In a fast-paced emergency room, doctors often need to make calls about treatment quickly. As a result, medication errors happen more frequently in the ER. The Institute of Medicine estimates that 7,000 people die each year in the United States as a result of these errors. Kids are particularly vulnerable since their dosing is often based on weight, which can be difficult to get just right when time is of the essence. Dr. Nirupama Kannikeswaran and Dr. Usha Sethuraman are both emergency room physicians at Children’s Hospital of Michigan in Detroit. They’re conducting research specifically looking at the rates of medication errors that occur in children presenting to the emergency room with mental health issues. Kannikeswaran said this particular population of children tend to stay in the Emergency Department (ED) longer through multiple shift changes with many providers, making them more vulnerable to medication errors. Further, as these children tend to be on multiple medications at when they come in, they are at a higher risk for medication interaction errors. “Those are the main reasons we chose to study this population in particular,” she said. The researchers hypothesize that medication error rates will be higher among children who present to the ED with mental health issues compared to the rest of the children in the ED. To conduct the study, which is being funded by the Blue Cross Blue Shield of Michigan Foundation, the team will retrospectively look at charts of children ages six to 18 years who presented to the ED over a period of time with a complaint related to mental illness. Hospital pharmacy records will be matched to patient records and reviewed for errors in dosing, frequency, allergy and drug-to-drug interactions. Errors will be classified as serious if they had a potential to cause harm, potential to cause failure of therapy or potential to cause non-life threatening adverse drug effects. The data should be compiled by the end of the year and Kannikeswaran hopes to see new processes implemented as a result of the study, to avoid medication errors among children with mental health issues presenting to the ED. “Ultimately the goal is to reduce medication errors completely,” she said. Pediatric patients with mental health illnesses offer a different level of complexity for ED physicians to handle. These children may not be able to express that they’re experiencing a negative reaction to a drug the same way an adult patient would. Changes that could be implemented depending on the research findings include:
- Extra educational efforts for staff about medications that tend to cause the most errors.
- Ongoing education for emergency room personnel about new psychiatric medications and their proper dosing.
- Easy reference guides for the most common general medications and their proper dosing.
- A system of regular pharmacy checks for prescribed medications with every shift change.
The Blue Cross Blue Shield of Michigan Foundation supports research and programs to improve the health of Michigan residents. No grant money comes from the premium payments of Blue Cross Blue Shield of Michigan members. To learn more about BCBSM Foundation grant programs, visit bcbsm.com/foundation. Photo credit: Christiaan Triebert