Medication errors and adverse drug events in pediatric inpatients.

CONTEXT: Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting. OBJECTIVES: To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies. DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999. MAIN OUTCOME MEASURES: Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts. RESULTS: We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs. CONCLUSIONS: Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.

Awake epidural anesthesia is effective and safe in the high-risk colectomy patient.

PURPOSE: This study was designed to examine the feasibility and safety of performing open colectomy using awake epidural anesthesia in high-risk patients with comorbid illnesses. METHODS: We retrospectively compared 15 high-risk patients who underwent colectomy using awake epidural anesthesia with 17 lower risk colectomy patients who received conventional general endotracheal anesthesia. All patients were operated on consecutively during the same time period by the same surgeon. RESULTS: Based on the number of coexisting diseased organ systems and by a weighted multifactorial index of operative risk, the patients receiving awake epidural anesthesia were significantly more ill than the patients receiving general anesthesia. No differences in complications, length of operative procedure, or number of lymph nodes in cancer specimens were found between the two groups. There was a trend favoring the epidural technique when operative blood loss, length of postoperative hospital stay, and return of bowel function were considered. CONCLUSIONS: Awake epidural anesthesia is a safe and effective technique in high-risk patients undergoing colectomy and achieves an operative risk that compares favorably with healthier patients receiving general anesthesia.

Epidermal growth factor enhances intestinal mitotic activity and DNA content after acute abdominal radiation.

BACKGROUND: Mediators of radiation-induced enteritis and colitis remain undefined. Epidermal growth factor (EGF) is an endogenous peptide that is trophic to the gastrointestinal tract. We tested the hypothesis that EGF enhances DNA synthesis and mitotic activity and prevents acute radiation enteritis after total abdominal radiation. METHODS: Four equal groups (n = 6) of Sprague-Dawley rats were studied: I (control), II (radiation), III (EGF), and IV (radiation + EGF). Animals in groups III and IV received EGF (10 micrograms/kg) every 8 hours for 48 hours before radiation exposure and for 72 hours after radiation, and the remaining animals were given an equal volume of vehicle. Animals in groups II and IV were administered a single dose of abdominal radiation (1000 cGy) 48 hours after the start of either vehicle or EGF. Distal ileum and colon were harvested 72 hours after radiation, examined histologically, and assayed for total DNA content. RESULTS: Group II or radiated animals had diarrhea, significant weight loss (p < 0.05), and decreased food consumption consistent with acute clinical radiation enteritis. Mitotic activity and total DNA content were significantly reduced (p < 0.05) when compared with group I (nonradiated controls). Group IV animals treated with EGF and exposed to radiation did not suffer the acute clinical manifestations of radiation enteritis. In addition, total DNA content and mitotic activity of the terminal ileum increased significantly (p < 0.05), and a significant increase in mitotic activity occurred in the distal colon when compared with radiated controls. CONCLUSIONS: The results of this study suggest that (1) a decrease in mitotic activity and total DNA content occurs early and persists for at least 72 hours after acute radiation, (2) EGF treatment significantly increases small and large bowel mitogenicity in acutely radiated animals, and (3) EGF significantly decrease the acute clinical manifestations of radiation enteritis.