Prevention of Medication Errors in Pediatric Patients

Year 2010, Volume: 17 Issue: 1, 63 - 71, 01.03.2010

Yrd. Doç. Dr. Ebru Kiliçarslan Törüner Prof. Dr. Firdevs Erdemir

Abstract

Children are particularly sensitive group that should be considered in all efforts which aim to prevent the medication errors and to provide safe of medication administrations. The increased need for calculations, dilutions and manipulation of pediatric medicines, together with a need to dose on an individual patient basis using age, body weight and/or surface area, means that they are more prone to medication errors at each stage of the medicines management process. Consequently, the risk for being harmed due to medication errors in pediatrics may increase. Dose calculation errors are the most observed medication error type in pediatric and neonatal units. This type of error may occur because of nonexistence of commercial forms of medicine for children, packaging, labeling, prescription system, working conditions of profession or special characteristics of the professionals. Accordingly, when taking measures for minimizing the medication errors, all these effects and processes should be taken in to consideration. To decrease the medication administration errors, recommended precautions and practices for nurses included careful medication calculations, double-check of medications, informing the child and care giver about pediatric medication, reporting the medication errors, and arranging the working conditions to diminish the distractions. In this article, the most common medication administration errors and recommendations to prevent medication errors in pediatric patients were discussed.

Keywords

Medication error, child, nursing, medication administration, error measures

Pediatrik Hastalarda İlaç Uygulama Hatalarının Önlenmesi

Abstract

İlaç uygulama hatalarının önlenmeye ve güvenli ilaç uygulamalarını sağlamaya yönelik çalışmalarda çocuklar özel dikkat gösterilmesi gereken hasta grubunu oluşturmaktadır. Pediatrik ilaçlarda gereken dozun çocuğun yaşına, vücut ağırlığına ve/ veya vücut yüzey alanına göre hesaplanması, ilaçların sulandırılması, sulandırılan ilaçtan istenen dozu elde etmek için hesaplamaların gerekmesi ilaç uygulama süreçlerinin her bir evresinde hata olasılığını artırmaktadır. Dolayısıyla, çocuğun ilaç hatalarına bağlı zarar görme riski artmaktadır. Pediatri ve yenidoğan ünitelerinde en sık görülen ilaç uygulama hatası tipi doz hesaplama hatalarıdır. Bu hatalar ilaçların çocuklara özel ticari formlarının bulunmamasından, ürünün paketleme, etiketleme ve adlandırma sisteminden, reçeteleme/ istemleme ve istem iletimi sistemlerinden, mesleğin çalışma koşullarından, profesyonel uygulamanın özelliklerinden kaynaklanabilir. Dolayısı ile ilaç hatalarının en aza indirilmesi için önlemler alınırken tüm bu etkenler ve uygulama süreçleri göz önünde bulundurulmalıdır. İlaç uygulama hatalarının azaltılmasında hemşirelere yönelik önerilen önlem ve uygulamalar arasında dikkatli doz hesaplamaları, çift kontrol, çocuk ve ailenin bilgilendirilmesi, hataların bildirimi, çalışma koşullarının düzenlenerek dikkat eksikliğine bağlı hataların azaltılması yer almaktadır. Bu makalede, çocuk hastalarda sık görülen ilaç uygulama hataları ve bu hataların önlenmesine yönelik öneriler tartışılmaktadır.

Keywords

İlaç hatası, çocuk, hemşirelik, ilaç uygulamaları, hata önlemi

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