When you're bleary-eyed and trying to comfort an ailing little one in the middle of the night it can be easy to grab the wrong medicine dropper or accidentally pour a little too much while you're half asleep. But when your tot's in the hospital, you assume that the medications have been double-checked for safety and measured precisely. Still, like everyone else, doctors and nurses are human and do occasionally make mistakes.
So, a group of researchers set out to take a closer look at medicine missteps among hospitalized kids. To help gauge the extent of the problem they created and tested a special tool that looked for "triggers" in a child's chart that indicated situations in which there was a higher risk of problems occurring with administered drugs. And their new tool discovered much higher rates of medicine flubs than other previous methods had found.
Looking at nearly 1,000 children's medical charts (chosen randomly) from 12 children's hospitals, the researchers uncovered approximately 11 "adverse drug events" for every 100 hospitalized kids and about 2.5 triggers indicating a possible problem per patient. The hospitals' usual methods for detecting drug errors revealed less than 4% of the issues that the researchers found with their fledgling tool.
Luckily, most (97%) of the medication mix-ups — mainly involving painkillers and antibiotics — caused only "mild, temporary harm" (most commonly itching and nausea).
But the study also reports that:
- Nearly a quarter of the medication blunders were considered preventable.
- About 18% could've been detected sooner.
- Almost 17% could've been handled better.
What This Means to You
Of course, whenever a child is in the hospital the last thing you want to do is question every move the health care providers make — that can just make it harder for the doctors and nurses to do their jobs. Instead, it's wise to work with them to make sure your children get the highest quality care.
Being a positive, proactive advocate for your kids' health essentially boils down to asking questions and really listening to the responses to find out what's happening and what might come next.
So, here are some things you can do to help keep you informed and ensure the best care for your kids, whether it's a brief trek to the ER or an extended stay:
- Make sure everyone (all nurses and doctors — including specialists) prescribing or giving your kids medicine knows:
- what other medications they're taking and exactly how much each day
- about any allergies to medications or eggs (which are used to make flu vaccines)
- Find out what medications your kids are being given or prescribed, how often, and why. Don't berate the doctors or nurses, of course, but do ask questions about what each medication does, how much is being given and when, and what side effects (if any) might come with them.
- Do the same for any tests that are administered or ordered. Ask what they're for, if there are any risks, and what the results will — or won't — show.
- Find out what all of the equipment and monitors measure or indicate, and what all of that beeping means.
- Don't hesitate to ask if you don't know or understand the doctors' specialties or their specific role in your kids' care.
- Discuss all of your concerns, even if the doctor doesn't ask about certain symptoms or issues. Be as specific as possible.
- Take notes so you can remember the doctor's instructions and any medications given or tests scheduled.
- Make sure to answer all of the anesthesiologist's questions as honestly and thoroughly as possible whenever your kids need a surgery requiring any kind of anesthesia. Things that may seem harmless could interact with or affect the anesthesia and how children react to it.
- Ask your doctor and/or anesthesiologist what to expect before, during, after surgery — procedures, timelines, common emotions, recuperation time, and possible symptoms afterward.
- Keep a medical journal or running list of symptoms, medications, tests, and issues to address if you're looking at a long hospital stay.
- Ask the doctor for reliable resources (like brochures, printouts, and website recommendations) to learn more about what's going on and what to expect.
- Make sure you have all the information — and paperwork — needed for follow-up appointments, tests, and prescriptions before leaving the hospital.
- Follow your gut — you know your children better than anyone and are the very best judge of when something is wrong.
Above all, stay informed, speak up, and build a trusting relationship with your kids' health care providers. Work together — as a team — to make sure all decisions, diagnoses, and treatments are based on your kids' best interests.
Reviewed by: Steven Dowshen, MD
Date reviewed: April 2008
Source: "Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in U.S. Children's Hospitals," Pediatrics, April 2008.
