Using Home Visits to Understand Medication Errors in Children

Current research methods are not well designed to detect medication errors that occur at home. We developed home visit methods to investigate home medication errors in children with chronic conditions. These methods include observation of parent administration of medication to the child by a trained nurse observer who takes detailed ethnographic notes; review of all prescription and over-the-counter medications for dispensing errors, pill counts, and medication reconciliation; and parent interviews to identify barriers to effective home use of medications, prior home medication errors that parents are aware of, and suggestions for systemic improvements. Details about each possible error detected are recorded using a structured data collection form (allergies, medication list, dispensing errors, administration errors). We conducted several pilot home visits and found that this approach has the potential to help understand home medication errors in order to develop interventions to improve the safety of medication self-management. Introduction Despite over 3,000 publications about medication safety over the last 5 years, there continue to be “enormous gaps in the knowledge required to implement a safe medication-use system,” according to the July 2006 Institute of Medicine (IOM) report, Preventing Medication Errors. This report called for research on the rate of errors in ambulatory care, particularly home care and pediatric care, and support for medication self-management. Among children, the rate of potentially dangerous medication errors is three times that of adults and outpatient wrong dose ordering errors are common, due to the complexity of weight-based dosing. 3, 4, 5, 6 Although the majority of pediatric medications are taken in the home, data on pediatric medication errors in the home setting are limited, and risks for children with chronic conditions, who use man medicines, may be great. y 7, 8 Research methods are needed to describe errors in the home use of pediatric medications. Medical record review is not well suited for detecting medication administration errors. The most efficient and accurate method to detect medication administration errors in the hospital setting is through direct observation of nurses by a trained researcher. 11, 12 It is reasonable to expect that direct observation would also be a good method of detecting medication errors in the home setting, and so we sought to develop comparable methods. To that end, we reviewed the literature, developed home visit methods, and conducted a pilot study. Each of these steps is described in separate sections in this article.