Many medications and medical devices can result in preventable harm in pediatric patients. This article describes one hospital’s efforts to implement explicit, structured processes and huddles to increase situational awareness regarding high-risk therapies among the care team and family members. After implementation, the percentage of electronic health record (EHR) alerts correctly describing high-risk therapies increased from 11% to 96%.

Medication administration in pediatric patients can be complex and requires specialized dosing. In this observational study including over 15,000 medication orders, drug formulation manipulation was three times more common in pediatric versus adult inpatient practices. Manipulations most commonly involved oral liquids and intravenous orders and occurred most often in patients aged 1 to 12 months.

Pediatric patients are at particularly high risk for medication errors. Challenges pharmacists face when providing care for children include a lack of standard dosage forms and concentrations and patient inability to describe symptoms. These guidelines provide practical recommendations to improve the safety of pediatric pharmacy services.

The vast majority of warnings about warfarin (a commonly prescribed anticoagulant) generated by a bar-code medication administration system were clinically insignificant.

Pediatric inpatients are at high risk for adverse drug events (ADEs). Pediatric-specific trigger tools and computerized surveillance systems are effective methods to detect ADEs and identify opportunities for prevention. This performance-improvement collaborative implemented a multifaceted change strategy in 13 institutions and produced a 42% reduction in ADEs. The change strategies included efforts to reduce interruptions during medication administration, adopt consensus-based protocols and order sets, ensure high reliability with the Five Rights, and foster a culture of safety. The interventions had the greatest impact on opioid-related ADEs, which decreased by 51% across participating hospitals. The authors recommend using quality improvement collaboratives to drive improved patient care.