An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country

Figures & data

Table 1 Comparative Summary of Essential Elements of a Prescription, as per International and Local Standards

Prescription Elements	Pharmacy and Drugs Act 2001	WHO Guideline	Ravagen et al (2019)^Citation10	Used for Assessment in this Study
Date of prescription	√	√	√	√
Patient Identifiers
Name	√	√	√	√
Age		√	√	√
Sex			√	√
Diagnosis	√			√
File number^a			√
Address^a	√	√	√
Weight^b			√	√
Treatment Identifiers
Medication name^c		√	√	√
Strength	√	√	√	√
Dosage	√	√	√	√
Formulation	√	√	√	√
Duration			√	√
Quantity^d		√
Repeats			√
Generic name		√	√	√
Abbreviations and decimal points^e		√	√	√
Prescriber Identifiers
Prescriber name	√	√	√	√
Address^a	√	√
Qualification	√		√	√
Professional registration number			√
Signature	√	√	√	√
Legibility	√		√	√
Contact number^a		√
Warnings^f		√

Notes: ^aThe study did not include the file number, patient, and prescriber addresses, as well as the prescriber contact number, even though they are required. The omission was because all prescriptions were internally distributed through the hospital outpatient department, where the patient and prescriber were. No external prescriptions were considered. Similarly, the professional registration number was not included as the prescribers are all public servants working at the facility. ^bThe inclusion of the patient’s weight is crucial for pediatric cases, and situations where the dosage is contingent upon weight. This practice serves to facilitate a dual verification process by the pharmacist. ^cThe medication’s complete name is examined to ensure that it is not truncated, and the generic name is scrutinized separately. ^dThe omission of medicine quantity in the given context can be attributed to the fact that the dosage, frequency, and treatment duration serve as surrogate measures. In many cases, determining the quantity of medication to dispense is typically assigned to the pharmacy. ^eIt is important to note that no officially sanctioned acronyms exist for pharmaceutical substances. The WHO’s Guide to Good Prescribing³¹ advises against potentially perplexing acronyms due to the potential for misinterpretation. Likewise, decimal points should be limited to situations when they cannot be avoided. ^fPharmacists usually provide verbal warnings during the dispensing process. √ (Elements available in the document).

Abbreviation: WHO, World Health Organization.

Figure 1 Scores of Prescription Completeness and Accuracy across 17 Essential Elements for King Harman Maternity and Children Hospital, Ola During Children’s Hospital, and Rokupa Government Hospital, 2021, (N=366). The 17 Elements are represented by the Blue bars, and the Black bars represent the four Broad Categorizations.

Table 2 Global Accuracy Scores per Prescription and by Elements for King Harman Maternity and Children Hospital, Ola During Children’s Hospital, and Rokupa Government Hospital, 2021

Variables	Overall		Hospitals						K-value	P-value
			KHMCH		ODCH		RGH
	n (366)	%	n (122)	%	n (122)	%	n (122)	%
Global accuracy of prescription writing: Score out of 34
100%	0	0	0	0	0	0	0	0	5.471	0.065
80–100%	106	29.0	49	40.2	34	27.9	23	18.9
40–79%	257	70.2	73	59.8	85	69.7	99	81.1
0–39%	3	0.8	0	0	3	2.5	0	0
Score out of 34: Median |IQR|	25.00	6.00	26.00	4.00	24.00	8.00	26.00	2.00
Date of prescription
100%	358	97.8	121	99.2	121	99.2	116	95.1	6.372	0.041
80–100%	358	97.8	121	99.2	121	99.2	116	95.1
40–70%	0	0	0	0	0	0	0	0
0–39%	8	2.2	1	0.8	1	0.8	6	4.9
Patient identifiers
100%	31	8.5	0	0	31	25.4	0	0	19.807	<0.001
80–100%	63	17.2	0	0	63	51.6	0	0
40–79%	271	74.0	122	100.0	28	23.0	121	99.2
0–39%	32	8.7	0	0	31	25.4	1	0.8
Score out of 10: Median |IQR|	6.00	0.00	6.00	0.00	8.00	8.00	6.00	0.00
Treatment identifiers
100%	112	30.6	42	34.4	28	23.0	42	34.4	7.662	0.022
80–100%	228	62.3	76	62.3	61	50.0	91	74.6
40–79	133	36.3	46	37.7	58	47.5	29	23.8
0–39	5	1.4	0	0	3	2.5	2	1.6
Score out of 14: Median |IQR|	12.00	4.00	12.00	4.00	11.50	3.00	12.00	4.00
Prescriber identifiers
100%	31	8.5	17	13.9	1	0.8	13	10.7	49.702	<0.001
80–100%	33	9.0	19	15.6	1	0.8	13	10.7
40–79%	293	80.1	88	72.1	101	82.8	104	85.2
0–39%	40	10.9	15	12.3	20	16.4	5	4.1
Score out of 8: Median |IQR|	4.00	2.00	6.00	2.00	4.00	0.00	4.00	2.00

