Pediatric Medication Safety in Emergency Department

Running head: PEDIATRIC MEDICATION SAFETY IN EMERGENCY DEPARTMENT
PEDIATRIC MEDICATION SAFETY IN EMERGENCY DEPARTMENT
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PEDIATRIC MEDICATION SAFETY IN EMERGENCY DEPARTMENT
In the recent years, medication error has been resorted to be one of the most common
types of error occurring in different hospitals. The rate of medication error in the pediatric
patients has also been increased and this is threefold to the rate of medication error in the adult
patients. Researchers have recognize the pediatric emergency setting to be one of the place with
the healthcare centers that have the high risk environment for the medication errors (Moreira et
al. 2015). A number of factors may be considered the contributors for the development of such
high-risk climate within the pediatric emergency department. Some of these factors are the
handling of the complex patients with multiple medications that are seen to be mainly unknown
to the emergency department staffs. Others are the lack of standard pediatric drug dosing as well
as formulations. This also include weight based dosing, a hectic and strenuous environment with
frequent interruptions from the different stakeholders as well as verbal orders (Sethuraman e al.,
2015). Many other contributors are the lack of clinical pharmacist in the Ed care tem that also
accompanies the inpatient boarding status. Some of the other features include the improper use
of the information technology systems that are mainly seen to lack the features of the pediatric
safety and different transitions in the care. Many of the studies also refer to the fact that a large
number of pediatric patients requiring emergency treatment are seen to go to the community care
centers rather than the pediatric hospitals which might not have the expertise or the resources to
treat emergency pediatric patients (Tanner et al. 2017). This assignment will try to shed more
light on the topic and will highlight how different interventions can be adopted by professionals
to help in developing a safe environment in the emergency department of the pediatric patients.
It has been seen that medication error is one of the most common form of error that occur
in the emergency departments affecting children largely. Children become more vulnerable and
get exposed to chances of preventable deaths than in comparison to that of the adults. One of the
most important factors that is seen to contribute in medication error is that the children come in
different sizes. This, in association with the necessity of weight based dosing is mainly seen to
give a very hard time for the nursing professionals in the tensed climate in the emergency
department that makes them conduct math errors (Patton et al. 2017). One of the studies has
given an example stating that 10-fold error is one of the most dangerous errors that threaten the
life of individuals. The study has stated that children can be administered with 10-fold dose in a
single syringe. However, this might never provide a visual cue to the professional who is
administering the medication in comparison to giving the 10 prefilled syringes with medication

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PEDIATRIC MEDICATION SAFETY IN EMERGENCY DEPARTMENT
like that when administering epinephrine to the adult patient (Ruddy et al. 2015). Therefore, this
kind of situations results in the medication error in the emergency department exposing the child
to unsafe practices. Another example that can be also stated is the use of heparin that researchers
have stated to be risky for the administration to that of the small children.
It is extremely important for the professionals to perform math properly for conversion of
the doses in the milligrams to that of the millimeters. This becomes one of the factors for
occurrence of medication errors in the children who are admitted. Many of the researchers have
opined that in many cases math errors may be mainly because of the poor mathematics skills..
Moreover, other additional factors that may also result in math errors during dosing is the wok
climate that often includes chaotic as well as hurried pace in the emergency department (Hansel
et al. 2015). This is mainly because often the situations become such that dose calculations
become nearly impossible. The professionals also face many other challenges when they try to
administer medications in the emergency departments. It has also been seen that the medications
that are administered and provided to the children in the emergency setting are used off-label. By
this statement, it means that the medications are not been approved through the same type of
trials in the pediatric patients as that happens for approval of medications for that of the adults in
the Food and Drug administration approval (Stevens et al. 2015). It might also imply that
sometimes, the medication may be available in the form that might not be considered proper and
appropriate for the dosing of that of the small children. Many of the pharmacists are of the idea
that even if the medications are available, the appropriate forms of medication might not be
stocked by the respective facilities with mainly an aim to limit the inventory. Often nursing
professionals are seen to uptake certain creative forms of doing solutions. Many a cases have
been reported where nurses have been seen to use an intravenous form of medication that they
mix with the cherry syrup and then administer them orally (Mc.Donald et al. 2018). When asked
to the nurses, many of them were seen to be stated that they have seen their seniors to do so
while many other say that as they work, they tend to follow the protocol. These kind of uncertain
practices become one of the most plausible reasons for the occurrence. One another example that
has been also noted in the observational studies was the administration of the small pieces of the
dissolvable tablet for the sublingual administration in infants and toddlers (Bogner 2018).

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PEDIATRIC MEDICATION SAFETY IN EMERGENCY DEPARTMENT
During the time of the pediatric resuscitations, professionals of many healthcare
emergency departments are seen to face different types of difficulties for the effective
administration of the correct doses to that of the pediatric patient. This might be because if two
reasons. It might be because they do not have a proper child resuscitation cart or it might also be
because their carts may be prepared and arranged in ways by which it might mirror the adult
carts. Nurses might also face apprehensions because a child is involved but they also express
many stressors that result in occurrence of such medication errors in the pediatric patients (Neuss
et al. 2016). Some of the stressors may involve lack of proper equipments for handling the
situation, issue in sizing the equipments if the child. The nursing professionals are also seen to
have a lack of the familiarity with the pediatric doses. They might also face various kinds of
issues in calculation of the doses in the resuscitation situations. They may also face difficulty in
quickly estimating the weight of the child, which might make the sessions of the calculations
much more complicated. Many of the professionals prefer using the cart set up for reflecting the
color zones of the Broselow Resuscitation Tape because of the size variance among different
children. Many of the researchers are of the idea that the professionals should always weigh the
children and record them by following the unit of kilograms rather than pounds (Goldman et al.
2018). There have been many evidences that have reported errors occurring among the
professionals during the converting of the weight from pounds to that of kilograms and vice
versa. Therefore, many of the healthcare authorities have kept the emergency departments where
the scale is locked so that they can only weight in kilograms.
Therefore, most of the researchers are of the opinion that there is an urgent need for
alternation of the culture and these changes should be in regards with the patient safety. One of
the most important aspect that needs to be changed is the reporting systems that would be non-
punitive in nature and should be a blame free environment. This should be such that it would be
possible for the higher authorities and professionals to know and uncover the different potential
for the risks in the emergency departments (Guise et al. 2017). This knowledge would be also
helpful in the development of the communication among team members that would include
handoffs as well. However, one thing must be kept in mind by the healthcare organization is that
the interventions which should be taken should be such that they would keep the patients in the
centre of all the initiatives. This is indeed trying that changes in the culture of the work,
organization and the emergency department would not only be lengthy but also difficult. This is