Selbst et al., 2004). Most EDs do not have a pharmacist on staff to review orders or assist with medication use (Selbst et al., 2004). At the administration phase, a drug may be delivered twice if the first dosing is not promptly recorded in the medical record.

To reduce the high frequency of medication errors that occur in pediatric emergency care, the committee recommends that the Department of Health and Human Services and the National Highway Traffic Safety Administration fund the development of medication dosage guidelines, formulations, labeling guidelines, and administration techniques for the emergency care setting to maximize effectiveness and safety for infants, children, and adolescents. Emergency medical services agencies and hospitals should incorporate these guidelines, formulations, and techniques into practice (5.2). Agencies could commission research studies and/or convene a panel of experts to carry out these tasks. The Office of Emergency Medical Services within the National Highway Traffic Safety Administration (NHTSA) is a natural leader for this effort; within DHHS, a number of agencies could lead the effort, including the FDA, HRSA, and AHRQ. Implementing the proposed guidelines would not only improve patient safety, but also potentially reduce providers’ liability claims since medication errors have been shown to be the second most frequent and second most expensive reason for such claims (Physician Insurers Association of America, 1993).

IMPROVING SAFETY FOR PEDIATRIC PATIENTS

The task of ED and EMS providers—to care for patients of all types, often with limited patient information and in a difficult, crowded environment—is enormous, and many providers and organizations are up to that task. However, there is enough evidence to suggest the need for action to improve the safety of emergency care, including that provided to pediatric patients. The committee therefore recommends that hospitals and emergency medical services agencies implement evidence-based approaches to reducing errors in emergency and trauma care for children (5.3). Those organizations that give guidance to providers, such as government agencies and professional organizations, should encourage providers to implement measures designed to protect patient safety. Continued research is needed to determine the best strategies for improving patient safety in prehospital and ED care; however, these strategies should focus on the factors that contribute to the deterioration of performance, such as crowding, problems with communication and information, and lack of provider resources.

Various hospitals and EMS agencies have tried several promising strategies with some success that could be replicated in other organizations. These initiatives have the potential to help all patients, not just children. Below we



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