Drug therapy, Understood and Guided

A Drug therapy, Understood and Guided.

Drug-associated harm affects up to 10% of patients
Drug order errors are common
Patients at greatest risk from drug therapy are often those at greatest need of treatment.
Preventing drug-errors and drug-associated harm sounds simple but is challenging.


Describing therapeutic complexity, therapeutic overlap and research gaps in paediatric pharmacotherapy.
Evaluating drug dose recommendations, dosing error, the frequency of dosing error and its consequences.
Describing adverse consequences of drug therapy.


Preparation-Associated Error. We measured errors of > 10% in two thirds of morphine infusions, 23% of chemotherapy infusions and 35% of practice infusions made by healthcare professionals.  Preparation associated error is larger in the smaller doses frequently administered to young children and is way more common than dose order errors. We described the frequency (CCM2003, Ann Pharm. 2006) its origins (CMAJ 2008) and that very small volumes of commercially available drug preparations are required to prepare recommended doses for children (CMAJ 2011).

Paediatric Drug Safety Data. Our evaluation of 1548 drug product monographs in the Canadian Compendium of Pharmaceuticals showed 75% of drugs had no data about pediatric safety and yet the indications to given most (97%) medications did not exclude children (Ped. Drugs 2008).

Pharmacotherapeutic Volume and complexity. We described large volumes of drug therapy provided to critically ill children (Ped Drugs 2009). Our evaluation of over 3million concurrent drug administrations in 16,000 patient-admissions described the resulting complexity associated with concurrent drug administration (JCC 2017). Our subsequent description of poly-therapy and therapeutic overlap calls into question the effectiveness of single diuretic agents, analgesics and sedatives in many children (PCCM 2019).

Computerised Support. Error reduction and reduced adverse drug events with computerized provider order entry and decision support systems was found in our systematic review. We found greater improvements in latter years (JGIM 2019).

Acquired Organ Dysfunction. We showed acute kidney injury occurred in a quarter of critically ill children, and was associated with the number of nephrotoxic mediations administered (PCCM 2016). More detailed pharmaco-epidemiologic evaluation found administration of 3 of 20 drugs we evaluated were associated with subsequent development of acute kidney injury (Ped Drugs 2016).

Describing beneficial error.  We enunciated the concept of The Error-Berg (Gaetani Anesthesiology 2019).  Where errors can cause harm, have potential to cause harm (but do no harm) and may cause benefit.  

Dosing of enteral acetaminophen in critically ill children: a cohort study. (Roumeliotis Arch Dis Child 2021)

Our Current Work

Exploring medication error and associated harm in larger populations.
Understanding the notion of medication error and operationalizing reasonable definitions in the context of current dosing recommendations. DECIDUOUS.
EXEMPLAR: understanding drug safety profiles.
5DRIP : describing drug therapy in the context of other bedside activities.

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