Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis

Basil, Josephine Henry; Premakumar, Chandini Menon; Ali, Adliah Mhd; Tahir, Nurul Ain Mohd; Shah, Noraida Mohamed

doi:10.1007/s40264-022-01236-6

Cited by 14 publications

(8 citation statements)

References 88 publications

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“…In the current study, this was the most common physician-related ME (15% vs. 2%, CG to IG), but was considerably lower compared to previous studies ( Folli et al, 1987 ; Chedoe et al, 2007 ; Labib et al, 2018 ; Jafarian et al, 2019 ). We assume that this is due to improvements in access to current and evidence-based formularies, clinical pharmacy services, and computerized physician order entry systems ( Chedoe et al, 2007 ; Campino et al, 2008 ; Abbassi et al, 2022 ; Henry Basil et al, 2022 ; Shaniv et al, 2023 ). Reflecting on risk factors, Leopoldino et al (2019) found that DRPs were associated with increased LOS and number of prescribed drugs ( p <0.001).…”

Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

Yalçın,

Kaşıkcı,

Çelik

et al. 2023

Front. Pharmacol.

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Introduction: Drug-related problems (DRPs) incidence is higher in neonatal intensive care units (NICUs), compared to other pediatric wards due to aspects like off-label medications, pharmacokinetic/dynamic variability, or organ dysfunction/immaturity. This study aimed to determine whether and to what extent a clinical pharmacist intervention improves medication safety and prevents DRPs [medication errors (MEs), adverse drug reactions (ADRs), drug-drug interactions (DDIs)].Methods: A prospective, randomized, double blind, controlled study in NICU-admitted neonates was conducted. NICU patients were randomly assigned to the intervention (clinical pharmacist-led) (IG) or control group (standard care such as clinical diagnosis, pharmacotherapy) (CG). The clinical pharmacist was involved in the IG to identify-prevent-intervene MEs, or identify and monitor ADRs and DDIs. The primary outcome was the number of neonates who developed at least one DRP compared with those seen across IG and CG. Secondary outcomes included length of hospital stay, total number of drugs or DRP type.Results: Neonates were randomly assigned to CG (n = 52) or IG (n = 48). In total, 45%, 42%, and 16% of patients had at least 1 MEs, ADRs, and clinically significant DDIs, respectively. The number of patients with at least 1 ME was 28 (53%) and 17 (35%) in the CG and IG (p>0.05). The median (range) number of ME was higher in CG [1 (0–7)] than in IG [0 (0–4)] (p = 0.003). Applying regression analysis, the CG had 2.849 times more MEs than the IG (p<0.001). Furthermore, the number of patients (CG to IG) with at least one detected ADR or clinical DDI was 19 (36%) to 23 (47%) (p>0.05) and 4 (7%) to 12 (25%), respectively (p = 0.028).Conclusion: Clinical pharmacist availability to systematically and standardized identify, prevent and resolve DRPs among NICU patients is effective. Daily detailed clinical pharmacist observations and interventions enables prevention and monitoring of DRPs.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT04899960.

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Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

Yalçın,

Kaşıkcı,

Çelik

et al. 2023

Front. Pharmacol.

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“…To develop a comprehensive method for identifying neonates at risk of MAEs, a total of 15 candidate predictor variables have been identified through the following sources: (1) an extensive systematic review conducted to evaluate the available literature on the factors associated with MAEs among neonates, 17 (2) national data containing information on the causes of MAEs among neonates, extracted from the medication error reporting system (MERS) through the MOH Pharmaceutical Services Programme and (3) expert panel. The expert panel consists of a paediatrician with 14 years of clinical experience, a clinical pharmacist with 15 years of clinical experience and a senior nurse with an advanced diploma in Neonatology and 20 years of clinical experience.…”

Section: Methodsmentioning

confidence: 99%

“…Given that the prevalence of MAEs among neonates has been reported to be as high as 94.9%, 17 a validated model incorporating an extensive list of potential risk factors associated with MAEs would facilitate the healthcare professionals involved in the medication use process to identify at-risk neonates in the neonatal intensive care unit (NICU). To the best of our knowledge, a predictive risk score to identify neonates at risk of MAEs specifically is not yet available.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a risk prediction model for medication administration errors among neonates in the neonatal intensive care unit: a study protocol

Basil

Premakumar

Ali

et al. 2023

bmjpo

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IntroductionMedication administration errors (MAEs) are the most common type of medication error. Furthermore, they are more common among neonates as compared with adults. MAEs can result in severe patient harm, subsequently causing a significant economic burden to the healthcare system. Targeting and prioritising neonates at high risk of MAEs is crucial in reducing MAEs. To the best of our knowledge, there is no predictive risk score available for the identification of neonates at risk of MAEs. Therefore, this study aims to develop and validate a risk prediction model to identify neonates at risk of MAEs.Methods and analysisThis is a prospective direct observational study that will be conducted in five neonatal intensive care units. A minimum sample size of 820 drug preparations and administrations will be observed. Data including patient characteristics, drug preparation-related and administration-related information and other procedures will be recorded. After each round of observation, the observers will compare his/her observations with the prescriber’s medication order, hospital policies and manufacturer’s recommendations to determine whether MAE has occurred. To ensure reliability, the error identification will be independently performed by two clinical pharmacists after the completion of data collection for all study sites. Any disagreements will be discussed with the research team for consensus. To reduce overfitting and improve the quality of risk predictions, we have prespecified a priori the analytical plan, that is, prespecifying the candidate predictor variables, handling missing data and validation of the developed model. The model’s performance will also be assessed. Finally, various modes of presentation formats such as a simplified scoring tool or web-based electronic risk calculators will be considered.

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“…A high rate of mortality in NS is associated with a relatively high level of treatment failure: in the review of 90 randomized controlled trials (RCT), it was reported in 15 studies [ 22 ]. The current list of antibiotics used in NICU is broad and reasons for NS treatment failure may be drug-related, with administration and/or dosing errors [ 23 , 24 , 25 , 26 ], which can be attributed to poor physicians’ awareness about antibiotics pharmacokinetics and, thus, pharmacodynamics in full-term and especially premature newborns. Extrapolating adult antibiotic regimens to the neonatal population may result in increased toxicity or altered efficacy of treatment due to different degrees of organ and system maturation.…”

Section: Introductionmentioning

confidence: 99%

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

et al. 2023

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Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.

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Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis

Cited by 14 publications

References 88 publications

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

Development and validation of a risk prediction model for medication administration errors among neonates in the neonatal intensive care unit: a study protocol

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

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