Medication Preparation Errors Involving Very Small and Difficult-to-measure Volumes in a Pediatric Hospital: A 14-year Descriptive Study

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ID: 328117
2026
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Ranked #163 of 247 articles by views in American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

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Abstract
Abstract Purpose Medication preparation errors are a major source of preventable harm in pediatric hospitals. Oral liquid medications, especially those involving difficult-to-measure or very small volumes, may increase the risk of such errors, yet supporting evidence is limited. This study aims to determine whether difficult-to-measure and very small oral liquid medication volumes are associated with higher rates of preparation errors in a pediatric hospital pharmacy. Methods We conducted a retrospective cohort study of all oral liquid medication preparations produced between January 2010 and December 2023 at a tertiary pediatric hospital. Preparation errors identified by pharmacists were extracted from the pharmacy department’s workflow management system. A prospective substudy (December 2023–October 2024) was also carried out to characterize the nature and magnitude of rejected preparations. Results During the study period, 1,554,986 oral liquid preparations were produced. Difficult-to-measure and very small volumes accounted for 20.4% and 1.4% of preparations, respectively. The overall preparation error rate was 0.9%. Error rates were significantly higher for difficult-to-measure (1.4%) and very small volumes (2.0%) compared to other volume types (p < 0.001). In the prospective substudy (N = 911), 65% of rejected preparations involved inaccurate volumes, with high-magnitude errors disproportionately linked to difficult-to-measure and very small volumes. Conclusion Difficult-to-measure and very small volumes significantly increase the risk of preparation errors. Volume rounding, standardized concentrations, and age-appropriate formulations should be prioritized to improve pediatric medication safety.
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Authors Pascal Bédard, Denis Lebel, Hélène Roy, Jean‐Marc Forest, Marie‐Élaine Métras
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Journal American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
Year 2026
DOI
10.1093/ajhp/zxag272
URL
https://doi.org/10.1093/ajhp/zxag272
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