Drug Use and Type of Adverse Drug Events–Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital
Received 26 September 2019
Accepted for publication 13 December 2019
Published 31 January 2020 Volume 2020:12 Pages 31—40
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Rajender Aparasu
Per Nydert, 1, 2 Maria Unbeck, 3, 4 Karin Pukk Härenstam, 1, 5 Mikael Norman, 1, 2 Synnöve Lindemalm 1, 2
1Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden; 2Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; 3Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; 4Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; 5Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
Correspondence: Per Nydert
Astrid Lindgren Children´s Hospital at Karolinska University Hospital, Stockholm SE-171 76, Sweden
Tel +46 8 51770000
Purpose: The objectives of our study were to determine drug use, type and incidence of all adverse event associated with drug or drug-related processes (Adverse Drug Events, ADE) among pediatric inpatients in relation to hospital unit and length of stay.
Patients and Methods: 600 pediatric (0– 18 years) admissions at a Swedish university hospital during one year were included and stratified in blocks to 150 neonatal, surgical/orthopedic, medicine and emergency-medicine unit admissions, respectively. Adverse events were identified from medical records using a pediatric trigger tool. All triggers identifying an adverse event related to drugs and drug-related devices were included. Data on drug use were extracted from the hospital drug-data warehouse.
Results: In total, 17794 daily drug orders were administrated to 486 (81.0% exposed) admissions. Parental nutrition, potassium salts and morphine constituted half of all high-risk drugs prescribed. Two-thirds of intravenous irritating drug doses consisted of vancomycin, esomeprazole and meropenem. In 129 (21.5%) admissions, at least one ADE was identified, out of which 21 ADE were classified as more severe (National Coordinating Council Medication Error Reporting Prevention-Index, NCCMERP≥F). The ADE incidence was 47.4 (95% confidence interval: 39.4– 57.3) per 1000 admission days and varied by unit category. In neonatal units, 56.9 (49.5– 65.4) ADEs/1000 admission days were detected, in surgery/orthopedic 54.2 (40.3– 72.8), in medicine 44.1 (33.1– 58.7), and in emergency-medicine 14.3 (7.7– 26.7) ADEs/1000 admission days were found. The most common types of ADEs were identified by triggers that were not directly aiming at drugs including insufficiently treated pain (incidence peaking already in the first days), skin, tissue or vascular harm (peaking at the end of the first week) and hospital-acquired infections (peaking in later admission days).
Conclusion: Adverse drug events are common in pediatric patients. The incidence of ADEs and type of ADE varies by hospital unit and length of hospital stay.
Keywords: patient safety, pediatrics, adverse drug event, pharmaceutical preparation, inpatients
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