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children and drugs: the medicating of america’s pediatric population


Medication Errors Children

I don’t think that crashing a 727 jet every day and killing everybody aboard is a good standard of care in U.S. hospitals.  If that happened in aviation, they would shut the airlines down.”   From Paul Levy’s Not Running a Hospital Blog.  Levy is an author, speaker, and former CEO of Beth Israel Deaconess Medical Center in Boston.

Prescribing errors are the most common medication errors in primary care practices.   Most of the medication errors in primary care practices are prescribing errors, and more than half of these errors reach patients, concludes a new study.  Since 2003, 200,000 out-of-hospital medication errors have been reported to poison control centers (PCCs) in the United States annually, and∼30% of these involve children under 6 years of age.  From the February 2009 issue of the Agency for Healthcare Research and Quality (Prescribing Errors are the Most Common Medication Errors in Primary Care Practices: Research Activities).

The Institute of Medicine’s report, “To Err is Human: Building a Safer Health System” bears witness to the fact that medical errors are not uncommon. According to this report, which defined an error as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim”, over one million preventable adverse events occur each year in United States hospitals as a result of healthcare. Of these events, an estimated 100,000 caused patients serious harm, while between 44,000 and 98,000 led to death in hospitals in the United States. According to this report, more people die annually from preventable adverse events related to healthcare than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516) in the United States. This grim report indicates how common it is for medical practitioners to make errors in their day to day clinical practice.”  Dr. AK Edwin from a 2009 issue of the Ghana Medical Journal (Non-Disclosure of Medical Errors an Egregious Violation of Ethical Principles).

“Any preventable medication event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.”  The definition of “Medical Error” from the study discussed below.

A Jumbo Jet crashes, killing everyone on board.  It’s a big deal — in the news and on the TV for weeks — maybe months.  Now realize that Paul Levy’s quote from above gets it all wrong.  The truth is, we’ve known for at least a decade that medical errors are killing far more Americans than this every single day of the week, every month of the year, all year round (HERE & HERE).  There are multitudes of studies on drug errors concerning adults.  But what about our nation’s children?  Unfortunately, excepting COUGH MEDICATIONS, the rates of medication errors for every major class of children’s drug continues to skyrocket.

A brand new study from the latest issue of Pediatrics (Out-of-Hospital Medication Errors Among Young Children in the United States, 2002–2012).  The studies conclusions —– “Increased efforts are needed to prevent medication errors” — don’t even come close to telling the whole story (between 2002 and 2012, a medication error occurred every eight minutes in America’s six and under population  — an average of 63,358 per year).   Now let’s hear, in the immortal words of Paul Harvey, the rrrrrrrrest of the story.

Firstly, the data was all (that would be all as in “all”) taken from the National Poison Database System, which monitors and records calls made to 55 different Poison Control Hotlines here in America.    Doesn’t it make you wonder how many people either took their child to the ER, called their physician, or didn’t call anyone at all (or maybe they called Uncle Bob)?   These children were not counted in the statistics.  Heaven only knows how many other children were not counted as well.  Quite possibly, the vast majority.  But who would know?  It’s called UNDERREPORTING and in this case was probably purposeful.

There is one thing we do know for certain.  When it comes to drug reactions (including VACCINE REACTIONS), the number of people contacting the reporting agencies is less than the number of people who don’t — in most cases, far less.  In fact, many of the studies I looked at said that this number was in the 1 in 100 range (see previous paragraph).  In other words, the statistics above may be so low due to “under-reporting” as to be worthless.  Listen to to these cherry-picked sentences of a 2008 report by Dr. Zane Robinson Wolf, dean and professor, La Salle University School of Nursing and Health Sciences, and Dr. Ronda G. Hughes, senior health scientist administrator for the Agency for Healthcare Research and Quality  (Chapter 35 of Patient Safety and Quality: An Evidence-Based Handbook for Nurses; Error Reporting and Disclosure).

  • “The focus on medical errors that followed the release of the Institute of Medicine’s (IOM) report To Err Is Human: Building a Safer Health System1 centered on the suggestion that preventable adverse events in hospital were a leading cause of death in the United States. 
  • “Because many errors are never reported voluntarily or captured through other mechanisms, these improvement efforts may fail.”
  • “Near misses (i.e., an event/occurrence where harm to the patient was avoided), can occur 300 times more frequently than adverse events.”
  • “Traditional mechanisms have utilized verbal reports and paper-based incident reports to detect and document clinically significant medical errors; yet the correlation with actual errors been low.  Error-reporting mechanisms may capture only a fraction of actual errors.”
  • “Many errors go unreported by health care workers.  Self-reporting errors can be thwarted by several factors.”

Believe me when I tell you that this is merely scratching the surface of under-reporting medication errors.  But let’s forget this for a moment.  What we really need to be collectively asking ourselves why our children are in this position to become “statistics” in the first place.  Let me explain what I mean.  It is my contention that the vast majority of doctor visits for children (not to mention the drugs they are prescribed) are unnecessary (HERE).  We can easily see this when we look at one single class of drugs (ANTIBIOTICS), and the crazy numbers of health issues they are being over-prescribed for (URI’s and EAR INFECTIONS are two of many).   Some doctors would agree.  For a better explanation, I would suggest that everyone own a copy of Dr. Robert Mendelsohn’s How to Raise a Healthy Child in Spite of Your Doctor (HERE).


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