ORIGINAL ARTICLE Medication errors in hospitalised children Elizabeth Manias, 1 Sharon Kinney, 1 Noel Cranswick 2 and Allison Williams 3 1 Melbourne School of Health Sciences, The University of Melbourne, 2 Department of Clinical Pharmacology, Royal Children’s Hospital, Parkville and 3 School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia Aim: This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children’s hospital, and to examine the types, causes and contributing factors of medication errors. Methods: A retrospective clinical audit was undertaken of medication errors reported to an online incident facility at an Australian children’s hospital over a 4-year period. Results: A total of 2753 medication errors were reported over the 4-year period, with an overall medication error rate of 0.31% per combined admission and presentation, or 6.58 medication errors per 1000 bed days. The two most common severity outcomes were: the medication error occurred before it reached the child (n = 749, 27.2%); and the medication error reached the child who required monitoring to confirm that it resulted in no harm (n = 1519, 55.2%). Common types of medication errors included overdose (n = 579, 21.0%) and dose omission (n = 341, 12.4%). The most common cause relating to communication involved misreading or not reading medication orders (n = 804, 29.2%). Key contributing factors involved communication relating to children’s transfer across different clinical settings (n = 929, 33.7%) and the lack of following policies and procedures (n = 617, 22.4%). More than half of the reports (72.5%) were made by nurses. Conclusion: Future research should focus on implementing and evaluating strategies aimed at reducing medication errors relating to analge- sics, anti-infectives, cardiovascular agents, fluids and electrolytes and anticlotting agents, as they are consistently represented in the types of medication errors that occur. Greater attention needs to be placed on supporting health professionals in managing these medications. Key words: clinical audit; hospital communication systems; hospitalised child; medication errors. What is already known on this topic 1 Children are particularly susceptible to experiencing a medica- tion error. They vary in weight, body surface area, and organ maturity, which can affect their ability to metabolise and excrete medications effectively. 2 Medication error rates in hospitalised children vary considerably due to the diverse environments in which studies are conducted and various data collection methods used. 3 Leading causes of paediatric medication errors have been shown to be performance deficits, procedures or protocols not being followed, knowledge deficits, calculation errors, and lack of communication. What this paper adds 1 All reported medication errors were associated with a cause relating to communication in some way; the most common causes relating to communication involved misreading or not reading medication orders and problems with bedside communication. 2 The most common contributing factors involved communication relating to patient movements across different clinical settings and the lack of following policies and procedures. 3 In over half of all reported cases, the medication error reached the child who required monitoring to confirm that it resulted in no harm. Safe and effective medication management in children ensures a healthy state of wellbeing and has economic and social ben- efits. 1,2 An important aspect of safe and effective medication management is to examine medication errors and their charac- teristics, with the aim of identifying and implementing preven- tative strategies. 3,4 Children are particularly susceptible to experiencing a medication error. 5 They vary in weight, body surface area, and organ maturity, which can affect their ability to metabolise and excrete medications effectively. In comparing adult and paediatric medication error rates, between 3.2 and 323.0 medication errors/100 admissions have been found in adults, while between 2.4 and 44.3 medication errors/100 admissions occur in children. 6 Improper dose or quantity has been shown to be the most common type of medi- cation error in children, while the use of wrong medication has been shown to be the most common type of error in adults. 7 Medication error rates in hospitalised children vary considerably due to the diverse environments in which studies are conducted and various data collection methods used. Rates have varied between 0.15 and 17.2 medication errors per 100 admissions. 8–10 Correspondence: Dr Elizabeth Manias, Melbourne School of Health Sci- ences, Level 6, Alan Gilbert Building, 161 Barry Street, The University of Melbourne, Parkville, Vic. 3010, Australia. Fax: +613 8344 5391; email: emanias@unimelb.edu.au Conflict of interest: The authors declare that they have no known conflicts of interest in relation to this paper. Accepted for publication 6 June 2013. doi:10.1111/jpc.12412 Journal of Paediatrics and Child Health (2013) © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 1