Medication errors are a major patient safety problem for children and physicians have a role in their prevention.

Medical errors represent a major public health problem in the United States, and medication errors represent an important subset with specific challenges for providing safe care for children. Medication errors lead to prolonged hospitalizations, unnecessary evaluations and treatments, and occasionally death. Pediatric patients are particularly vulnerable to these errors since dosages are prescribed based upon the child’s weight or body surface area (Fig. 61.1). Children also cannot intercept errors like adults can, and the pharmacokinetics of certain drugs are age-dependent and require alterations in prescribing (Fig. 61.1).

To combat these sources of prescribing error, physicians should always make a point of performing medication calculations themselves, making use of computerized calculations and other decision support tools, such as reference texts and ordering outlines, that help to provide appropriate reference material at the point of calculating and prescribing.

Documentation of the formula used and the actual calculations is helpful, because calculation errors can be detected more effectively.

In addition to recognizing calculation errors with this type of documentation, dosage errors can also be identified. In the example above, a therapeutic dose of erythromycin to treat an acute infection is 50 mg/kg/day; however, the use of erythromycin as a prokinetic agent is dosed at 20 mg/kg/day. A number of sources are available to help the physician confirm the dose of a medication, including The Harriet Lane Handbook and personal digital assistant (PDA) programs, such as Epocrates.