Abbreviations: K-value, Kruskal Wallis test value; χ², Chi-square; IQR, Interquartile Range; KHMCH, King Harman Maternity and Children Hospital; ODCH, Ola During Children’s Hospital; RGH, Rokupa Government Hospital.

Table 3 Types and Severity of Medication Errors for King Harman Maternity and Children Hospital, Ola During Children’s Hospital, and Rokupa Government Hospital, 2021

Type of Medication Error	KHMCH n (%)	ODCH n (%)	RGH n (%)	Total n (%)
Prescription Error	0	1 (1.5%)	0	1 (1.1%)
Wrong medicine	0	0	0	0
Duplicate therapy	0	1 (1.5%)	0	1 (1.1%)
Contraindication	0	0	0	0
Unnecessary medicine	0	0	0	0
Dispensing Error	1 (7.7%)	23 (34.8%)	1 (10%)	25 (28%)
Medicine omitted	1 (7.7%)	23 (34.8%)	1 (10%)	25 (28%)
Administration Error	12 (92.3%)	42 (63.6%)	9 (90%)	63 (70.7%)
Wrong route of administration	0	0	0	0
Wrong dose	1 (7.7%)	7 (10.6%)	0	8 (9%)
Wrong frequency	4 (30.8)	18 (27.3%)	4 (40%)	25 (28.1%)
Wrong time of administration	4 (30.8%)	8 (12.1%)	3 (30%)	16 (17.9%)
Wrong patient	0	0	0	0
Wrong dosage form	0	0	0	0
Medicine delay	3 (23.0%)	9 (13.6%)	2 (20%)	14 (15.7%)
Total number of medication errors	13 (14.6%)	66 (74.2%)	10 (11.2%)	89 (100%)
Severity of medication error
Category A	0	0	0	0
Category B	4 (30.8%)	32 (48.5%)	3 (30%)	39 (43.8%)
Category C	9 (69.2%)	34 (52.5%)	7 (70%)	50 (56.2%)
Category D	0	0	0	0
Category E	0	0	0	0
Category F	0	0	0	0
Category G	0	0	0	0
Category H	0	0	0	0
Category I	0	0	0	0

Abbreviations: KHMCH, King Harman Maternity and Children Hospital; RH, Rokupa Government Hospital; ODCH, Ola During Children’s Hospital.

Table 4 Potential Drug-Drug Interactions for King Harman Maternity and Children Hospital, Ola During Children’s Hospital, and Rokupa Government Hospital, 2021

Potential Drug-Drug Interaction	Effects	Type of Interaction (PD/PK)	Number of Interactions (%)
Major
IV Gentamycin + IV Furosemide	Increase the risk of oto- or nephrotoxicity	PD	2 (3.1%)
Ibuprofen +IM Diclofenac	Increase the potential of serious gastrointestinal toxicity	PD	1 (1.6%)
Moderate
IV Gentamycin + IV Ampicillin	Ampicillin reduces the effect of Gentamycin	PK	41 (64.1%)
IV Ceftriaxone + IV Furosemide	Furosemide increases the risk of nephrotoxicity of some cephalosporins.		17 (26.6%)
Minor
IM Diclofenac + IV Ceftriaxone	Diclofenac increases biliary excretion and reduces renal excretion of ceftriaxone	PK	3 (4.7%)

Abbreviations: PD, Pharmacodynamics; PK, Pharmacokinetics; IV, Intravenous; IM, Intramuscular.

Pharmacy Board of Sierra Leone (PBSL). Pharmacy and drugs act 2001. Available from: http://www.sierra-leone.org/Laws/2001-12.pdf. Accessed April 20, 2021.

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Geoffrey CU, Plou S. Research randomizer 1997–2021. Available from: https://www.randomizer.org. Accessed April 25, 2021.).

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