What is it about?

We looked at published evidence to investigate what causes errors in prescribing medicine for children. We found that differences between children and adults make it hard to prescribe safely. Because children vary widely in size, medication doses are calculated based on their weight. This means that doctors have to carry out challenging calculations, creating opportunities for error. Similarly, because young children cannot swallow tablets, they need medicines in liquid form, creating additional opportunities for error. By describing the root causes of errors, this study points to ways to make prescribing safer. Governments and pharmaceutical companies could work to make medicines more suitable for use in children. When training doctors, educators could focus on the risky aspects of prescribing shown by this study. Hospitals could support doctors by providing more pharmacists and by introducing computerised prescribing systems to help with calculations.

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Why is it important?

Most of the time, medication use is safe and beneficial to children's health. But evidence shows that 13% of medication prescriptions that doctors write for children contain errors. The World Health Organization, concerned with the severity of the problem, have recently launched a campaign, Medication Without Harm, to try to reduce medication errors and the harm that they cause. To support this goal, we decided to examine existing evidence about how prescribing errors in children happen. What we found was that errors result from a wide range of causes, many of which are unique to prescribing for children. These causes were not as simple as a lack of knowledge about medications. Instead, the multiple causes of errors showed that prescribing for children is a complex and highly contextualised process. This knowledge is important because it suggests that, to tackle the prescribing error, solutions will be needed on various levels. For example, educational efforts need to become more sophisticated - giving doctors opportunities to prescribe for children under supervision rather than just learning in the classroom. And educational approaches should also be supported with other measures to support and simplify the process of prescribing.


As a paediatrician I was aware that safe medication use in children brings about unique challenges. Nonetheless, I was surprised by evidence showing how different the prescribing process in children is, and how this contributes to errors. This evidence was valuable, because it points to a need for specific paediatric medication safety solutions, rather than just relying on the same approaches used in adults. Looking at the available evidence, however, I was struck that much of it was based on expert opinion rather than primary research to investigate the causes of errors. I hope that this publication can guide current medication safety efforts, but also serve as a call to the research community to pursue further in-depth study into how medication errors in children happen.

Richard Conn
Queen's University Belfast

Read the Original

This page is a summary of: What causes prescribing errors in children? Scoping review, BMJ Open, August 2019, BMJ,
DOI: 10.1136/bmjopen-2018-028680.
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