ABSTRACT
Background: Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients. Methods: The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal-Wallis H and Mann-Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p<0.05 considered statistically significant. Results: Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80-100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80-100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=<0.001), treatment (p=0.022), and prescriber (p=<0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015). Conclusion: A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.
ABSTRACT
OBJECTIVE: This study sought to describe the prevalence and clinical outcome after emergency blood transfusion among children presenting with severe anemia in a tertiary children's hospital in Sierra Leone. METHOD: This was a retrospective study of 395 children who received emergency blood transfusion at the Ola During Children's Hospital in Freetown. Association between mortality and sociodemographic and clinical factors was assessed using χ2 test. Statistical significance was set at P < 0.05. RESULTS: Three hundred ninety-five of 4719 children (8.4%) admitted to the emergency room of the Ola During Children's Hospital received emergency blood transfusion within 24 hours of presentation. Twenty-five (6.3%) were excluded because of incomplete data. The median age of the subjects was 24 months (interquartile range, 14-48). There were 191 boys (51.6%) and 179 girls (48.4%), giving a male/female ratio of 1.06:1. The most common indication for emergency transfusion was severe malaria anemia (67.8%). The mean hemoglobin concentration before transfusion was 4.8 g/dL (±1.4 g/dL). A total of 339 children (91.6%) were discharged home, 8 (2.2%) were discharged against medical advice, and 23 children (6.2%) died. The median length of stay on admission was 3 days (interquartile range, 2-5). Children with severe sepsis (P < 0.001) and those with pretransfusion hemoglobin concentration less than 5% (P = 0.047) were significantly more likely to die after transfusion compared with the other categories of patients. In a multivariate regression analysis, none of the factors were independently associated with clinical outcome after blood transfusion in children who received emergency blood transfusion. CONCLUSION: The study suggests that emergency blood transfusion in children with severe anemia may improve in-hospital survival.
