Table 3.
Main drugs related to the most frequent medication errors in the pediatric critical care services (PCCS)
| PCCS | Types of Medication Errors | n (%) | Drug related in MEs, n | Clinical Relevance or Possible clinical implication* | |
|---|---|---|---|---|---|
| Mild | Severe | ||||
| PEC | Wrong speed rate of administration | 45 (11.7) | Omeprazole, 40 | Abdominal pain, Nausea | Respiratory system reactions |
| Ampicillin, 2 | Phlebitis, Injection site pain | Morbilliform rash or Serious allergic reactions | |||
| Metoclopramide, 1 | Diarrhea | Acute dystonic reaction | |||
| Amikacin, 1 | Injection site pain | Hearing loss | |||
| Ceftriaxone, 1 | Rash, Injection site pain | Hematological disorders | |||
| Abbreviations | 258 (67.2) | Glucose solution, 98 | Phlebitis | Hyperosmolar syndrome | |
| Potassium chloride, 53 | Injection site pain, Phlebitis | Cardiac arrhythmias | |||
| Saline solution, 28 | Phlebitis | Hypervolemia | |||
| Phenytoin, 12 | Injection site pain, Rash | Cardiac rhythm disturbances | |||
| Others, 67 | |||||
| Total No. of MEs | 384 | ||||
| PICU | Wrong speed rate of administration | 102 (15.8) | Omeprazole, 59 | Abdominal pain, Nausea | Respiratory system reactions |
| Metoclopramide, 43 | Diarrhea | Acute dystonic reaction | |||
| Spelling error | 63 (9.8) | Fentanyl, 38 | Headache, Nausea, Vomiting | Loss of consciousness & Tachycardia | |
| Sufentanil, 15 | Headache, Nausea, Vomiting | Loss of consciousness & Tachycardia | |||
| Furosemide, 8 | Electrolyte disorder | Cardiac rhythm disturbances | |||
| Others, 2 | |||||
| Misinterpretation/mistaken drug units | 46 (7.2) | Nystatin, 17 | Oral irritation, Sensitization | Stevens-Johnson syndrome | |
| Albuterol, 15 | Throat irritation, Nausea | Cardiac rhythm disturbances | |||
| Ipratropium bromide / Albuterol, 12 | Throat irritation, Nausea | Cardiac rhythm disturbances | |||
| Epinephrine, 2 | Dizziness, Sweating | Cardiac rhythm disturbances | |||
| Abbreviations | 432 (67.2) | Glucose solution, 174 | Phlebitis | Hyperosmolar syndrome | |
| Potassium chloride, 25 | Injection site pain, Phlebitis | Cardiac arrhythmias | |||
| Saline solution, 66 | Phlebitis | Hypervolemia | |||
| Phenytoin, 17 | Injection site pain, Rash | Cardiac rhythm disturbances | |||
| Others, 150 | |||||
| Total of ME | 643 | ||||
| NICU | Wrong speed rate of administration | 31 (22) | Omeprazole, 30 | Abdominal pain, Nausea | Respiratory system reactions |
| Metoclopramide, 1 | Diarrhea, Hypotension | Acute dystonic reaction | |||
| Spelling error | 25 (17.7) | Fentanyl, 21 | Headache, Nausea, Vomiting | Loss of consciousness & Tachycardia | |
| Furosemide, 2 | Electrolyte disorder | Cardiac rhythm disturbances | |||
| Others, 2 | |||||
| Abbreviations | 85 (60.3) | Glucose solution, 55 | Phlebitis | Hyperosmolar syndrome | |
| Saline solution, 9 | Phlebitis | Hypervolemia | |||
| Multivitamin, 4 | Stomach discomfort | Hypervitaminosis | |||
| Others, 17 | |||||
| Total No. of MEs | 141 | ||||
| NIMCU | Wrong speed rate of administration | 14 (12.7) | Omeprazole, 12 | Abdominal pain, Nausea | Respiratory system reactions |
| Vancomycin, 1 | Nausea | Hypokalemia & Red man Syndrome | |||
| Amikacin, 1 | Injection site pain | Hearing loss | |||
| Spelling error | 13 (11.8) | Fentanyl, 6 | Headache, Nausea, Vomiting | Loss of consciousness & Tachycardia | |
| Furosemide, 3 | Electrolyte disorder | Cardiac rhythm disturbances | |||
| Others, 4 | |||||
| Abbreviations | 83 (75.5) | Glucose solution, 37 | Phlebitis | Hyperosmolar syndrome | |
| Potassium chloride, 5 | Injection site pain, Phlebitis | Cardiac arrhythmias | |||
| Saline solution, 9 | Phlebitis | Hypervolemia | |||
| Multivitamin, 4 | Stomach discomfort | Hypervitaminosis | |||
| Others, 28 | |||||
| Total No. of MEs | 110 | ||||
*The clinical implications were consulted at https://www.drugs.com/sfx/ [25]
HPMC Hydroxypropyl methylcellulose, ME Medication Error, NICU Neonatal Intensive Care Unit, NIMCU Neonatal Intermediate Special Care Unit, PCCS Pediatric critical care services, PEC Pediatric Emergency Care, PICU Pediatric Intensive Care Unit