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PSNet: Patient Safety Network
Journal Article

Interventions to reduce pediatric medication errors: a systematic review.

Rinke ML, Bundy DG, Velasquez CA, et al. Pediatrics. 2014;134(2):338-360.

Pediatric patients are at particularly high risk for medication errors. Numerous strategies have been suggested for decreasing this preventable harm, but few have been robustly tested. This systematic review sought to determine the effectiveness of interventions to reduce pediatric medication errors, though many limitations and gaps were identified in the current literature. For example, only 1% of studies were conducted at community hospitals, and only 11% were in ambulatory settings. Also, even though 41% of studies involved computerized provider order entry, a meta-analysis could not be performed due to inconsistent methodology between studies. The review did highlight several promising interventions that improved medication safety, including clinical decision support tools, provider education programs, and preprinted order sheets. An AHRQ WebM&M commentary emphasizes the high potential for weight-based medication errors in pediatrics and provides recommendations to help mitigate this risk.