Using critical incident data to promote paediatric medication safety: a regional quality improvement initiative in Northern Ireland

Background
Medication errors in children are a common cause of serious avoidable harm. Existing quality improvement (QI) measures, hampered by lack of evidence about errors’ characteristics and causes, have had limited impact. Critical incident data can provide this information but remain an underused resource in guiding QI.

Aim
To describe a programme of service evaluation and research, driven by mixed methods analysis of critical incident data, used to underpin paediatric medication safety QI in Northern Ireland (NI). Objectives were to:
(i) Analyse a large dataset of reported paediatric medication incidents in children, describing their characteristics and underlying causes, to provide an evidence base for QI;
(ii) Investigate how systematic analysis of aggregated critical incident data can inform improvement;
(iii) Draw attention to the need to improve paediatric medication safety in NI;
(iv) Demonstrate a transparent, learning focused approach to reported medication error.


Methods
Mixed methods analysis of reported medication errors in children in secondary care: quantitative analysis of error characteristics; and qualitative analysis of factors contributing to thes; dissemination strategy comprising publication of regional report, concurrent research articles, and direct engagement of NI healthcare community; measures of success to include early evidence of impact on practice.

Results
Incident analysis included 1522 errors. Quantitative analysis identified neonatal care, medication dosing and omission, and treatment with antimicrobials, paracetamol, and vaccines as high-risk areas of practice. Qualitative analysis revealed that multiple interacting causes, including inadequate communication, distractions, and not using information sources, led to errors. This information fed into wide-reaching recommendations. Outputs included the proposed regional report, two research articles and multi-level stakeholder engagement. QI initiatives guided by findings; formation of a group to enact recommendations; and development of a business case to increase paediatric pharmacist provision represented indicators of impact.

Conclusion
This QI initiative shows how critical incident data can guide paediatric medication safety and provides a model that could applied in other settings such as adult secondary care.