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choice of agent, remain vigilant for changes in patient status, and intervene
before a minor issue becomes a serious one. The needs of the provider or the
institution must not be placed ahead of the safety or comfort of the patient. A
physician should always prepare, and ensure adequate staffing, for a deeper
level of sedation than originally planned.

Medication Errors
There is always a chance for error with medications. All ED staff, including
physicians, nurses, pharmacists, and support staff, should take steps to
prevent medication errors. Look-alike and sound-alike drugs, sometimes
with similar packaging, are contributing factors in some errors. Caution
should be used in stocking medications.
Allergic reactions are potential complications with any medications.
Preventable errors related to medication allergies may occur when the
healthcare provider fails to obtain an adequate medical history, fails to read
the record, or does not review previously documented allergies.
Some of the more serious medication errors involve a misplaced decimal
point, which can result in a 10-fold error. Dosing errors are the leading
category of mishaps involving medications and about 10% of these are
related to an incorrect weight (obtained or recorded incorrectly) for the child.
The patient’s weight must be carefully recorded in an obvious location in the
record and it is best to record this consistently in kilograms. Studies
performed on inpatient units have shown that computerized physician order
entry systems, particularly those with automated alerts for high- or lowdosage errors, have reduced medication errors by 55%.
Institutions are required by The Joint Commission and the Centers for
Medicaid and Medicare Services (CMS) to establish a list of “high-alert”
drugs that would require special or additional checks in their dosing,
preparation, and administration; however, all medications should be double
checked before they are administered. Research shows that 95% of all
mistakes are found when someone checks the work of another.
Having a satellite pharmacy that serves the ED with unit dosing rather

than having nurses prepare medications may be beneficial. It is interesting to
note that, in the hospital setting, 39% of errors are detected before reaching
the patient. In the ED setting, only 23% of errors are detected before