Effects of sharing information on drug administration errors in pediatric wards: a pre–post intervention study

Figures & data

Table 1 Characteristics of patients

Characteristics	Phase 1	Phase 2	Combined	χ^2 (P-value)
No of patients (%)	217 (51.1)	208 (48.9)	425 (100.0)	0.6174 (0.535)
Observer (Frequency [%])
1	110 (50.7)	114 (54.8)	224 (52.7)	0.722 (0.396)
2	107 (49.3)	94 (45.2)	201 (47.3)
Median age in monthsc (range)	8.0 (0.03–185.0)	6.0 (0.03–185.0)	7.0 (0.03–185.0)	−0.870a (0.385)b
Age group (Frequency [% in each phase])
Neonates: 0–27 days	39 (18.8)	55 (28.5)	94 (23.5)	8.060 (0.045)*
Infants: 28 days–1 year	124 (59.9)	99 (51.3)	223 (55.8)
Children: 2–11 years	35 (16.9)	36 (18.7)	71 (17.7)
Adolescent: 12–16 years	9 (4.3)	3 (1.6)	12 (3)

Notes:

a,b z and P-values obtained from the Mann–Whitney U test.

c Assuming 1 month is 30 days.

* P<0.05.

Table 2 Characteristics of the drug administrations

Characteristics	Phase 1, frequency (%)	Phase 2, frequency (%)	Combined, frequency (%)	χ^2 (P-value)
No of doses observed	1,284 (47.8)	1,401 (52.2)	2,685 (100)	−3.1932 (0.0014)**
Ward
Ward A	457 (35.6)	549 (39.2)	1,006 (37.5)	3.694 (0.055)
Ward B	827 (64.4)	852 (60.8)	1,679 (62.5)
Observer
1	573 (44.6)	725 (51.7)	1,298 (48.3)	13.610 (<0.001)**
2	711 (55.4)	676 (48.3)	1,387 (51.7)
Administration rounds (hours)
08:00	605 (47.1)	596 (42.7)	1,201 (44.8)	16.236 (0.001)**
12:00	262 (20.4)	372 (26.6)	634 (23.6)
16:00	205 (16.0)	192 (13.7)	397 (14.8)
18:00	212 (16.5)	237 (17.0)	449 (16.8)
Staff with medication apron
Yes	561 (46.2)	608 (45.2)	1,169 (45.7)	0.241 (0.623)
No	654 (53.8)	737 (54.8)	1,391 (54.3)
Routes of administrationa
Oral	402 (31.1)	427 (30.5)	829 (30.9)	0.216 (0.642)
Nasogastric	393 (30.6)	382 (27.3)	775 (28.9)	3.643 (0.056)
Intravenous	302 (23.5)	403 (28.8)	705 (26.3)	9.519 (0.002)**
Groups of medication useda
Antibacterial drugs	332 (25.9)	409 (29.2)	741 (27.6)	3.733 (0.053)
Vitamins and minerals	259 (20.2)	253 (18.1)	512 (19.1)	1.938 (0.164)
Bronchodilators	132 (10.3)	100 (7.1)	232 (8.6)	8.382 (0.004)**
Diuretics	80 (6.2)	64 (4.6)	144 (5.4)	3.648 (0.056)
Analgesics	77 (6.0)	71 (5.1)	148 (5.5)	1.110 (0.292)
Antiemetics	47 (3.7)	74 (5.3)	121 (4.5)	4.093 (0.043)*
Corticosteroids	39 (3.0)	51 (3.6)	90 (3.4)	0.752 (0.386)
Antisecretory drugs	32 (2.5)	64 (4.6)	96 (3.6)	8.375 (0.004)**

Notes:

a Only the main categories are shown in this table, and hence, the total does not add up to 100%.

* P<0.05.

** P<0.01.

Figure 1 Types of drug administration errors in both Phase 1 and Phase 2.

Abbreviations: adm, administration; prep, preparation; tech, technique.

