gCHAPTER 5

DISCUSSION
This chapter is where results are interpreted and explained within the thesis or dissertation. This
section delves into the meaning, importance, and relevance of the results. it focuses on
explaining and evaluating the findings from the results, showing how the results relates to the
literature review and my dissertation topic, and making an argument in support of the overall
conclusion. In this chapter, I will discuss the significant findings in my results along with
previously reported findings and proffer possible explanations for my results that are contrasting
to those previously published in the literature.

5.0 DISCUSSION

Forty studies were identified that reported the incidence of Medication errors in children,
of these, 38 were real world studies that documented the occurrence of medication errors either
through observation, review of incidence reports, medical records/charts of patients, as well as
interviews and questionnaires performed by the nurses, while 2 were simulation experiments
aimed at assessing the skill and then areas were errors were likely to occur during the medication
delivery process under a defined medical scenario . Majority of the studies were conducted in the
US ( citation), 4 were from Ethiopia, and 3 from Australia. And 1 each from the United
Kingdom, Taiwan, China, France, Switzerland, and Malaysia. The highest number of study were
observed from the year 2013-2022, this surge could be attributed to an increased awareness of
patient safety and advancements in technology, which may have facilitated both the
identification and prevention of medication errors The least number of publications was observed
from the year 1998-2002.

Following the application of the quality assessment criteria only 29 papers documented at least
two types of medication errors while 7 papers focused solely on one specific error, and 4 did not
specifically state the errors but rather focused on the causes of the errors themselves. This made
classifying the study and its implication a challenging task, as it was not clear what they had
defined that constituted a medication error.
Majority of the studies (35.5%, 13) utilized questionnaires and Observational checklist as their
instrument of study ( cite ), this method proves effective as the observers were trained prior to
the experiment on how to identify specific errors during the medication delivery processes by
various advanced and skilled healthcare professionals (cite). The questionnaire survey was
structured to obtain number of errors and causes of errors based on the perspective of the nurses
and their real life experiences whilst working in the pediatric department as well as test their
understanding of administration guidelines and children pharmacotherapy. The study designs
predominantly consisted of observational and cross-sectional studies, accounting for 51% and
42% respectively, which demonstrates that researchers are more focused on observing natural
occurrences of errors in real-world settings. These study designs may allow for more practical
interventions, as they capture medication errors in their authentic context.

Review of patient medical records, charts, and prescriptions followed as a common method to
determine medication errors (30%, 12) , this review involved the use of specific Analytical tools
( name an analytical tool) to analyses data from patient medical records and charts, as wells as
valid errors that occurred during the course of treatment of the patient these medical report
contain information like the medication ordered by the pediatric residents, emergency medicine
and family practice residence, pediatric nurse practitioners, and attending physicians. The
medication orders are written on a medical chart and carried out by the nursing staff in the
pediatric department (Selbest et al.,1998). as this record analysis were usually supervised by an
external personnel (Fortescue et al.,2003). while incident reports were used in 15% (6) of the
studies.

In terms of population demographics, the nurses involved were predominantly female (92%),
and a large portion had 6-10 years of experience. However, the limited representation of male
nurses (7.7%) and the variable experience levels suggest that staffing diversity and experience
could play roles in error rates, but this area has not been thoroughly investigated. Regarding
patient demographics, children aged 6-12 made up the largest group, with the majority weighing
between 6 and 15 kg. These details align with the typical pediatric inpatient population, which is
more vulnerable to medication errors due to developmental factors like organ immaturity and
varied body weights (Baraki et al., 2018).
The results reveal a wide range of medication errors, with administration errors (75%) being the
most prevalent, followed by prescription errors (35%), omission errors (42%), documentation
errors (27%) and dispensing error (12.5%). The high incidence of administration errors
highlights the need for strict protocols in medication handling. Incorrect dosing was the most
common issue, indicating that dosage calculation and delivery methods should be key areas of
focus in error reduction strategies. Wrong dosage errors was also prevalent in prescribing errors
signifying that not only nurses but clinical physicians need recurrent education on medication
dosage calculations also on knowledge of drug pharmacology to ensure streamlined process of
treatment therapy in children. For instance, Aysun Unal et al. reported that 70.4% of prescription
errors involved incorrect dosages, a critical issue given the narrow therapeutic windows in
pediatric pharmacology (Unal et al., 2020). Kaushal et al. similarly highlighted that 74% of the
errors involved wrong drug prescriptions, with 59.4% involving incorrect dosage, underscoring
the need for precise dosage calculation and careful drug selection (Kaushal et al., 2001). The
recurrence of such errors across various drug classes, including anti-infectives, analgesics, and
sedatives, suggests a systemic issue that requires standardized protocols for prescribing
medication to children.

