Drug errors found to affect 1 in 15 children

CHICAGO - Medicine mix-ups, accidental overdoses, and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method.

That number is far higher than earlier estimates, and bolsters concerns already heightened by well-publicized cases such as the accidental drug overdose of actor Dennis Quaid's newborn twins in November.

"These data and the Dennis Quaid episode are telling us that . . . these kinds of errors and experiencing harm as a result of your health care is much more common than people believe," said Charles Homer of the National Initiative for Children's Healthcare Quality. His group helped develop the detection tool used in the study.

Researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children. That compares with an earlier estimate of two per 100, based on traditional detection methods. The rate reflects the fact that some children experienced more than one drug-treatment mistake.

The new estimate translates to 7.3 percent of hospitalized children, or about 540,000 youngsters each year, a calculation based on government data.

Simply relying on hospital staffers to report such problems had found less than 4 percent of the problems detected in the new study.

The new monitoring method developed for the study is a list of 15 "triggers" on young patients' charts that suggest possible drug-related harm. It includes use of specific antidotes for drug overdoses, suspicious side effects, and certain lab tests.

By contrast, traditional methods include nonspecific patient chart reviews and voluntary error reporting.

The researchers said their findings highlight the need for "aggressive, evidence-based prevention strategies to decrease the substantial risk for medication-related harm" to hospitalized children.

The study is being released today in the April issue of the journal Pediatrics.

It involved a review of randomly selected medical charts for 960 children treated at 12 freestanding children's hospitals nationwide in 2002. Triggers mentioned in the charts promoted an in-depth review of the patients' care.

Patient-safety experts said the problem is likely bigger than the study suggests because it involved only a review of selected charts. Also, the study didn't include general community hospitals, where most U.S. children requiring hospitalization are treated.

Study author Paul Sharek said evidence is needed to show whether a big push to prevent medical errors in recent years has put a dent in the problem since 2002, when the data were gathered.

Homer, of the children's health-care initiative, said some hospitals have started using trigger methods similar to those in the study. But he added, "we still have a long way to go."

Among triggers on the list was use of the drug naloxone, an antidote for an overdose of morphine and related painkillers. Symptoms include breathing difficulty and very low blood pressure.

More than half the problems the study found were related to those powerful painkillers, including overdoses and allergic reactions.

While 22 percent of the problems were considered preventable, most were relatively mild. None was fatal or caused permanent damage, but some had "the potential to cause some significant harm," said Sharek, medical director of quality at Stanford University's Lucile Packard Children's Hospital.

Quaid's twins got accidental life-threatening heparin overdoses in a Los Angeles hospital shortly after they were born in November. The babies have recovered. Quaid and his wife, Kimberly, have formed a foundation to prevent medical errors.