Protecting Pediatric Patients From Medical Harm

pediatric malpracticeThe revised American Academy of Pediatrics policy statement, “Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care,” appearing in the June 2011 issue of Pediatrics (published online Monday, May 30), cites several studies including one that found seven failures to prevent a clinically important deterioration per 100 hospitalized children, another that found 100 prescribing errors per 1,000 children seen in an emergency room, and another that found three preventable adverse drug events per 100 children seen in pediatric practices.

With increasingly complex medical advances and rapidly evolving technology, the risk of causing unintentional harm has increased, as well. Reducing unintended harm to pediatric patients requires pediatricians to support and adopt a culture of safety by assuming responsibility for patient outcomes, identifying and reporting errors and adverse events, and disseminating proven patient safety interventions to prevent errors and eliminate avoidable harm.

Source: American Academy of Pediatrics

Since the publication of “To Err is Human” in 1999, patient safety has become a focus in health care. Fortunately this spotlight has not overlooked the pediatric population. In fact, pediatric patients may be even more at risk than the adult population when it comes to medical errors. The Harvard Medical Practice Study that reviewed 30,000 hospital admissions from 1984 in New York State identified that 3.7 percent of hospitalized patients experienced an adverse event. This study included pediatric patients and found children experienced 12.91 adverse events per 1,000 discharges.

In addition to errors similar to those noted in the adult population, there are issues unique to the care of children. These include potential errors related to changes in weight and physiologic immaturity, the dependency that children have on others, and the healthcare provider’s lack of familiarity with the care of pediatric patients.

Children are generally resilient, but there is little room for error, especially in treatments such as medication dosing and fluid administration. Children’s small bodies make these errors more serious than the same errors affecting adults. Children often have less ability to compensate for the physiologic changes that occur during illness due to physiologic immaturity.

A good example of this is the respiratory syncytial virus or RSV. In adults this virus is manifested as the common cold. Adults may whine and complain while sick with this virus but rarely do they develop complications of any severity. In children, however, RSV can have severe consequences. Children less than three years of age have very small airways, which swell when attacked by this virus. This can lead to respiratory distress and develop into a life-threatening pneumonia. A child’s airway cannot always accommodate this swelling, whereas an adult’s airway is nearly unaffected.

Five frequently encountered issues may lead to litigation. These include:

1. Assessment or monitoring of the patient
2. Reporting or documenting changes in the patient’s condition
3. Following the appropriate chain of command
4. Appropriate delegation of nursing tasks
5. Medication or treatment errors

Children can suffer several critical illnesses frequently seen in the pediatric population, including sepsis, hypovolemic shock, increased intracranial pressure, and respiratory failure. These may cause injury or death, thereby leading to litigation.

Adapted from Susan Engleman, “Pediatric Nursing Malpractice Issues” in Iyer, Levin, Ashton and Powell, Nursing Malpractice, Fourth Edition, 2011. Order here.

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