What is the most effective position for the nurse to place a toddler in to administer medications?

When admitting children to a hospital unit, the nurse obtains a list of all prescription and over-the-counter medications as well as any herbal preparations a child is taking at home. To ensure patient safety, the nurse compares the medications the child has been receiving at home to the list of medications prescribed for the child’s hospital stay, identifying and communicating any discrepancies. This is referred to as medication reconciliation and is a process that is of paramount importance to preventing medication errors (Thompson, 2007). The Joint Commission’s national patient safety goals include an entire section on medication reconciliation listing detailed performance elements designed to ensure that accurate medication information is maintained and communicated among health care team members, patients, and their families (2011).

The nurse must also assess the parents’ knowledge of all the medications (and herbal remedies) the child is taking. This includes the name of the medication, the dose, number of times a day the child is taking the medication, knowledge of side effects, the child’s allergies, any adverse reactions the child might have experienced, and the time the medication was last administered. To facilitate medication reconciliation, parents are encouraged to bring all of their child’s medications to the hospital or a clinic visit. However, one study found that this occurs only about half of the time and that the majority of parents were not able to provide complete information about their child’s medication information, adversely affecting the medication reconciliation process (Riley-Lawless, 2009). At discharge, medication reconciliation includes providing clear, detailed written instructions to parents about all medications to be given at home as well as communicating precise medication information to the next health care provider.

Children are at greater risk than adults for medication errors and adverse drug events causing harm to a child because of pharmacokinetics, dosages by weight or body mass, and narrow therapeutic-to-lethal ranges for many medications (Takata, Taketomo, & Waite, 2008). The Joint Commission (2008) has indicated that a significant percentage of pediatric adverse drug events are preventable. Recommendations to reduce the risk of pediatric medication errors include the following:

One of the major reasons for the increasing use of computer systems such as patient electronic medical records (EMRs) and computerized physician order entry (CPOE) is to reduce medication errors (Takata et al., 2008; Thompson, 2007). EMRs that include electronic medication administration records (EMARs) can improve communication of patient medication lists and other information, such as allergies, between different health care providers working in the same facility or in other settings (Agrawal & Wu, 2009). Use of web-based or computer dose calculators have been shown to reduce dosage calculation errors for pediatric patients (Conroy, Sweis, Planner, et al., 2007). Although electronic systems have shown great potential to significantly reduce the incidence of medication errors, they have limitations and cannot eliminate all errors (Gerstle & Lehmann, 2007). These systems do not replace the responsibility of physicians and nurses for clear and complete medication orders, accurate dose calculations, and correct administration of medications to children.