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Nurses making too many child drug errors


Researchers have warned that hospital staff are making too many mistakes when prescribing drugs to children.

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Investigators from the University of London who studied five hospitals in the capital discovered 13% of 3,000 prescriptions were wrong, and on five occasions they had to stop nurses from administering drugs to protect young patients.

According to their report published in the journal Archives of Disease in Childhood, about 20% of medicines given to children in 2004 and 2005 were incorrect at these hospitals.

The researchers spent two weeks on 11 wards, observing nurses, and found there were 429 mistakes out of 1,554 drugs doses given to 265 children.

This overall error rate was 19%, but when reviewing 3,000 prescriptions given to 444 children during the same two weeks, pharmacists corrected nearly 13% - mostly due to incomplete prescriptions but 33% were dosing mistakes.

Researchers said they thought other UK hospitals would have similar results, and said the findings have a modern relevance despite the study being five-years old.

“It is highly unlikely that the situation has changed since our study was done. That is because prescribing for children is very difficult,” said study author Professor Ian Wong.


Readers' comments (8)

  • This study does not surprise me in the least. As an RGN who works with children as often as with adults, I completed an ENB course for 'contributing to' the care of sick children, (I was actually a team leader with Child Branch nurses under my supervision at the time). As part of that course I spent several weeks working on paediatric wards. The potential drug errors that I intervened to prevent made me shudder, even in the high dependency area. They were too numerous and varied to list here. Too many of the paediatric nurses did not seem to have a clue about drugs/ strengths/calculations etc. and back on the area where I worked, they were always coming to me to do calculations as they did not know how to. If my children were still small, I would not let them be given any drugs in hospital unless I had checked them myself. It is a worry that this remains a serious problem.

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  • I am not a top nurse as the one from the previous comment, just an ordinary staff nurse. I work for a teaching hospital on a high dependency specialised paediatric ward. Well, this study DOES surprise me! In my 11 years long practice the mistakes made solely by the nurses on our ward are very few, and to say we've prevented mistakes being made due to wrong prescription by doctors, is quite right! We do check our policies, the BNF and the protocol, and whenever anything is a bit unclear, we check with the pharmacist! So the comment "The top nurse" made, has offended us all - we all read "Nursing Times"! If the practice where she completed her ENB course was so appalling, why she did not report this to the management and have the nurses retrained, but kept it quiet? We DO KNOW how to calculate medicines, the right way to give them, and to the right patient! And we DO KNOW what the drugs are for, their strength, different preparations, side effects etc! And NO, we are not asking anybody to do the calculations for us! Even the student nurses can calculate drug doses, we've drummed into them the formulae and we are asking them to know what the drugs are for! So the research comes as a surprise to me, and the comment above is quite offensive! It gives us staff nurses a bad name - I don't even want to think what the public would think of us after reading all that! And to say, in any one of the three Trust's hospitals I would be happy to leave my children into their care! With all staff shortage and increased workload we are doing our best to care for our patients and their families too. So please do not make us look bad, because we are definitely not!

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  • I do think that drug administration is one skill that all nurses need to be competent in before qualification and registration.

    However, I would also agree that the first comment is quite unfair in labelling paediatric nurses as being incapable of calculating drug doses and administering medications safely. This is a problem across the profession, including adult nursing and we have to remember that this is one study based in London, where there is a dense population of childrens hospitals. Furthermore, although the authors feel that this data is relevent despite being 5 years old, I feel that clinical areas are now quick to learn from adverse incident reports, with Trusts placing medication safety high on their clinical governance agenda.

    Paediatric drugs errors are more often related to human error and misplacement of a decimal point, rather than incompetency. I am sure most nurses have made a calculation error at least once in their career, yet that does not make them incompetent. It is because of the complexity of drug calculations within the paediatric settings that most Trust require a second nurse to check the dose prior to administration.

    However, if I had concerns regarding any registered nurses ability to administer drugs safely, I would be addressing the problem through education (as a role model) and if necessary, their manager, in order to protect patients in their care.

    I think we need to spend more time supporting our professional colleagues rather than knocking them down.

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  • the article doesn't say who is prescribing these medicines for children and the hopsital I work in only allows some trained nurses to give paracetamol and brufen. Everything else needs to be prescribed by a doctor, so the fact that pharmacists are correcting prescriptions makes me think these are doctors prescribing not nurses. The 13% of the 3000 prescriptions that the researchers looked at is 390 and of these they only stopped 5 drugs being given, a small proportion in fact. All paediatric drugs are checked by two nurses in an effort to stop drug errors. The comment above from the adult trained nurse is quite offensive to myself as a lot of errors that we have found have been done by adult only nurses looking after children mainly in mixed accident and emergency departments. We spend a lot of time ensuring that all nurses can work out the required medicines having to do specific training which involves a maths assessment.

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  • So what is the point of a nursing degree?
    Perhaps they should have better more old-fashioned training on the job over a longer period like they used to do thirty years ago. Whoever thought of the degree-ification of nursing idea to find an excuse to pump up nurses salaries, ought to be strung up.
    The business of creating suoer-nurses could have worked perfectly well within the apprenticeship style training. Taking the best nurses out for further training would have been far superior to inculcating a culture which made every Tom Mary, and Tracey, think they were sub-doctors. A big, big, mistake. Nursing is a technical profession with some social skills added on. If it is anything else, you end up with nurses failing to prescribe properly, patients not being fed, and new patients bineg put on bloody infected matresses. Nurses think they are doctors....

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  • Shooting the messenger doesn't alter the facts. ('top nurse'?- I did not say I was a 'top nurse', I said I was a team leader, which I was, is that wrong?). The comment I posted told the truthful facts about experiences I had, which support the findings in the article above and which occurred about the same time as that research. Not saying something does not make it not so. The reply below my comment also makes the assumption that I did nothing about these 'near misses'. Remember, I was in that situation as a learner and on reporting my concerns I received the same rather hostile reception that I did here. Damned if you do and damned if you don't............. The report found 20% of the medicines given to children during their study were incorrect. We are all human and we all make mistakes, me included, but that is, surely, 'too many' by anyone's standards and I genuinely thought what I saw on that placement was also too many. Having at the time a child with medical conditions which could have meant she was admitted to those wards, it scared me as it would scare any mother. How would any of us feel if it was our child and there was a serious error?

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  • This debate seems to be getting rather heated!
    I am invovled with nursing research and have done some studies looking at medication errors. The important thing to remember here is that everyone will make mistakes, that is the nature of the human being. There is a lot of evidence to suggest that errors are caused by issues in the process or system within which they occur. It is also well document by the NPSA that children are at a special risk of errors for all the reasons that have been mentioned above.

    I think the thing to take away from this study is not the fact anyone is saying nurss are incompetent, it is to look at why these errors occur from the start to the finnish and work out how to reduce them.

    I have looked up the study by Wong and it does not mention that nurses were actually prescribing so i think the article in NTimes is a little misleading. But that is the nature of media that they want to create a reaction!! In this case they have been very successful.

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  • I am Human Factors trainer in the UK aviation industry so as an outsider I am very interested in errors committed in safety critical industries.

    Does the NHS promote Human Factors and their causes? do they promote Prof James Reason study of human error in the medical proffesion? Just a thought as we read alot about medical error but is the error being addressed successfully.

    Just a thought

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