Basic mistakes by GPs and 111 helpline put children’s lives at risk
CHILDREN are being severely harmed and even killed by basic errors committed by GPs, pharmacists and NHS call handlers, a study has found. Preventable mistakes in the treatment of children led to 12 deaths, 41 cases of severe harm and 658 cases of minor harm in England and Wales, a report found.
Efforts to improve primary care of children have ‘ stagnated’, said the authors, whose findings were based on an analysis of more than 2,000 ‘adverse incident’ safety reports – where mistakes have been made in treatment involving children – between 2003 and 2013.
Most errors – 30 per cent – involved the 111 telephone health care phone line, closely followed by out-of-hours health centres (28 per cent). Community pharmacies made up 18 per cent of the reported blunders and GP surgeries were involved in 10 per cent.
The figures are likely to be an underestimate due to some safety incidents not being reported. The authors of the study, led by Dr Philippa Rees of Cardiff University, expressed particular concern about the safety of assessing children by telephone.
They wrote in the journal PLOS Medicine: ‘These concerns exist due to the potentially fatal consequences of underestimating the urgency of a child’s condition, the non-specific nature of many child- hood illnesses, the speed with which children deteriorate, and the lack of face-to face contact.’
The authors said they were also concerned about the safety of Clinical Decision Support software used by call handlers for assessing the symptoms of child patients. In some cases handlers followed the wrong protocol – such as ‘head wound’ rather than ‘head injury’. There were also cases where they failed to use protocols. Nearly a quarter of reported errors involved respiratory conditions, including asthma and coughs, head and limb injuries, accidental overdoses, and non-specific symptoms such as fever or weight loss, the study found.
In one tragic example, a GP prescribed antibiotics to a two-monthold baby with a temperature of 38 degrees instead of sending the child to hospital. NICE guidelines state that such a fever in a baby is a ‘red flag’ and should result in immediate admission to hospital. The baby died.
Around one in three incidents (31.9 per cent) involved errors in medica- tion – such as children being prescribed the wrong dose of a drug.
In examples of dispensing errors, one child was prescribed ear drops instead of eye drops – leading to ‘a prolonged burning sensation’ in the eyes. In another case, a 16-year-old patient was given the wrong medicine for three days and ‘suffered serious side effects including catatonic seizures’. The error was blamed on similar packaging.
Of the 12 reported deaths, nine were due to errors in diagnosis. Of these two were due to inadequate triage, two inadequate diagnosis, two through a failure to identify high-risk children, one insufficient assessment, one inadequate discharge planning, and one was classed as ‘other’.
The authors said the UK ‘performs poorly relatively compared to other economically developed countries on numerous indicators of care quality for children’.
They said that around 2,000 more children die each year in the UK compared to Sweden, the best performing European country for child mortality.
In recommendations, the team called for ‘ robust evaluation of the effectiveness and safety of NHS 111’ for assessing children.
They demanded safer systems for prescribing drugs at community pharmacies; better triage during out of hours services and enhanced communication between professionals and parents.
They also called for mandatory paediatric training for trainee GPs, and more reliable systems for dispensing medication in community pharmacies.
Dr Rees said: ‘It has been widely acknowledged that child health services in the UK are lagging behind those of neighbouring European countries in terms of quality.
‘Within primary care – where most sick children present – improvement efforts have been particularly stagnant.
‘This study highlights weaknesses in various primary care systems. These are weaknesses that NHS professionals are accustomed to working with and around, in order to prevent harm to children.
‘Health care organisations must now address these systems issues to help professionals provide safe care. Ultimately we hope this study helps to focus and inspire much overdue improvement efforts within this setting, at both a local and national level, and help us realise one of the fundamental concepts of medical ethics – to first do no harm.’
‘Weaknesses in primary care’