Nesligül ÖZDEMİR, Emre KARA, Ayşe BÜYÜKÇAM, Kübra AYKAÇ, Ayçe ÇELİKER, Kutay DEMİRKAN, Ateş KARA

Evaluation of medication errors in pediatric patients using antibiotics

Background. Medication errors are frequently seen in pediatric patients. Medication error studies on pediatric cases were found to not only be limited but also the collaboration of clinical pharmacists and physicians on this topic was not published in Turkey. This study aimed to identify drug-related problems, especially in antibiotics. Methods. This study was a point prevalence study with pediatric inpatients that used at least one antibiotic at a pediatric tertiary care reference hospital on November 16, 2016. Medications of patients were evaluated by clinical pharmacists in terms of drug-related problems and by physicians in terms of correct indications. Results. Eighty-nine hospitalized patients were using antibiotics at the time of the study. The median age was 42 months (range: 1-226 months), and 49 (55.1%) of the patients were male. Clinical pharmacists detected a total of 210 potential drug-drug interactions in 46 (51.7%) patients. Approximately 48.5% of the patients in pediatric wards and 52.4% of the patients in surgical wards had at least one potential drug-drug interaction. A total of 39 medication errors were identified in 36 patients’ drug orders. Most of the errors (51.3%) were due to dosing and administration time errors (35.9%). The number of errors per patient in surgical services was higher (0.47) than the pediatric services (0.42). Forty-three percent of errors were antimicrobial-related, and 70.5% of them were classified as dosing errors. Conclusions. Evaluation of patients’ drug usage by a clinical pharmacist in terms of drug-related problems such as drug interactions, side effects and prescribing errors leads to better pharmaceutical care

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. Ferner RE, Aronson JK. Clarification of terminology in medication errors: definitions and classification. Drug Saf 2006; 29: 1011-1022. https://doi. org/10.2165/00002018-200629110-00001

2. Tobaiqy M, Stewart D. Exploring health professionals’ experiences of medication errors in Saudi Arabia. Int J Clin Pharm 2013; 35: 542-545. https://doi.org/10.1007/s11096-013-9781-0

3. Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Ann Pharmacother 2006; 40: 1766-1776. https://doi.org/10.1345/aph.1G717

4. Ferranti J, Horvath MM, Cozart H, Whitehurst J, Eckstrand J. Reevaluating the safety profile of pediatrics: a comparison of computerized adverse drug event surveillance and voluntary reporting in the pediatric environment. Pediatrics 2008; 121: e1201-e1207. https://doi.org/10.1542/peds.2007-2609

5. Al-Jeraisy MI, Alanazi MQ, Abolfotouh MA. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia. BMC Res Notes 2011; 4: 294. https://doi.org/10.1186/1756-0500-4-294

6. Zeleke A, Chanie T, Woldie M. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Int Arch Med 2014; 7: 18. https:// doi.org/10.1186/1755-7682-7-18

7. The Joint Commission. Preventing pediatric medication errors. 2008. Available from: https:// www.jointcommission.org/-/media/tjc/documents/ resources/patient-safety-topics/sentinel-event/sea- 39-ped-med-errors-rev-final-4-14-21.pdf (Accessed on 12 January 2017)

8. Baser S, Manav G. Çocuk hemşirelerinin ilaç hatası yapma durumları ve eğilimlerinin incelenmesi. Çukurova Üniversitesi Sağlık Bilimleri Dergisi 2018; 7: 41-49.

9. Bilsin E. Investigation of medication errors witnessed by intern nurses during pediatric practices. Arch Health Sci Res 2020; 7: 116-122. https://doi. org/10.5152/ArcHealthSciRes.2020.596887

10. Gök D, Yıldırım Sarı H. Pediyatride ilaç hataları ve hata bildirimi. İzmir Dr. Behçet Uz Çocuk Hastalıkları Dergisi 2016; 6: 165-173.

