Articles Posted in Pharmacy Errors and Children

Medication errors are an unfortunate yet common occurrence throughout the United States. While these errors can have deadly consequences, they are most dangerous to vulnerable populations such as older adults, pregnant women, and children. In Maryland, those who suffer a medication error may hold the responsible party liable for their losses. Children are a unique population in that they have little to no control over the medication they consume yet can face the most consequences after a medication error. Statistics indicate that over 50% of American children consume one medication or more every week, and one study revealed that almost half of caregivers gave an incorrect dose.

While a single dosing error of a common medication may not result in a significant injury, persistent errors can raise the likelihood of serious harm. In light of the growing concern surrounding pediatric medication errors, the American Academy of Pediatrics (AAP) published a piece on preventing home medication errors. The authors acknowledged that home medication errors commonly occur with liquid medications requiring preparations. Caregivers with reduced health literacy or limited English proficiency are at an increased risk for making an administration error.

In addition to home caregivers, health care providers may also be responsible for pediatric medication errors. Many health care provider practices enhance the occurrence of errors. Providers who do not include complete information related to indication, frequency, or duration, can affect how the caregiver administers the medication. Further, providers who fail to include a consistent dosage or conduct a thorough medication review may inappropriately prescribe medication.

Medication errors occur every day and in most recent years, they have received significant attention from the media and have been the subject of many studies. But such studies often focus on adult errors rather than pediatric errors. Children may be at greater risk because of the additional calculations and variations in medication for children. A recent study with implications for Maryland medication error victims looked at the occurrence of ten-fold medication errors in children.

According to the article, results from the study were recently released after the two-year study was conducted on pediatric ten-fold medication errors. In one case, a professional administered an unintentional ten-fold overdose to a four-year-old child. The investigation looked at medication errors not just in prescribing, but also in dispensing and administering doses. A consultant explained that there are more steps involved to calculate a children’s prescription than an adult prescription. The dosing for children is often based on weight. Sometimes another calculation needs to be to convert medicine to a liquid formula and sometimes another calculation to adjust the concentration based on the specific product that is available.

The study showed that of the ten-fold medication errors that occurred during the study, the vast majority—76 percent—occurred during the prescription phase. Another 20 percent occurred while administering the medication and 4 percent while dispensing it. The study offered solutions to decrease pediatric medication errors, such as shifting medications from liquid form to tablet form but noted that not enough is known about such errors to give a clear solution.

The Pharmacy Times recently reported an issue that many parents are facing when administering ibuprofen oral medication to their children. Maryland medication errors can result in serious adverse side effects to infants and children taking cold and flu medication or pain relievers. In some cases, these errors result from a caretaker’s failure to read the packaging instructions. However, marketing errors increase the likelihood of a dosing error.

The report focuses on the two different concentrations of children’s and infant’s ibuprofen. The infant’s formulation is intended for babies aged 6-23 months, weighing between 12-23 pounds. The infant’s formation is 40 mg/mL, whereas the children’s formulation contains 20 mg/mL. The childrens’ formulation is intended for children aged 2-11 years or weighing 24-95 pounds. While companies rely on the consumer carefully reading the dosing and administration instructions, confusion often arises because of the similarities in packaging and labeling.

Pediatric hospitals and medical providers are becoming more aware of the confusion, and as such, parents are receiving education regarding dosage upon discharge. However, the Institute for Safe Medication (ISM) reported that medical providers had received several reports about medication mix-ups occurring after a child was discharged.

A statute of limitations, or the time period in which a claim must be filed, is generally strictly construed. In a Maryland pharmacy error case for personal injury or wrongful death generally has to be filed within the three-year statute of limitations applicable to those cases in Maryland. A medical malpractice claim generally has to be filed within five years of the date of injury or within three years of the date the injury was discovered, whichever comes first. This means that if a pharmacy error victim files after the statute of limitations has passed, the claim will be dismissed, regardless of the merits of the claim. The statutes are strictly construed because they are meant to limit the liability of defendants over an indefinite period of time to increase fairness and predictability.

Maryland medication and pharmacy errors of any type are concerning, but they are of particular worry when they affect children. Children’s immune systems are more vulnerable than adults, and they may lack the ability to articulate and explain what is wrong or what is happening to them, making errors more difficult to detect. Because children’s bodies are still growing, certain errors can also inhibit growth and have serious long-term consequences. While relatively rare, all parents should be on the lookout for pharmacy errors when it comes to their children.

To make this easier for parents, The Pharmaceutical Journal recently announced a new initiative focused solely on this problem: inviting researchers to submit articles on the subject to be published, increasing the availability of information on prevention and common errors. The Journal hopes to publish articles on how pharmaceuticals can improve the health of children, new policies that may prevent errors of this kind, and evidence-based best practices across all sectors.

The Pharmaceutical Journal explained in depth why this initiative matters. Most research on pharmaceuticals and drug administration focuses on adults, who can be studied more easily with less ethical concerns. However, children are not simply small adults, and the data collected on adult subjects cannot necessarily be translated to children, whose bodies, physiology, are remarkably different. For instance, drug doses, which are generally standardized across all adults, perhaps only differing due to weight or sex, have to be individually calculated for every child receiving the drug, based on their age, weight, body surface area, and clinical condition. This individualized calculation may lead to more errors. Additionally, the physiology of children is changing, meaning that old processes and procedures for calculating dose calculations may now be incorrect. Specifically, obesity is on the rise, with the number of overweight or obese children increasing globally. Because of this, pharmacists should be particularly cautious when treating children, and more information on the subject could help them do just that.