Assessing prescribing and medication administration Errors in the management of acute diarrhea amongst Pediatric inpatient at regional referral hospitals in Dar es salaam, Tanzania

Abstract

Background Acute diarrhea is a major public health problem especially in developing countries. It accounts for 700,000 death in children under five years of age worldwide making it the second leading cause of child mortality. Standard treatment guideline for diarrhea management is zinc supplement and ORS (Oral Rehydration Salt) which are regarded as universal treatment of acute watery diarrhea. There is dearth of information on the magnitude and type of medical occurring in the course of implementing the standard management of diarrhea among children. Objectives to determine prescribing and medication administration errors in management of acute diarrhea among pediatric in patients in Regional Referral Hospitals Dar es Salaam, Tanzania. Methods Facility-based cross-sectional study was conducted. Retrospective data from July 2017-July 2018 of 1200 prescribing and medication administration errors to pediatric inpatients was done. After approval of the institutional ethics committee, data was collected to get the following details of demographic characteristics: age, gender, weight, diagnosis, medication details that checked for medication errors in acute watery diarrhea such as wrong drugs, wrong frequency, wrong dose, duration not written, route of administration not written, no prescribers signature, omitted dose by comparing with National essential drug list, Standard treatment guideline and WHO pocket book for treatment of acute diarrhea. In the management of diarrhea, all these three guidelines recommend use of Oral Rehydration Solution (ORS) and zinc supplements for acute watery diarrhea (AWD). Raw data was cleaned and coded then entered into EPIDATA software and analyzed using SPSS Version 22. Proportions were used to describe the basic characteristics of the study participants such as age and sex as well as the types and pattern of prescribing and medication errors. Bivariate analysis was conducted were Chi-test was used to test association between categorical variables. A p value of <0.05 was used to show statistical significance. Variables were included in the multivariate models if they were significantly associated with the outcomes in bivariate analyses (P < 0.05) or if they were believed to be mechanistically relevant (age and sex for prescription errors). Consequently, all variables were then used in multivariate logistic regression analysis and adjusted odds ratios with 95% CI were used to assess the significance and strength of associations. Results Out of 1200 prescriptions reviewed during the study, the highest prescribing errors were wrong timing 53.92%, wrong dose 19.72%, and wrong drug 12.25%, and the most medication administration errors observed were omitted drugs, 62.25%, documentation errors 62.17%, and unauthorized drugs 5.42%. Prescription error was 40% more likely among prescriptions of those one year and older compared to those younger than one year (AOR=1.41, 95% CI 1.08-1.83; p-value 0.01). Also prescription by medical officers and interns were significantly less likely to contain a prescription error (p-value <0.001). AWD with comorbidity 37% less likely to have prescription errors compared to AWD without comorbidity. Compared to registered nurse administered prescriptions, an enrolled nurse administered prescription had about 40% was less likelihood to be found with an error (p-value<0.001). Also, administration for condition without comorbidity compared to comorbidity was less likely to be found with an administration error (p-value 0.01). Conclusion Prescribing and medication administration errors were a significant problem in pediatric inpatient setting in the selected hospitals. Of these errors; wrong timing, wrong dose, wrong frequency, omission, documentation errors and timing were the most common types of errors observed with high proportion. Zinc supplements and ORS prescription pattern in this study was lower than what is recommended by WHO diarrhea treatment guideline. There is a need to ensure that mechanisms are in place like those of continuous prescription and drug administration audits to monitor, improve the prescription habits of doctors, and administration habit to ensure doctors and nurses adhere to National and international standards in management of acute watery diarrhea.