Evaluation of Medication Dosing Errors in Outpatient Pediatrics in Primary Health Care Centers in Nablus City

Discussion Committee: 
Dr. Rowa’ Al-Ramahi /Supervisor
Dr. Hamzeh Al Zabadi /Co-supervisor
Dr. Maher Khdour /External Examiner
Dr. Abdulsalam Al-Khayyat /Internal Examiner
Dr. Rowa’ Al-Ramahi /Supervisor
Dr. Hamzeh Al Zabadi /Co-supervisor
Ghader Al Shareef
Background: Pediatric patients are sensitive to medication errors including dosing errors and could be exposed to dangerous consequences if these errors occur. Medication dosing errors are probable to happen among outpatient pediatrics recurrently, and in commonly used medications. This is a public health issue that could be preventable by integrating strategies of different partners. Objectives: To assess the prevalence of medication dosing errors in outpatient pediatrics aged (/1-144) months old in Primary Health Care centers in Nablus city and its possible associated factors. Methods: The study was a prospective cross sectional study. A review of physicians’ prescriptions was conducted. A sample of 400 pediatric prescriptions was reviewed and re-evaluated in terms of weight–adjusted dose. The prescriptions were obtained from all centers of Primary Health Care centers in Nablus City. The medication dosing errors were defined as over-dose, under-dose, inappropriate frequency or duration. Results: The patients were prescribed a total of 782 medications, twenty nine different drugs were prescribed, the most common out of the total 782 prescribed medications were: Paracetamol (29.5%), Chlorpheniramine (17.0%) and Amoxicillin )16.1,(%. The oral route was the most commonly prescribed as 702 out of 782 (89.8%) medications were oral medications. Most prescriptions included either one error in 31.8% of the total 400 patients or two errors in 30.8% of all patients. As percentages from the total prescribed 782 medications: 168 medications were potential over doses (21.5%), 200 were potential under doses (25.6%) and 51 were medications that should not be prescribed in similar conditions depending on the age. Regarding frequency and duration of the total prescribed medications: 37 medications were prescribed in a frequency that might be more than needed while 231 ones were potentially prescribed less frequent than needed, duration of 8 medications was potentially more than needed while 28 had potentially shorter duration. Weight, age, center and number of medications prescribed were found to be factors associated with potential inappropriate dosing errors. Conclusion: Medication dosing errors among young outpatient children in Nablus city were common. Many variables were found to be significantly associated with such errors like weight, age, number of medications prescribed and the center; this provided us with better understanding of the way how these errors happen. Studies on the clinical impact of these potential errors and effective error prevention strategies are needed.
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