11. Ozdemir N, Celiker A, Kuskonmaz BB, Okur FV, Uckan Cetinkaya D. Evaluation of drug-related problems in a pediatric bone marrow transplantation unit identified by a clinical pharmacist in-training in a 7-month period. Clin Exp Health Sci 2020; 1: 21-26. https://doi.org/10.33808/clinexphealthsci.590213

12. Isik MN, Dalgic N, Okuyan B, Yıldız Yıldırmak Z, Sancar M. Hastanede yatan pediatrik hastalarda ilaç tedavisinin incelenmesi: klinik eczacı önerileri. Çocuk Enfeksiyon Dergisi 2020; 14: 237-243. https:// doi.org/10.5578/ced.69774

13. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2017. Oslo, 2016 (Accessed on 12 January 2017).

14. Tschudy MMA, Kristin M, eds. The Harriet Lane Handbook: A Manual For Pediatric House Officers (20th ed). Philadelphia, PA: Mosby Elsevier, 2012.

15. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Available at: https://www.uptodate.com/ contents/search (Accessed 12 January 2017).

16. Kliegman RM, Stanton B, St Geme JW 3rd, Schor NF, Behman RE, eds. Nelson Textbook of Pediatrics (20th ed). Phialdelphia: Elsevier, 2016.

17. Micromedex Solutions. Drug interactions. Available at: https://www.micromedexsolutions.com/ micromedex2/4.34.0/WebHelp/Tools/Interactions/ Drug_Interactions_severity_definitions.htm (Accessed on 8 January 2017).

18. Pharmaceutical Care Network Europe (PCNE). Classification for Drug related problems: The PCNE Classification V 7.0. Available at: http://www.pcne. org/upload/files/152_PCNE_classification_V7-0.pdf (Accessed on January 19, 2017).

19. Grohskopf LA, Huskins WC, Sinkowitz-Cochran RL, Levine GL, Goldmann DA, Jarvis WR; Pediatric Prevention Network. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005; 24: 766-773. https://doi.org/10.1097/01.inf.0000178064.55193.1c

20. Gerber JS, Newland JG, Coffin SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010; 126: 1067-1073. https://doi.org/10.1542/peds.2010- 1275

21. Feinstein J, Dai D, Zhong W, Freedman J, Feudtner C. Potential drug-drug interactions in infant, child, and adolescent patients in children’s hospitals. Pediatrics 2015; 135: e99-e108. https://doi. org/10.1542/peds.2014-2015

22. Getachew H, Assen M, Dula F, Bhagavathula AS. Potential drug-drug interactions in pediatric wards of Gondar University Hospital, Ethiopia: a cross sectional study. Asian Pac J Trop Biomed 2016; 6: 534-538. https://doi.org/10.1016/j.apjtb.2016.04.002

23. Thiruthopu NS, Mateti UV, Bairi R, Sivva D, Martha S. Drug utilization pattern in South Indian pediatric population: a prospective study. Perspect Clin Res 2014; 5: 178-183. https://doi.org/10.4103/2229- 3485.140558

24. Ceyhan M, Yildirim I, Ecevit C, et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey. Int J Infect Dis 2010; 14: e55-e61. https://doi.org/10.1016/j. ijid.2009.03.013

25. Glanzmann C, Frey B, Meier CR, Vonbach P. Analysis of medication prescribing errors in critically ill children. Eur J Pediatr 2015; 174: 1347- 1355. https://doi.org/10.1007/s00431-015-2542-4

26. Rashed AN, Neubert A, Tomlin S, et al. Epidemiology and potential associated risk factors of drug-related problems in hospitalised children in the United Kingdom and Saudi Arabia. Eur J Clin Pharmacol 2012; 68: 1657-1666. https://doi.org/10.1007/s00228- 012-1302-x

27. Poole RL, Carleton BC. Medication errors: neonates, infants and children are the most vulnerable! J Pediatr Pharmacol Ther 2008; 13: 65-67. https://doi. org/10.5863/1551-6776-13.2.65

28. Wilson DG, McArtney RG, Newcombe RG, et al. Medication errors in paediatric practice: insights from a continuous quality improvement approach. Eur J Pediatr 1998; 157: 769-774. https://doi. org/10.1007/s004310050932

29. Prot-Labarthe S, Di Paolo ER, Lavoie A, et al. Pediatric drug-related problems: a multicenter study in four French-speaking countries. Int J Clin Pharm 2013; 35: 251-259. https://doi.org/10.1007/ s11096-012-9740-1

30. Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001; 285: 2114-2120. https://doi. org/10.1001/jama.285.16.2114