Abstract / Summary
Medication errors are a major patient safety concern in pediatric healthcare. Despite increasing attention to medication safety in Saudi Arabia, consensus regarding priority interventions remains limited. This study aimed to identify and prioritize medication safety recommendations for pediatric settings in Saudi Arabia using a Delphi approach. A modified Delphi study was conducted between January and March 2026. Eligible pediatric clinical pharmacists with ≥ 2 years of pediatric or neonatal clinical experience and active practice in Saudi Arabia participated in two Delphi rounds. In Round 1, experts generated recommendations across predefined domains, which were reviewed, refined, and consolidated. In Round 2, experts rated each recommendation using a five-point Likert scale. Consensus was defined as ≥ 80% agreement and ≤ 15% disagreement. Nineteen experts completed both Delphi rounds (100% retention). A total of 301 recommendations were consolidated into 81 recommendations across eight domains, of which 70 achieved consensus. All recommendations within the staff-related, protocol/guideline, medication-related, and technology-related domains met the predefined consensus criteria. Fifteen recommendations were identified as priorities based on the highest observed level of expert consensus (median = 5, agreement = 94.7%, and disagreement = 0%). These priorities included staff training, antimicrobial stewardship, standardized medication concentrations, double-check systems for high-risk medications, improved communication, electronic prescribing, barcode medication administration, smart infusion pumps, and therapeutic drug monitoring. Expert consensus identified priority strategies to improve pediatric medication safety in Saudi Arabia, emphasizing workforce development, standardized practices, antimicrobial stewardship, and healthcare technology.