Medication administration errors, including wrong drug preparation, incorrect dosage, and wrong
route of administration, are alarmingly frequent in pediatric care. Manias et al. observed that
74.5% of the errors involved incorrect medication administration, including wrong dosage and
infusion rates (Manias et al., 2012). The frequency of these errors is particularly concerning, as
they occur at the final step of the medication process and directly impact patient outcomes.
Given the complexity of pediatric drug administration, especially in intravenous infusions, it is
crucial to implement standardized protocols and enhance staff training to minimize these errors
(Conn et al., 2020). Omission errors, where necessary medications are not administered, are
another notable issue. Fortescue et al. reported that 18.9% of errors involved omitted
medications from prescriptions or failures in administration. In pediatric patients, especially
those with chronic or critical conditions, omitted medications can lead to serious health
deterioration. These findings underscore the need for regular review of patient medications to
ensure that all necessary drugs are administered as prescribed (Bonafide et al., 2019).
Documentation and transcription errors, such as illegible prescriptions and incomplete
transcription of medical orders, are another prevalent issue. Lopez et al. reported that illegible
prescriptions and missing necessary information accounted for 55% of the errors observed in
chemotherapy patients (lopez et al., 2022). The consequences of such errors are far-reaching, as
they not only delay treatment but also increase the likelihood of incorrect drug administration.
Further emphasizing the need for improved documentation practices to ensure that all necessary
information is accurately captured.

Dispensing errors, though less frequent compared to other group of errors, still pose significant
risks. Incorrect labeling, dispensing expired medications, and improper preparation of
compounded medications are some of the common dispensing errors identified. For example,
Feyissa et al. found that 16% of the errors were related to dispensing issues, primarily involving
systemic anti-infective medicines and gastrointestinal drugs (Feyissa et al., 2020). Niemann et al.
noted similar trends, especially in patients with kidney and liver diseases, where incorrect
preparation of medications could exacerbate existing health conditions (Niemann et al.,2014)
These findings highlight the critical role of pharmacists and the need for robust verification
processes before medications are dispensed. These errors can stem from systemic issues in the
pharmacy, such as poor communication between healthcare providers and pharmacists, or the
complexity of compounding medications for pediatric patients, which often involves precise
measurements and adjustments

Monitoring errors, though less frequently reported, also present significant risks. These errors
occur when there is a lack of regular assessment of the patient’s response to medication, which
can result in delayed detection of adverse drug reactions or therapeutic inefficacy. Manias et al.
reported a 2.5% rate of monitoring errors, particularly in the use of analgesics and anti-infective
agents (Manias et al., 2012). Given the rapid changes in pediatric patients’ health, continuous
monitoring is essential to ensure that medications are achieving the desired therapeutic outcomes
and to adjust treatment plans as necessary.
Various factors across each study gave crucial insight to the causes of these errors in pediatric
medical care, one of which highlights the role of human factors, such as lack of pharmacological
knowledge and cognitive overload, in contributing to these errors

Moreover, environmental factors such as frequent interruptions during medication tasks (37%)
and poor lighting (12.5%) were found to significantly contribute to error rates. These factors
suggest that improving the work environment could substantially reduce errors.

Lastly, while interventions were documented in only 37.5% of the studies, those that were
implemented showed promise. Technology-based interventions, such as Computerized Physician
Order Entry (CPOE), and education-based interventions like staff training, were particularly
effective in reducing errors. However, the limited implementation of these interventions across
studies suggests that there is still a significant