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Medication errors are occurring frequently on pediatric wards, with “devastating” impact on children and their families, concludes a new survey of Canadian hospitals that found four deaths over the three-month span studied, and an average of 20 drug-administration mistakes per hospital ward.

“I saw four lethal errors, which doesn’t seem like very much, but that’s four children who died,” Kim Sears, a Queen’s University nursing professor and the lead researcher, noted in an interview. “Each site had at least one child die in it during the three months, because of a medication … I had only 18 [hospital wards] in total — that’s a very small sample.”

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While many of the mix-ups were near-misses, 14% were potentially lethal, the survey of nursing staff found, adding to a growing body of knowledge on the harm inadvertently done to patients in hospital.

Nurses who took part in the anonymous survey in three provinces were most likely to blame heavy workload, distraction and poor communication for the mistakes, said the study just published in the Journal of Pediatric Nursing.