Double Trouble: Children Return to ED, Growing Staff Shortages Pose Rising Risk of Medication Administration Errors

by | Mar 16, 2022

Picture this scenario: It’s the night shift in a community hospital ED that sees mostly adults. Two harried parents rush in with their three-week-old who is running a high fever. The initial concern is sepsis, so the immediate need is to administer antibiotics. For an adult patient, quickly hanging a premixed antibiotic bag, or adding the antibiotic to a 100 mL or 250 mL bag of fluids, is a routine step.

That’s not the case with a tiny infant. Getting an IV into this patient is difficult. To make matters worse, the antibiotics needed require a weight-based calculation and reconstitution. There is no pharmacy support at this hour at this ED, so the nursing staff must do this on their own – something they are not used to doing. Stress is building and the team is uncomfortable taking care of this baby in a way that is safe and will yield the best outcome. The standard of care for antibiotic treatment for a rule out sepsis patient is one hour from door to admission, so the clock is ticking.

Despite the strain of the situation, the nursing team is ultimately able to properly administer the antibiotics and the infant suffers no harm.

Severe pediatric sepsis accounts for more than 75,000 hospitalizations in the U.S. annually growing at a rate of 8% a year. Newborns with fevers, sickle cell patients, children with untreated or undertreated infected wounds or illness, and immunocompromised pediatric patients are seen in all EDs needing treatment for possible sepsis.

Unfortunately, the above scenario occurs all too often in EDs across the country. Confusion and uncertainty surrounding medication administration for children is a common occurrence, especially in a non-pediatric ED. Several issues are contributing to accelerate these dangerous incidents even further, seriously jeopardizing the safety of our vulnerable pediatric patients.

Nursing shortage problem

While kids return to the ED, the staff needed to help them is shrinking. Even before the pandemic, the healthcare industry was predicting a coming shortage of skilled nurses. The stress and burnout from COVID-19 has accelerated that process.

In a recent survey by the American Association of Critical Care Nurses, 92 percent of respondents said the pandemic had “depleted nurses at their hospitals, and as a result their careers will be shorter than they intended.” Two thirds (66%) reported they were considering leaving the profession because of what they have had to deal with during COVID-19. [1]

One of the ways the industry is trying to backfill the drain is through the use of travel nurses – registered nurses who work in short-term roles at hospitals, clinics, and other healthcare facilities around the world. The travel nurse industry grew 35 percent year-over-year in 2020 and is expected to grow by 40 percent going forward.[2]

Unfortunately, this option can be both expensive and disruptive. While it will likely help maintain overall patient care in the short term, it may introduce additional risk in the area of pediatric medication administration. Many experienced, full-time nurses employed by hospitals already don’t have significant experience preparing and administering meds to children, and it’s not likely the majority of travelling nurses will bring extensive experience in this area either. A recent Forrester report said this “burnout-turnover” will cause “irreversible patient impacts” including adverse drug events due to medication errors.[3]

Technology can help

Pediatric medication safety and supporting nurses with medication administration is an area where we live and breathe every minute of every day. The key message is that there is a problem right now, and as a hospital leader it’s critical that you find ways to address it. Additionally, technology which both assists nursing workflow and reduces caregiver risk can help appreciably with retention of valued employees.

Events like the one I opened with are unfortunately all too commonplace. Having a quick and easy to use resource to help staff be confident and comfortable calculating, mixing, and administering appropriate medications is key in meeting standards for the best patient outcomes.

Hospital leaders are coming to realize that they must take innovative and aggressive steps to make sure those events don’t end in fatal consequences. Awareness of the problem is the first critical step and will hopefully lead to more effective solutions.


[1] COVID-19’s Impact on Nursing Shortages, The Rise of Travel Nurses, And Price Gouging, by Y. Tony Yang, Diana J. Mason, Health Affairs, January 28, 2022.

[2] COVID-19’s Impact on Nursing Shortages, The Rise of Travel Nurses, And Price Gouging, by Y. Tony Yang, Diana J. Mason, Health Affairs, January 28 2022.

[3] Healthcare industry will face higher medication errors, declining patient trust in 2022: Forrester, by Anastassia Gliadkovdskaya, November 10, 2021.