Adverse Drug Events in Pediatric Outpatients

Kaushal, Rainu; Goldmann, Donald A.; Keohane, Carol A.; Christino, Melissa; Honour, Melissa; Hale, Andrea S.; Zigmont, Katherine; Lehmann, Lisa Soleymani; Perrin, James; Bates, David W.

doi:10.1016/j.ambp.2007.05.005

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Volume 7, Issue 5 , Pages 383-389, September 2007

Adverse Drug Events in Pediatric Outpatients

Rainu Kaushal, MD, MPH
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Department of Public Health, Weill Medical College of Cornell University, New York, NY
- Department of Medicine, Children's Hospital Boston, Boston, Mass
- Harvard Medical School, Boston, Mass
- Address correspondence to Rainu Kaushal, MD, MPH, Department of Public Health, Weill Medical College, 411 East 69th Street KB 312, NY, NY 10021.
Donald A. Goldmann, MD
- Department of Medicine, Children's Hospital Boston, Boston, Mass
- Harvard Medical School, Boston, Mass
- Institute for Healthcare Improvement, Cambridge, Mass
Carol A. Keohane, RN, BSN
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
Melissa Christino, AB
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
Melissa Honour, MPH
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
Andrea S. Hale, RN, BSN, MPH
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
Katherine Zigmont, RN
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
Lisa Soleymani Lehmann, MD, PhD, MSc
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
James Perrin, MD
- Harvard Medical School, Boston, Mass
- Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Mass
David W. Bates, MD, MSc
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
- Information Systems, Partners Healthcare System, Boston, Mass

Received 21 January 2007; accepted 16 May 2007.

Objective

To determine rates and types of adverse drug events (ADEs) in the pediatric ambulatory setting.

Methods

A prospective cohort study at 6 office practices in the greater Boston area was conducted over 2-month periods. Duplicate prescription review, telephone surveys 10 days and 2 months after visit, and chart reviews were done. A 2-physician panel classified the severity, preventability, and ability to ameliorate (ie, if the severity or duration of the side effect could have been mitigated by improved communication) ADEs.

Results

We identified 57 preventable ADEs (rate 3%; 95% confidence intervals [CI], 3%–4%) and 226 nonpreventable ADEs (rate 13%; 95% CI, 11%–15%) in the medical care of 1788 patients. Of the ADEs, 152 (54%) were able to be ameliorated. None of the preventable ADEs were life threatening, although 8 (14%) were serious. Forty (70%) of the preventable ADEs were related to parent drug administration. Improved communication between health care providers and parents and improved communication between pharmacists and parents, whether in the office or in the pharmacy, were judged to be the prevention strategies with greatest potential.

Conclusions

Patient harm from medication use was common in the pediatric ambulatory setting. Errors in home medication administration resulted in the majority of preventable ADEs. Approximately one fifth of ADEs were potentially preventable and many more were potentially able to be ameliorated. Rates of ADEs due to errors are comparable in children and adults despite less medication utilization in children.

Key Words: medication errors, patient safety