Pediatric Informatics: Computer Applications in Child Health (Health ...

Chapter 25
Overview of Pediatric Inpatient
Medication Delivery
George R. Kim and Robert E. Miller
Objectives
To provide a framework for thinking about medication processes, focusing on
medication use and error prevention
To outline general and pediatric-specific vulnerabilities in medication delivery
To discuss pediatric-specific issues that technology can address
25.1 Introduction
The term “medication process” includes all aspects of the management of
pharmaceuticals used in the care of patients: drug manufacture (creating, packaging,
and assuring the quality and safety of medications for human use), pharmaceutical
procurement (acquiring, storing, and managing medications for patient care), medication
reconciliation (identifying, verifying, and realigning a patient’s current drug
regimen with the intended care plan when a change in medical care (admission,
discharge, transfer) occurs) and medication use. Medication use is the process of
prescribing, ordering, compounding, dispensing, and administering drugs, monitoring
(and documenting) their effects on patients. It is the last aspect of which this
section is an overview, and which is the focus of subsequent sections.
The complexity of each of the above-mentioned processes, within their respective
complex environments (chemical manufacturing plants, pharmacies, hospitals, and
clinics) makes medication processes inherently error-prone. Of these processes, the
largest negative impact on patient health comes from errors in mediation use. Illegible
handwriting, numerous human hand-offs of instructions, complex patient data, critical
drug dose information and ever-changing formularies of drugs with varying degrees
of potency and toxicity all contribute to the vulnerabilities and errors in medication
use, and to the challenges of efficiently and safely managing them. Not surprising,
adverse drug events (ADEs) result in more than 770,000 injuries and deaths each
year in the US and cost up to $5.6 million per hospital. 1
C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 331
in Child Health, Health Informatics,
© Springer Science + Business Media, LLC 2009