Identification of Priorities for Medication Safety in Neonatal Intensive Care

Kunac, Desireé L.; Reith, David

doi:10.2165/00002018-200528030-00006

Cited by 80 publications

(58 citation statements)

References 31 publications

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“…2 Neonates are more prone to medication errors at each stage of the medicine management process due to the increased need for calculations, dilutions, and manipulations of medications. 3,4 Furthermore, many medications are used off-label in the neonatal setting, meaning that they are not specifically licensed for use in neonates and are therefore often only available in adult formulations and concentrations. 5 As a result, prescribing and administration challenges often places neonates at risk of potentially fatal 10-fold or 100-fold dosing errors.…”

Section: Introductionmentioning

confidence: 99%

Interventions to reduce medication errors in neonatal care: a systematic review

Nguyen

Mosel

Grzeskowiak

2017

Therapeutic Advances in Drug Safety

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Background: Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods: A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and referencelist checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results: A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion: While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.

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Section: Introductionmentioning

confidence: 99%

Interventions to reduce medication errors in neonatal care: a systematic review

Nguyen

Mosel

Grzeskowiak

2017

Therapeutic Advances in Drug Safety

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“…Using the failure mode and effects analysis to study a neonatal intensive care unit, Kunac and Reith [5] identified 72 potential failures distributed across the entire medication process, occurring mostly at the time of medication prescription and during preparation for drug administration.…”

Section: Introductionmentioning

confidence: 99%

Improving the Quality of Medical Prescriptions in Neonatal Units

Pallás

De-la-Cruz²,

Del-Moral³

et al. 2007

Neonatology

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Background: Pediatric units, especially neonatal units, are highly vulnerable to error generally and to medication error in particular. Potential failures are distributed across the entire medication process, occurring mostly at the time of medication prescription and during preparation for drug administration. Objective: To estimate the prevalence of violations of good prescribing practice before and after the implementation of several measures aimed at improving the quality of the medical prescription. Methods: Before and after evaluation study with prospective data collection in a third level neonatal unit. 6,320 handwritten medical prescriptions for neonates admitted in the first study period and 1,435 in the second period were analyzed. Training on good prescribing practice and the implementation of a pocket PC-based automatic dosage calculation system were the interventions. The main outcome measure was the proportion of prescriptions with violations of good prescribing practice: incorrect dose, units, dose interval, route of administration or legibility. Results: Incorrect prescriptions decreased from 39.5% before the intervention to 11.9% after, with an adjusted prevalence ratio of 0.29 (0.25–0.34). The number of wrongly specified items on a single prescription decreased from 11.1% of the prescriptions with two or more wrongly specified items in the first period to 1.3% in the second period, with a prevalence ratio of 0.09 (0.05–0.14). Conclusions: Violations of good prescribing practice are common in neonatal units. A simple intervention should improve the quality of handwritten medical prescriptions for newborns admitted to intensive care settings.

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“…The main root cause of failure in this process was the employees' lack of awareness of the medication safety, and to prevent such errors, the hospital managers and administrators should use a briefing and training package for the new staff. It can be stated that the use of unskilled physicians and nurses and poor training are some important factors leading to the medical errors and their occurrence (14).…”

Section: Discussionmentioning

confidence: 99%

“…Tofighi et al (2009) in their study used FMEA method to identify and assess medical errors and found 4 high risk errors including delayed arrival of the patients at the triage room (risk priority number: RPN = 252), very short initial visit to prioritize patients and incorrect recording of patient blood oxygen (RPN = 245), and delays in performing patients' ECG (RPN = 160), respectively (13). Kunac and Reith (2005), detected and ranked potential errors in medication therapy processes of the NICU using FMEA. The researchers found 72 errors with 193 causes, among which "the lack of knowledge about the drug safety" and "when and how to prescribe the drugs" received the highest ranks, respectively (14).…”

Section: Introductionmentioning

confidence: 99%

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Assessing the Common Medical Errors in a Children’s Hospital NICU Using Failure Mode and Effects Analysis (EMEA)

Alimohammadzadeh¹,

Bahadori²,

Jahangir³

et al. 2017

Trauma Mon

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Background: Neonatal intensive care units are prone to a variety of errors due to their special conditions. Failure mode and effects analysis (FMEA) is a method for risk assessment and management, which assesses the safety of patient care processes through its system approach. Objectives: The present study aimed to identify and assess common medical errors at Amirkola Children's hospital NICU in 2016. Methods: This was a cross-sectional study conducted from September 2015 to February 2016 in the NICU of Amirkola Children's Hospital in the city of Babol to identify and assess the medical errors and their effects qualitatively and quantitatively using FMEA through direct observations of the NICU processes, brainstorming, and focus group discussions (FGD). The FMEA standard worksheet was used for data collection. The collected data were analyzed using Excel 2010. Results: In this study, 4 key processes were selected through studying the care methods and brainstorming including drug administration, infection control, medical equipment use, and laboratory tests; 27 activities and 50 potential failure modes, as well as their impacts were detected and recorded in the final worksheet of FMEA. According to the calculated PRNs, 27 potential failure modes with PRN > 65 were determined as high-risk failures. The highest and lowest PRNs were, respectively, related to improper and incomplete washing and disinfecting the hands (PRN = 127) and illegibility of the lab requests for laboratory tests (PRN = 32). Conclusions: Based on the findings of this study, 57 potential failure modes in 4 key processes of the studied NICU were determined, among which 27 potential errors and failures with high risks were recognized. Therefore, it can be suggested that the senior managers and administrators should create multidisciplinary teams for patient safety at the organizational and unit levels.

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Identification of Priorities for Medication Safety in Neonatal Intensive Care

Abstract: Interventions to decrease medication-related adverse events in the NICU should aim to increase staff awareness of medication safety issues and focus on medication administration processes.

Cited by 80 publications

References 31 publications

Interventions to reduce medication errors in neonatal care: a systematic review

Interventions to reduce medication errors in neonatal care: a systematic review

Improving the Quality of Medical Prescriptions in Neonatal Units

Assessing the Common Medical Errors in a Children’s Hospital NICU Using Failure Mode and Effects Analysis (EMEA)

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