Medication safety in neonatal care: a review of medication errors among neonates

Abstract

Objective: The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum. Method: In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients. Results: A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team. Conclusion: This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards.

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

“…6,7 There is also the associated challenge of limited dosing protocols and evidence-based information regarding the efficacy, safety, dosing, pharmacokinetic, and clinical use of medications in neonates. 6 In addition, relative physiological immaturity means that neonates have less capacity in being able to buffer unintended consequences of medication errors. 8 Such susceptibility towards medication errors in neonates, as previously described, is further emphasized by previous research that observed that medication errors with the potential to cause significant harm were three times more likely to occur in the neonatal intensive care unit (NICU) than in adult wards.…”

Interruptions experienced by nurses during pediatric medication administration in China: An observational study

“…MAEs are commonplace in healthcare settings, particularly in pediatric units (Gill et al, ). Murphy and While () found that the pediatric population experiences higher risk of MAEs (three times greater) than the adult population, as pediatric medication administration needs individualized dosing, very often using off‐label medication, and need to complex procedure of calculations to dosage, resulting in common MAEs (Krzyzaniak, & Bajorek, ). Hence, pediatric patients are considered to be an at‐risk group in terms of medication administration (Özkan et al, ).…”

The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice

“…As such, the clinical pharmacist has an important role to play in the quality use of medicines in this patient group, potentially having a large impact on patient outcomes 5. The high incidence of off-label medicines use, polypharmacy and frailty in this patient group (characterised by young gestational ages, very small birthweights) increases the risk of medication errors and poses challenges to the safe and effective use of pharmacotherapy 6. Studies have shown that pharmacist-led interventions can improve medication management in the NICU: daily bedside reviews of medication orders, individualised total parenteral nutrition (TPN) regimens and education programmes, have been shown to reduce medication errors 7 8…”