Safety is the top priority for our institution. Safety has been reinforced since
it became a priority of federal and state governments, the Institute for Safe
Medication Practices (ISMP), and accrediting bodies (eg, the Joint Commission on
Accreditation of Healthcare Organizations [JCAHO], the National Committee for
Quality Assurance). Neonatal practice has required additional attention because
of the nature of the specialty and the high-risk drugs and patients in this
practice area. Our institution created several multidisciplinary teams to
address deficiencies in our medication use process. Each team had a member from
the nursing staff, neonatology staff, nurse practitioner group, and a clinical
pharmacy specialist; the neonatal intensive care nurse manager and pharmacy
manager were ad hoc members. The systems involved defining and standardizing
prescribing practices and processing and administration of medications. This
paper is a description of changes made in a hospital medication use system
without direct evaluation of the implementation of the changes. All the changes
were successfully implemented within a 10-month period (September 2004 through
June 2005) that encompassed 7 steps, including the elimination of the rule-of-6
method of drug preparation and administration, and utilization of an infusion
device with decision-support software (smart pump).
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