Medication errors have been found to be quite persistent in the medical field. This is especially because of underlying system factors that require finding out. The paper ‘ Interventions for Reducing Medication Errors in Children in Hospitals ’ by Maaskant et al., (2015) is critiqued in this paper to determine the effectiveness of the paper as a systematic review of literature in the subject of medication administration errors among children.
Search Process
The purpose of this study was to appraise empirical evidence that was offered relating to the major interventions for medication errors especially in the administration of medication within the hospital setting for children. The study made use of Cochrane Library alongside the Cochrane Database of Systematic Reviews and Database of Review of Effects (DARE) for articles published on the subject. The subject was not limited to language or date. After the inclusion and exclusion criterion was applied, various titles, abstracts and content were sieved and a number of articles located for the purpose of the study. Where articles did not make mention of data relating to medication administration errors (MAEs), those studies were not included.
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When reviewing the background and objective of the study, we realize that research has pointed to the seriousness of medication administration errors in the hospital setting. Not only does this affect the quality of care offered to the patients, it also shows a large amount of negligence on the part of the care provide, which could lead to serious legal repercussions for the hospital and the individual professional (Leape, 2009). Additionally, a large amount of patient admissions can also find their root cause in medication errors (Kongkaew, Hann, & Mandal, 2013). As a result, the purpose of this study is clearly outlined in showing the most common interventions to counter medication errors among children in the hospital setting for the provision of higher quality of care.
Levels of Evidence and Design Critique
The literature search method used was searching through electronic databases containing nursing data on the subject. Different databases as mentioned above were used. All of these are respectable peer-reviewed databases where data found thereon would be resourceful in finding accurate nursing data on the subject. For the purpose of data collection, randomized controlled trials were investigated with before-after studies being incorporated. These observations noted the impact of various interventions in improving medication safety for children under the age of 18 years. Measures investigated include medication errors, unintended consequences of interventions, potential harm and resource utilization. Hand-searching was done among the results to identify the best possible studies to use in the course of the study, removing duplicate citations and further manually examining the titles.
This shows the rigor through which the data was passed through before coming up with the 54 studies which were used in the course of this systematic review. From the studies obtained, a medication administration error was defined as a deviation from the prescriber’s medication as written in the patient’s chart or relevant policy (Keers, Williams, & Cooke, 2013). In this case, pharmacy and prescription related errors were not included in this definition, while ward-level and dispensing errors were considered. The data extracted from the search was consolidated into relevant themes using GRADE tables, which could accurately categorize and present the data obtained (Reason, 1990). Papers were not considered in terms of frequency so as not to mislead readers on the level of the burden, but were classified depending on the need for future research on the MAE cause or need for potential interventions in the areas of concern.
Clarity of Studies Critique
GRADE tables, in this case, were used because they consider the quality of the body of evidence to determine whether they are worth presenting. GRADE tables were used to summarize the data that was presented narratively throughout the paper as a glancing approach to presenting the review data. A quality assessment exercise was conducted to determine the viability of the studies in obtaining the information necessary for the interventions for MAEs. Only seven studies were primarily interested in determining the interventions for MAEs among children to come up with five different interventions.
Overall Findings of Systematic Review
The results of the study found several interventions for MAEs. Some of the successful interventions found were: the participation of a pharmacist in the care team, a computerized order system for the physician, an execution of a barcode medication administration system, the use of structured prescription forms and the creation of a feedback system. For the first two interventions, their frequency among the studies was at two, while all the other studies were spoken of at least once. Meta-analyses to determine heterogeneity between the studies was precluded. Despite some interventions showing a decrease in medication errors, results are not consistent. Moreover, significant reductions in patient harm were not seen in any of the results. Therefore, the strength of the evidence from this study was low.
Critique of Conclusions and Implications for Current Practice
With this in mind, evidence from the systematic review reveals that staff responsibility for medication errors is largely due to unsafe acts on their part. Nonetheless, the work environment of the care professionals largely influences the ability to make right decisions regarding medication administration (Keers R. N., Williams, Cooke, & Ashcroft, 2013). One of the strengths of this review is its ability to review the hospital environment over the last three decades to provide critical review of the causes of medication errors in the hospital environment. Most studies reported the potential of unsafe acts and the latent pathway as major causes of medication errors. It would be plausible, then, to say that interventions involving the rehabilitation of the care professional would largely reduce the occurrence of medication errors in the general hospital setting, and specifically for the pediatric sector (Kaushal, Barker, & Bates, 2001). Nonetheless, this is an area for further research as more evidence is needed to make conclusions.
In conclusion, the authors find inadequate research in intervention methods for the pediatric population with regards to medication errors. Current evidence remains quite limited. Therefore, there is a need for comparative studies which focus on pediatric medication safety. Such studies should have robust designs that are more likely to collect more and higher quality data on the subject. This is because, this systematic review, without time or language restrictions, has only yielded very little evidence towards meaningful interventions for medication errors among children in the hospital setting.
References
Kaushal, R., Barker, K. N., & Bates, D. W. (2001). How can information technology improve patient safety and reduce medication errors in children's health care? Archives of pediatrics & adolescent medicine, 155(9) , 1002-1007.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11) , 1045-1067.
Keers, R., Williams, S., & Cooke, J. (2013). Prevalence and nature of medication adminstration errors in healthcare settings: a systematic review of direct observational evidence. Annual Pharmacotherapy, 47 (2) , 237-256.
Kongkaew, C., Hann, M., & Mandal, J. (2013). Risk factors for hospital admissions associated with adverse drug events. Pharmacotherapy .
Leape, L. (2009). Errors in Medicine. Clin Chim Acta, 404 (1) , 2-5.
Maaskant, J. M., Vermeulen, H., Apampa, B., Fernando, B., Ghaleb, M. A., Neubert, A., & Soe, A. (2015). Interventions for reducing medication errors in children in hospital. (C. E. Group, Ed.) The Cochrane Library .
Reason, J. (1990). Human Error. Cambridge: Cambridge University Press.
