Pediatric Medication Safety in Adult Community Hospital Settings: A Glimpse Into Nationwide Practice

Abstract

Background and objectives: Most children in the United States are treated in adult settings. Studies show that the pediatric population is vulnerable to medication errors. It can be extrapolated that children cared for in adult settings are at equal or higher risk for errors. The goal of this study was to assess the existing pediatric medication safety infrastructure within adult hospitals.

Methods: Questionnaire developed through Research Electronic Data Capture (REDCap) and distributed to pediatric hospitalist programs listed on the American Academy of Pediatrics, Section on Hospital Medicine web site and members of the American Academy of Pediatrics Quality Improvement Innovation Networks listserv. There were >20 questions regarding the use of various safety measures and characteristics of the hospital.

Results: Thirty-eight program staff and 26 Quality Improvement Innovation Networks listserv members completed the survey (total = 64). Of these, 90.6% use order sets or computerized provider order entry with pediatric weight-based dosing, 79.7% review pediatric medication safety events or concerns, 58.7% were aware that their hospital had defined or documented maximum doses on orders, and 50.0% had milligram-per-kilogram dosing required to be in the order. A majority of respondents document weights only in the metric system (kilograms or grams) in both the emergency department and the pediatric unit (84.4% and 92.1%, respectively). A total of 57.8% of hospitals had pharmacists trained in pediatrics, with hospitals with >300 beds more likely to have a pediatric pharmacist than those with <300 beds (75% vs 44%, P ≤ .05).

Conclusions: Pediatric medication safety infrastructure shows variations within the sites surveyed. Our results indicate that certain deficiencies are more widespread than others, providing opportunities for targeted, but hospital-specific interventions.