Personalised performance feedback reduces narcotic prescription errors in a NICU

Sullivan, Kevin M.; Suh, Sanghee; Monk, Heather M.; Chuo, John

doi:10.1136/bmjqs-2012-001089

Cited by 20 publications

(43 citation statements)

References 27 publications

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“…The reviewers pointed out that, although the median effect of performance feedback might be perceived as small, the 75th percentile effect size was much larger (16 %), suggesting that audit and feedback, when optimally designed and used in the right context, can play an important role in improving professional practice [23]. Sullivan et al [45] reported that a narcotic prescribing error feedback programme in the NICU reduced the errors by 83 % and also increased the time between errors from 3.94 to 22.63 days. They provided group feedback as well as individualised feedback to the clinicians who had prescribed the errors.…”

Section: Discussionmentioning

confidence: 96%

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

Shlomai

Rao

Patole

2015

Eur J Clin Microbiol Infect Dis

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Healthcare-associated infections (HCAIs) cause significant morbidity and mortality in neonatal intensive care units (NICUs). Meticulous hand hygiene is the most effective strategy to prevent HCAI. However, hand hygiene compliance (HHC) is low, especially in ICUs. Hence, we aimed to evaluate the efficacy of strategies for improving HHC in NICUs. A systematic review of the literature and meta-analysis were carried out. PubMed, EMBASE, Cochrane CENTRAL and CINAHL were searched in October 2013. PRISMA guidelines were followed. The quality of included studies was assessed by the Newcastle-Ottawa scale (NOS). Sixteen eligible non-randomised studies were included. A total of 27,155 hand hygiene moments were observed. Meta-analysis using a random effects model indicated that a range of strategies, such as educational campaigns, musical parodies, reminders, easy access to hand hygiene sanitisers, UV sensors and performance feedback, improved HHC [odds ratio (OR) 2.04; 95 % confidence interval (CI) 1.40, 2.97]. Significant statistical heterogeneity was noted. Studies which specifically provided performance feedback at either the individual or group levels reported a more significant improvement in HHC compared to those that did not (OR 2.81; 95 % CI 1.32, 5.96 vs. OR 1.55; 95 % CI 1.13-2.11). Strategies to improve HHC in NICUs seem to be more effective when they include performance feedback at the personal or group levels. Randomised controlled trials (RCTs) specifically assessing the benefits of performance feedback in improving HHC are needed.

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Section: Discussionmentioning

confidence: 96%

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

Shlomai

Rao

Patole

2015

Eur J Clin Microbiol Infect Dis

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“…The six intervention types included: technology (n = 38), organizational (n = 16), [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] personnel (n = 13), [72][73][74][75][76][77][78][79][80][81][82][83][84] pharmacy (n = 9), [85][86][87][88][89][90][91][92][93] hazard and risk analysis (n = 8), 10,[93][94][95][96][97][98][99] and multifactorial (i.e. a combination of any of the previous themes; n = 18).…”

Section: Overview Of Included Studiesmentioning

confidence: 99%

“…Development of preformatted medication order sheets [56][57][58][59][60][61][62][63][64] Medication distribution and supply (n = 6) Preparation of prediluted medications for administration [65][66][67][68][69][70] Nurse prescribing (n = 1) Transcription of paper-based orders to electronic orders by nursing staff 71 Personnel (n = 13) Staff education (n = 13) Personalized feedback of medication prescribing errors [72][73][74][75][76][77][78][79][80][81][82][83][84] Pharmacy (n = 9) Ward based (n = 6) Interventions identified through introduction of ward-based paediatric/neonatal clinical pharmacy service [85][86][87][88][89][90] Dispensary based (n = 3) Interventions identified through dispensary-based pharmacy service [91][92][93] Hazard and risk analysis (n = 8) Quality improvement tools (n = 4) Use of failure modes, effects, and criticality analyses to redesign care processes 10,[95][96][97] Error detection tools (n = 3) Automated detection of medication errors 93,…”

Section: Intervention Type Example Of Intervention Referencesmentioning

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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“…Many studies to reduce PEs and AEs in hospitalized children have investigated the impact of a single intervention such as education or training . The results of those studies showed that none of the interventions were superior in terms of error reduction.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

Bannan

Tully

2016

J Clin Pharm Ther

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Summary What is known and objective Bundle interventions are becoming increasingly used as patient safety interventions. The objective of this study was to describe and categorize which bundle interventions are used to reduce prescribing errors (PEs) and administration errors (AEs) in hospitalized children and to assess the quality of the published literature. Methods Articles published in English and Arabic between 1985 and September 2015 were sought in MEDLINE, EMBASE and CINHAL. Bibliographies of included articles were screened for additional studies. We included any study with a comparator group reporting rates of PEs and AEs. Two authors independently extracted data, classified interventions in each bundle and assessed the studies for potential risk of bias. Constituent interventions of the bundles were categorized using both the Cochrane Effective Practice and Organization of Care Group (EPOC) taxonomy of intervention and the Behavioural Change Wheel (BCW). Results and discussion Seventeen studies met the inclusion criteria. All bundles contained interventions that were either professional, organizational or a mixture of both. According to the BCW, studies used interventions with functions delivering environmental restructuring (17/17), education (16/17), persuasion (4/17), training (3/17), restriction (3/17), incentivization (1/17), coercion (1/17), modelling (1/17) and enablement (1/17). Nine studies had bundles with two intervention functions, and eight studies had three or more intervention functions. All studies were low quality before/after studies. Selection bias varied between studies. Performance bias was either low or unclear. Attrition bias was unclear, and detection bias was rated high in most studies. Ten studies described the interventions fairly well, and seven studies did not adequately explain the interventions used. What is new and conclusion This novel analysis in a systematic review showed that bundle interventions delivering two or more intervention functions have been investigated but that the study quality was too poor to assess impact.

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Personalised performance feedback reduces narcotic prescription errors in a NICU

Cited by 20 publications

References 27 publications

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

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

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

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