Two adverse drug reaction studies reported a median prevalence of 25.6% of patients (IQR 21.8-29.9); 79.2% of reactions warranted withdrawal of medication. Sixteen studies reported on prescribing errors (median prevalence 6.5%; IQR 4.7-13.3); of which, the median rate of dose prescribing errors was 11.1% (IQR 2.9-13). Ten studies reported on administration errors with a median prevalence of 16.3% (IQR 6.4-23). Administration technique errors represented 53% (IQR 52.7-67.4) of these errors. Errors detected during medicines reconciliation at hospital admission affected 43% of patients, 23% (Range 20.1-46) of prescribed medication; 70.3% (Range 50-78) were classified as potentially harmful. Medication errors detected during reconciliation on discharge from hospital affected 33% of patients and 19.7% of medicines, with 22% considered potentially harmful. No studies examined the prevalence of monitoring or dispensing errors. CONCLUSIONS: Children are commonly affected by drug-related problems throughout their hospital journey. Given the high prevalence and risk of patient harm,, there is a need for a deeper theoretical understanding of paediatric medication systems to enable more effective interventions to be developed to improve patient safety.