Medication errors common in schools

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Poisonings exposures in children and adolescents at school are relatively common, new research has found… and medication errors account for a significant number of cases

The data, from the University of Sydney, found that the most common pharmaceutical exposures were to paracetamol, the ADHD medications methylphenidate and clonidine, and ibuprofen, the majority being deliberate self-poisoning.

The data was published in the Archives of Disease in Childhood and includes cases reported to the NSW Poisons Information Centre between January 2014 and June 2018. The Centre takes 50% of Australia’s poisoning calls.

The data also included incidents of poisoning in schools from NSW, the ACT and Tasmania.

“The study found 1751 calls relating to exposures at school made to the Poisons Information Centre, with 61% concerning accidental exposures, 12% concerning deliberate self-poisonings and 12% from medication dosing errors,” said senior author Dr Rose Cairns, from Sydney School of Pharmacy in the Faculty of Medicine and Health, and senior poisons specialist at the NSW Poisons Information Centre.

“Most self-poisoning exposures were from over-the-counter products such as paracetamol, and most accidental exposures occurred from stings and bites, exposures to plants and in science class.

“Poisoning exposures at school appear to be increasing, with 81 calls per quarter in 2014-2016, and 129 calls per quarter in 2017-2018.

“Children are at risk of different types of poisoning depending on their age and developmental stage.

“Younger children are at risk of accidental exposures, while adolescents are at risk of self-harm poisonings. Deliberate self-poisoning (self-harm exposures/overdose) is increasing in children and adolescents in Australia, and elsewhere,” Dr Cairns said.

In self-poisoning incidents, paracetamol and ibuprofen were the most commonly-taken poisons, and victims were more likely to be girls (79%).

As for medication errors, 150 cases involved a dosing error with a medication prescribed for the child involved, while 40 cases were prescription medication administered to the wrong child.

Just over half (55) of poisoning cases were male, and accidental exposures, dares, pranks and recreational exposures occurred more frequently in boys.

“Many of these poison exposures were likely preventable, so we need to focus on strategies for prevention and school-based initiatives and programmes to make the school environment safer for students,” said Dr Cairns.

“A better understanding of reasons for poisonings, and circumstances surrounding exposures, is key to guiding public health strategies for poisoning prevention.

“Despite there being policies and procedures regarding medication handling in Australian schools, medication administration errors were common over the study period,” she said.

“While low risk, our study highlights the importance of medication skills training by school staff to ensure correct administration of medications to students.

“Some medicines are self-administered by students during school time, so increased counselling by prescribers may also help, or consideration of dosing regimens that avoid medication during school hours.

“This is particularly important as Australian studies have found that the prescribing of medicines in children and adolescents, particularly of psychotropics, has increased substantially and it was these medicines where the dosing errors occurred most frequently.

“For accidental poisoning exposures schools could undertake a risk assessment of common chemistry experiments and reinforce the use of personal protective equipment in class. This includes the provision of well-fitting goggles to prevent eye exposures.

“In the case of deliberate self-poisonings, schools could look to increase teacher training for identifying and responding to mental health problems, anti-bullying strategies, more school counsellors, regulation of social media use, and mental health first aid training for teachers.

“The increased funding for school counsellors and psychologists announced in September is a step in the right direction.”

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