Most parents have had the harrowing experience of taking their sick child to the pediatrician or to an emergency room. This scenario generally includes a miserable child and a concerned parent; both of whom are hoping to walk away with a prescription for medicine that will make it all better quickly. Parents often leave the office with a script in hand, trusting that the doctor is prescribing the right medication in the proper dosage. In most cases, all goes well and the child’s health gradually improves. However, there’s always a chance for error when prescription medications are involved.
“Medication errors are one of the most common medical errors in general,” explains Sergey Kunkov, M.D., director of Pediatric Emergency Medicine at Stony Brook University Medical Center. “In fact, according to the Medication Error Study conducted by the Physician Insurers Association of America, medication errors are the second most frequent and second most expensive event causing liability claims.” 

According to data from www.statehealthfacts.org, over 3.6 billion prescriptions are filled in the United States every year. Given such high numbers, it’s not surprising that the Food and Drug Administration (FDA) has received nearly 30,000 reports of medication errors since 1992—a number believed to be on the low-end, since it only accounts for cases that have actually been reported.
Fortunately, there’s a lot we can do to protect our kids. Read on to learn more about what can go wrong, how the medical community is working to prevent errors and how you as a parent can take an active role in ensuring that a prescription mistake doesn’t happen to your child.

What Can Go Wrong

Adverse reactions to prescription errors can range from mild to severe, depending on the drug being administered and the dosing involved. Typical minor reactions could include feeling lethargic, developing a rash or some gastro-intestinal symptoms. More serious reactions can occur if the child’s allergic to the medication.

“An allergic reaction could include symptoms such as swelling to the face, mouth or throat, wheezing, difficulty breathing and vomiting,” explains Jeffrey Schor, M.D., founder of PM Pediatrics, an after-hours urgent care practice with offices in Syosset, Selden and Bayside. Parents are advised to seek immediate medical attention if your child has any type of respiratory reaction.    
           
“It is actually more common to get incorrect dosing, than it is to receive the wrong drug,” explains Justin LaCorte, M.D., pediatric emergency medicine specialist at Huntington Hospital’s Clark Gillies Children’s Emergency Care Center. “This is especially true in pediatric treatment, which typically involves liquid medication.”
           
The consequences of incorrect dosing vary greatly. “The most minor case would be that the dosage prescribed is too little, so the medication isn’t effective and the child doesn’t get better,” explains Dr. Schor.

On the flip side, the dosage prescribed may be too high, in which case the possible reaction is dependent on the drug. “Too high a dosage of an antibiotic may not cause as much of a problem as too high a dosage of blood pressure medication, which could cause the patient’s blood pressure to drop to dangerously low levels,” notes Dr. Schor. “While medications for ADD are stimulants, too high of a dosage could send the body into overdrive, causing blood pressure to get too high. Any time there is an overdose of any medication that has known serious side-effects, there can be life-threatening consequences.”  

Necessary Changes

“This is a preventable issue and the medical community is acutely aware of these errors,” says Dr. Kunkov, who adds that steps are being taken to prevent such mistakes from happening. 

For instance, dosing is specific to a child’s weight, so the number one push is for doctors to have an accurate measurement of the child’s weight, says Dr. Kunkov. Weight should be written in the chart, with all calculations based on it. Another important factor is that weight is taken in uniform measurements (either kilograms or pounds). “If kilos and pounds are confused, twice as much medicine may be prescribed,” he adds. “Most hospitals are transitioning to a kilos-only scale for the safety of the child.”  

Another scenario involves the child receiving the wrong drug or dosage, either through a mistake made by the prescribing doctor, or because a pharmacist read the prescription incorrectly. Two helpful tools—Computerized Physician Order Entry (CPOE) and Electronic Prescribing—are being utilized more frequently to prevent such errors. With CPOE, the doctor enters prescription information via computer.

“We use CPOE at the hospital,” says Dr. Kunkov. “When the pharmacy receives the prescription, they double check it for the correct dose per child’s weight. Also, the nurse does a double check before administering the medicine.”

With Electronic Prescribing, doctors use a computer or a handheld device to enter prescription information through the special online system, which is then either printed out for the patient or sent directly to the pharmacy. Dr. Kunkov says the computer system checks for mistakes and will also assist with the calculations for dosing, allowing for less room for errors due to medication dose miscalculations and illegible handwriting.

 Parental Vigilance
As parents, we’re our child’s first line of defense.  To help prevent prescription errors, consider the following suggestions from our experts:       

1. Ask questions and write everything down.  Ask the name of the medicine, what it’s used for, how it should be administered (how often, how much, for how long), possible side effects and what to do if a dose is missed. Jot down this information.
2. Verify weight. Make sure your child has been weighed properly and that the dosing prescribed was based on this weight.
3. Verify the drug at the pharmacy. Check the description on the drug label to ensure that it matches the medication itself.  If the description says “this is a pink liquid,” make sure your medication is indeed a pink liquid. Also, double check with the pharmacist that the medication is the correct drug for your child’s ailment. 
4. Mention allergies and other medications to avoid allergic reactions or drug interactions. It’s also helpful to consistently fill prescriptions at one pharmacy, because they generally store allergy information in their computer system. 
5. Watch for dyes and flavorings. “Most of the time there’s no problem unless the child has food allergy,” says Dr. LaCorte. Children with allergies may need to steer clear of medicines that contain dyes or flavorings, but all parents can request a dye-free medication, regardless of allergies. As for flavoring, Dr. Kunkov says that fewer chemicals and dyes are preferable, but if the medication is not palatable without flavoring, your child may not swallow it. “It’s usually better to add the flavoring so the child will take the medication,” he says. If your child has a known allergy, speak to the pharmacist about flavoring options. 
6. Understand prescription labels to ensure proper dosing. Caregivers may read prescription labels incorrectly and accidentally give too high a dose of medication. To ensure an accurate dose, read labels carefully and use a measuring spoon made specifically for children’s medicine. 
7. Organize your medications. “It’s important to keep each family member’s medications separate to avoid giving the wrong medicine to the wrong child,” says Dr. Schor.

Parent vigilance can go a long way in preventing medication mishaps, but if your child shows any signs of a reaction to their medication, discontinue use and contact the prescribing physician or head to the hospital. Parents can also call Poison Control at 800-222-1222 (see sidebar for more information), but Dr. Kunkov advises using common sense. “You know your child best,” he says. “If you think something is wrong, take your child to their pediatrician or to the emergency room.”

Maureen Heaney has vowed to be hyper-aware when it comes to giving medicine to her two children.