First do no harm: Improving paediatric medication safety

Dr Alice Roueche and Dr Jane Runnacles, consultants in General Paediatrics

The pen is mightier than the sword…” we might need to update that adage for the e-prescribing world, but the message is the same – you are more likely to cause harm to a paediatric patient through prescribing medication than any other medical action.

Children are particularly prone to medication related harm.  Up to 15% of inpatient prescriptions have errors on them.  In fact, children are 3% more likely than adults to be harmed by medication errors.

In adults, errors are picked up as dosing regimens are more standard.  But in a specialty with weight-based drug calculations for patients ranging from 500g to 100kg+, the potential for error is huge.

 

And, let’s face it, the published numbers are likely to be underestimates.  When you were bleeped last night to change an inaccurate prescription was it logged as a formal Incident Report?  How many ‘near misses’ have you seen on your ward that were never formally escalated?

This year the WHO has launched its new Global Patient Safety Challenge, “Medication without Harm”.

This includes a call for action for health care professionals:

 

“Do medication right. The five rights: right patient, right medicine, right time, right dose, and right route”

“Talk the talk: tell your patients about their medications”

As paediatricians, prescribing in high risk situations, we need to look at how we respond to this, both as individuals and as a professional community.

 

The solution

You might be in a hurry and have scrolled down quickly. Yes, we know we make errors so cut to the chase, how do we fix the problem? Well, genuinely, we the authors don’t know. Sorry about that.

But, before you leave in disgust, we do know some people who might know.

We believe the answer lies within our medical community.  We believe that there are no paediatric departments that haven’t at some level tried to tackle this.  An audit of prescribing standards, pharmacists on the ward round, apps, Druggles… there are so many ideas out there that have been tried and often tested.  And we want people to share these ideas and the learning from them.  So www.medsiq.org has been developed by the RCPCH to allow people to share their ideas and projects.  Already we have 71 resources, 721 registered users and a growing community.  We have bimonthly webinars that you can join to discuss topics such as “how safe are emergency drug calculator apps?” or how to make drug infusions safer.  These discussions have led to RCPCH working groups to tackle the problem so by joining the discussion you can really make a difference.

The content of the site is split into different areas:

 

  • Safe prescribing
  • Error reporting
  • Supporting patients and families
  • E-learning

There are also generic QI resources to help you to develop your ideas into projects.

 

Example content

Project: Implementation of DRUG-gles – safety huddles focused on medication error. http://www.medsiq.org/tool/drug-gle-druggle

Resource: Medication Error Reporting & Prevention Tool (MEPR) – a tool to help identify and categorise errors. http://www.medsiq.org/tool/medication-error-reporting-prevention-tool

 

What to do next…

Have a browse on the website and look at the ideas that are on there. Is there something you’d like to introduce on your ward or in your clinic?  Or have you already done a project and could submit the results for others to learn from?

Also – we are not working alone.  We hope that you are already aware of the brilliant resource that is Medicines for Children.  You can use this website to find patient information sheets for almost all of the medicines we use regularly in paediatrics and neonates.  We also work with Making It Safer Together (MIST), a collaborative of hospitals working together to improve paediatric patient safety.  Look and see if your Trust is taking part and see if you can get involved: http://www.mist-collaborative.net/

Whilst we are proud of MedsIQ and what it has achieved, we are aware that it is only as good as its community.  To be useful it needs to be used – we need people to sign up, submit projects, share learning and resources.

So if you are looking for a QI project, keen to improve patient safety or just want to find ways to improve your personal prescribing practice, visit MedsIQ today.

 

Actions for today:

Visit the website (www.medsiq.org)

Become a champion

Get three colleagues to sign up

Use the website to get ideas for your own QI project and then share it with us…

Join our next webinar

And if you are still not sure, join us on Dec 5th 2017 for our free study day on “Co-producing solutions for Medication Safety with families”.  https://www.rcpch.ac.uk/events/co-producing-solutions-medication-safety-families

Have you been inspired to write something for PaediatricFOAM? Get in touch with us and join the team! Support, guidance and consultant input will be provided.

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