Table 3 Examples of each type of drug administration errors in Phase 1

Type of error (frequency)	Examples of drug administration errors (frequency)
Incorrect administration technique (482)	– Did not flush NG tube between NG drugs and before or after adm (233)
	– No pre-flushing prior to/after IVB/IVI adm (49)
	– Fast IVB – given in 10 s instead of a few minutes (50)
	– Did not swab injection port/site (118)
	– Incorrect MDI adm (8)
	– Did not practices contact precaution/handwash (10)
Incorrect preparation (239)	– Leftover of drugs in mortar (11)
	– Did not dilute drug prior to NG adm (24)
	– Did not shake extemporaneous/ready-mixed suspension (61)
	– Did not observe aseptic procedure when preparing IV drug (3)
	– Did not label the drug when more than one was prepared (16)
	– Did not remove bubbles in IVI/IVB prep (45)
Incorrect administration time (42)	– Fluticasone given 4 h late
	– IVI ceftriaxone given 2.5 h late
	– IVI benzylpenicillin given 3 h late
	– Paracetamol given at 14:30 h, should be at 08:00 h
Incorrect dose (40)	– Carbamazepine: given 180 mg instead of 150 mg
	– Gentamicin: increased to 40 mg but given 30 mg
	– Nystatin: given 1 mL instead of 0.5 mL
	– Erythromycin: given 800 mg instead of 500 mg
	– Benzylpenicillin: given 1 mL instead of 0.8 mL
	– Ursodeoxycholic acid: given 30 mg instead of 60 mg
Deteriorated/expired drug (39)	– Frusemide (24 h expiry) given after >4 days
	– Captopril (24 h expiry) given 2 days later
Omission error (7)	– Frusemide and spironolactone not given
Others (2)	– Incorrect frequency
	– IVI cloxacillin placed at inappropriate place
Unauthorized drug (1)	– IVB Augmentin^® (amoxicillin and clavulanate potassium) given to wrong patient

Abbreviations: NG, nasogastric; adm, administration; IVB, intravenous bolus; IVI, intravenous infusion; s, seconds; MDI, metered-dose inhaler; h, hours.

Table 4 Factors that were associated with drug administration errors

Step 9 analysis	Total no of dosesa	Frequency of errors (%)	Wald (P-value)	Adjusted OR (95% CI)
Phase of the study
1	1,215	511 (42.1)	114.954 (<0.001)**	2.981 (2.441, 3.640)
2	1,341	356 (26.5)
Ward
A	953	342 (35.9)	19.989 (<0.001)**	1.642 (1.321, 2.041)
B	1,603	525 (32.8)
Observer
1	1,227	554 (45.2)	181.683 (<0.001)**	4.055 (3.308, 4.971)
2	1,329	313 (23.6)
Routes of admb
Nasogastric	775	394 (50.8)	291.563 (<0.001)**	9.337 (7.225, 12.066)
Other routes	1,781	473 (26.6)
Intravenous	580	293 (50.5)	49.186 (<0.001)**	3.905 (2.668, 5.713)
Other routes	1,976	574 (29.0)
Medications usedb
Antibacterial drugs	643	322 (50.1)	32.771 (<0.001)**	2.899 (2.013, 4.173)
Other medications	1,913	545 (28.5)
Corticosteroids	84	26 (31.0)	6.825 (0.009)**	2.053 (1.197, 3.522)
Other medications	2,472	841 (34.0)

Notes:

a The total number of doses in this table may be less than the original number due to missing data in some of the variables, and hence, 129 cases had to be excluded from the binary logistic regression analysis.

b Only the main categories are shown in this table and hence the total does not add up to 100%.

** P<0.01.

Abbreviations: OR, odds ratio; CI, confidence interval; adm, administration.

Table 5 Clinical significance of drug administration errors

Clinical significance	Examples	Phase 1 (n=852), frequency (%)	Phase 2 (n=496), frequency (%)	Total (n=1,348), frequency (%)
Grade 1	Calciferol, captopril, ferrous sulfate, folic acid and ibuprofen given >1 h late	56 (6.6)	18 (3.6)	74 (5.5)
Grade 2	No pre-/post-flushing of injections Antibiotics given >1 h late Underdose of calciferol, promethazine and paracetamol Did not shake antibiotic suspension Medication left in the mortar	448 (52.6)	256 (51.6)	704 (52.2)
Grade 3	Incorrect labeling Fast IVB Overdose of nystatin and paracetamol Underdose of digoxin and gentamicin	345 (40.5)	221 (44.6)	566 (42.0)
Grade 4	Overdose of carbamazepine Overdose of domperidone Fast IVB of vitamin K	3 (0.3)	1 (0.2)	4 (0.3)

Notes: Grade 1: probably clinically insignificant. Grade 2: minimally clinically significant. Grade 3: definitely clinically significant. Grade 4: life-threatening.

Abbreviations: h, hour; IVB, intravenous bolus.