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

28 Medication Administration and Information Technology 359
verification steps, 10% with pharmacy dispensing and the remaining 40% with the
medication administration process. Specific conditions or issues increase the risk
of harm to patients in medication administration by increasing the probability or
impact of errors.
28.3.1 General Risks
ISMP high-risk drugs 2 have higher administration complexities or toxicities.
Investigational drugs pose added risks to patients due to their experimental
nature and undocumented interactions with disease states and other drugs.
Sound (or look)-alike medications increase the risk for “wrong drug.”
Central venous catheters pose a risk for preventable blood stream infections.
Continuous infusions (including total parenteral nutrition) make drugs and their
effects (including toxicities) immediately available on delivery.
28.3.2 Pediatric and Neonatal Specific Risks
Alternative routes of administration for the same drug may result in wrong-form/
wrong-dose/wrong route errors. Rectal and intramuscular routes (which may be
dosed differently) are frequently used when intravenous and oral routes are
unavailable.
Smaller margins for errors due to smaller absolute dose volumes may result in
acute errors of high impact (decimal place errors or cumulative errors over time,
such as for chemotherapeutic drugs).
Prescriber unfamiliarity with pediatric dosing by clinicians who care for children
infrequently (such as general surgeons and/or non-pediatric residents on
rotation on pediatric services) requires higher vigilance in catching errors prior
to administration.
Alternative (liquid) forms of medications require carrier fluids that may interact
with other drugs.
Multiple births, especially in neonatal intensive care, increase the risk for
“wrong patient” errors.
Variability in redundant patient identification by infants and young children
when caretakers are unavailable (such as in intensive care) may increase the risk
for “wrong patient” errors.
Breast milk, a bodily fluid that is infant nutrition and that may serve as a medium
for infectious agents, is prone to administration errors. Reported NICU breast
milk management errors have included “wrong route” 3,10 and “wrong patient” 4
errors (with concerns of infection). In addition, prolonged storage of breast milk
has been associated with decreases in bactericidal and antioxidant capacity. 5,6
Continuous infusions using standard infusions in very low weight neonates have
posed challenges.