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What causes prescribing errors in children? Scoping review
  1. Richard L Conn1,2,
  2. Orla Kearney3,
  3. Mary P Tully4,
  4. Michael D Shields2,5,
  5. Tim Dornan1
  1. 1Centre for Medical Education, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
  2. 2Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
  4. 4Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester Academic Health Sciences Centre, Manchester, UK
  5. 5Centre for Experimental Medicine, The Institute for Health Sciences, Queen's University Belfast, Belfast, UK
  1. Correspondence to Professor Tim Dornan; T.Dornan{at}


Objectives (1) Systematically assemble, analyse and synthesise published evidence on causes of prescribing error in children. (2) Present results to a multidisciplinary group of paediatric prescribing stakeholders to validate findings and establish how causative factors lead to errors in practice.

Design Scoping review using Arksey and O’Malley’s framework, including stakeholder consultation; qualitative evidence synthesis.

Methods We followed the six scoping review stages. (1) Research question—the research question was ‘What is known about causes of prescribing error in children?’ (2) Search strategy—we searched MEDLINE, EMBASE, CINAHL (from inception to February 2018), grey literature and reference lists of included studies. (3) Article selection—all published evidence contributing information on the causes of prescribing error in children was eligible for inclusion. We included review articles as secondary evidence to broaden understanding. (4) Charting data—results were collated in a custom data charting form. (5) Reporting results—we summarised article characteristics, extracted causal evidence and thematically synthesised findings. (6) Stakeholder consultation—results were presented to a multidisciplinary focus group of six prescribing stakeholders to establish validity, relevance and mechanisms by which causes lead to errors in practice.

Results 68 articles were included. We identified six main causes of prescribing errors: children’s fundamental differences led to individualised dosing and calculations; off-licence prescribing; medication formulations; communication with children; and experience working with children. Primary evidence clarifying causes was lacking.

Conclusions Specific factors complicate prescribing for children and increase risk of errors. Primary research is needed to confirm and elaborate these causes of error. In the meantime, this review uses existing evidence to make provisional paediatric-specific recommendations for policy, practice and education.

  • therapeutics
  • qualitative research
  • paediatrics
  • medical education and training

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  • Contributors RLC conceptualised the study, contributed to and supervised data collection, led the analysis, led the stakeholder consultation and wrote the manuscript. RLC is the guarantor of the work. OK led data collection and contributed to study design, analysis and writing of the manuscript. MDS contributed to data analysis and writing of the manuscript. MPT contributed to study design, analysis and writing of the manuscript. TD contributed to study design, data collection, analysis and writing of the manuscript. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

  • Funding RLC’s Research Fellowship/PhD Studentship is funded by the Royal Belfast Hospital for Sick Children Research Fellowship. Queen’s University Belfast sponsored the research.

  • Disclaimer The funders had no role in the design, conduct or reporting of the research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Queen’s University Belfast School of Medicine, Dentistry and Biomedical Sciences Research Ethics Committee approved the stakeholder consultation (Ref 17.59).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data comprise records of article selection, data extraction sheet and the anonymised stakeholder consultation transcript. We will supply relevant data on request.