By Tammy Webber, Associated Press, 04/24/01

CHICAGO -- Potentially harmful medication errors occur three times more often among hospitalized children than adults, according to a new study.

Many mistakes -- including prescribing medication at incorrect dosages or drugs that could cause allergic reactions -- could be prevented by requiring physicians to enter orders into a computer and clinical pharmacists to be more involved in pediatric wards, researchers said.

"The high risk of medication errors highlights the importance of developing, testing and implementing effective error-prevention strategies in pediatrics," the study's authors wrote in Wednesday's Journal of the American Medical Association.

In the six-week study at Children's Hospital Boston and Massachusetts General Hospital for Children, researchers found 616 medication errors out of 10,778 orders written -- an error rate of 5.7 percent.

Of those, 26 were considered adverse drug events, meaning they harmed the child. In 115 cases, the mistakes were caught before the medication was administered or the error did not cause a bad reaction; of those, physician reviewers said 18 were potentially fatal or life-threatening.

The remaining mistakes were errors that weren't considered potentially harmful, such as ordering antibiotics without specifying how the drug should be administered, said lead author Rainu Kaushal, a physician at Brigham and Women's Hospital in Boston.

The overall error rate was similar to those found in previous studies of adult hospitals, but the number of potentially harmful errors was three times greater among children.

Kaushal said it was not surprising that errors were greater among children, especially those in neonatal intensive care units.

"There is a lot of weight-based dosing in pediatrics, and pharmacists often have to dilute (medication) or chop pills," she said. "There is also the breadth of ages (among children), children cannot communicate quite as well if there is a side effect" and small and critically ill children cannot withstand errors as well as older children and adults.

Most of the errors were made when the doctors ordered the medication, rather than because of dispensing errors, researchers said.

Two years ago, a blistering report by the Institute of Medicine called attention to medical mistakes in hospitals. It said errors kill up to 98,000 hospitalized Americans a year and demanded major changes.

Kaushal said using computerized systems rather than writing drug orders on paper could prevent many errors because they alert doctors to patient allergies and check for harmful drug interactions and the correct dosages. Previous studies showed that computer ordering and decision support reduced error rates by as much as 81 percent in adult hospitals.

Assigning clinical pharmacists to work with doctors on medication and dosage decisions could also reduce errors, the study said.

Dr. Charles Homer, executive director of the National Initiative for Children's Healthcare Quality, said the study's conclusions "were right on target."

"Medication errors are common for adults and this paper demonstrates they're equally common in the care of children," said Homer, who also is chairman of the American Academy of Pediatrics' Committee on Quality Improvement. "We need to commit the same kinds of time and energy to improve safety for children."