An Assessment of Medication Errors among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country

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 in three hospitals in Freetown, Sierra Leone.
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 against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs that were 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: 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 for pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and the number of medicines prescribed (r=0.211, P=0.015).
Conclusion: Low GAS depicts poor compliance with prescription writing guidelines and high prescribing 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.

Keywords:  Pediatrics, Prescription, Medication errors, Drug-drug interactions, Sierra Leone