HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Thursday, April 10, 2008

Increase in Child Hospitalization Mistakes

The April edition of the journal Pediatrics reports some distressing news - one in fifteen hospitalized children may experience medical harm resulting from medicine mix-ups, overdoses, and bad drug reactions.  The purpose of the study, "Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals" was to "to develop a pediatric-focused tool for adverse drug event detection and describe the incidence and characteristics of adverse drug events in children's hospitals identified by this tool."  The authors concluded,

Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations. 

The Boston Globe reports further on the studies findings and conclusion,

The new monitoring method developed for the study is a list of 15 "triggers" on young patients' charts that suggest possible drug-related harm. It includes use of specific antidotes for drug overdoses, suspicious side effects, and certain lab tests.  By contrast, traditional methods include nonspecific patient chart reviews and voluntary error reporting . . . .

Patient safety advocates said the problem is probably bigger than the study suggests because it involved only a review of selected charts. Also, the study did not include general community hospitals, where most US children requiring hospitalization are treated.

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