Introduction Medication errors are the commonest critical incidents in neonatal care. NPSA report frequent errors with gentamicin prescription, administration and monitoring. We developed a pathway to promote the safe use of gentamicin in our unit. Abstract PF.40 Table 1 Pre-pathway Post-pathway p* Dose given within 1 h of prescribed time 39 (73%) 46 (82%) 0.02 Documentation of gentamicin level 33 (62%) 41 (78%) 0.04 Appropriate action following gentamicin level result 32 (61%) 43 (77%) 0.04 Documentation of length of gentamicin therapy 22 (42%) 34 (61%) 0.045 *χ2 or Fisher's Exact test. Aim The aim of the project was to compare standards of prescription, administration and monitoring of gentamicin before and after implementation of the pathway. Standards were derived from national NPSA recommendations and local guidelines. Methodology We studied two time periods, before and after the introduction of the pathway. The dosing regimen was similar during both periods. Data was obtained from the electronic patient data management system, the drug prescription chart (pre-pathway) or the dedicated pathway documentation (post-pathway). Results 53 cases (pre-pathway) and 56 cases (post-pathway) were analysed. There were 418 doses of gentamicin administered over the two time periods. Median gestation and birth weight was lower in pre-pathway infants compared to those in post-pathway (30 vs 31 weeks, p=0.04; 1.24 vs 1.51 kg, p=0.04). Conclusion The introduction of a dedicated antibiotic pathway enhanced practice around gentamicin therapy with fewer delays in antibiotic administration, improved documentation and better practice around monitoring of gentamicin levels.
Introduction Sildenafil is increasingly used to treat PPHN secondary to chronic lung disease in neonates. Severity of PPHN has been linked to increased mortality at two years.1 There is no national guideline advising clinicians on dosage or weaning schedules for use of Sildenafil in neonates. Methods A telephone survey of tertiary level neonatal units in England and Wales (n = 48) was conducted in December 2013 and January 2014. Neonatal consultants were contacted to ensure robust data. In the event a consultant was not available, staffs employed by the unit for at least 24 months (Specialist registrar, Advanced Neonatal Nurse Practitioner (ANNP) or nursing sister) were surveyed. Results The response rate was 90% (n = 43/48). Sildenafil was used frequently (>5 patients per year) in 12% (n = 5), infrequently, (1–5 patients per year) in 23% (n = 10) and rarely (<1 per year) in 51% (n = 22). Majority of units had used Sildenafil within the last 6 months 49% (n = 21). 60% (n = 26) used Sildenafil only after discussion with Cardiologists, 35% (n = 15) commenced Sildenafil after discussion with neonatal colleagues. No unit had fixed indications for commencement of Sildenafil. Amongst those with a guideline (n = 6); the initial dose varied between 250–300 mcg/kg commenced between 4 and 12 hourly. Guidelines on two units were unclear on rate of increase of Sildenafil. No guideline stipulated weaning/stopping practice. Conclusion Sildenafil is infrequently used in NICU, however only 6 units did not use Sildenafil in the past 24 months. Variability in practice amongst units mirrors the need for a national consensus guideline.
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