Reducing medication errors in the neonatal intensive care unit

Simpson, Judith; Lynch, Robert E.; Grant, Jonathan J.; Alroomi, L G

doi:10.1136/adc.2003.044438

Cited by 156 publications

(173 citation statements)

References 11 publications

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“…[15,16] The importance of the presence of a clinical pharmacist in a paediatric unit to monitor drug treatment and prevent medication errors is well established in some countries. [7,9,17] Clinical pharmacists monitoring medication orders might prevent more than half (58%) of all errors, including 72% of potentially harmful errors. Furthermore, they may improve doctor-pharmacist communication, preventing 47% of all errors.…”

Section: Researchmentioning

confidence: 99%

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

2017

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Section: Researchmentioning

confidence: 99%

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

2017

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“…Another study established that 25% of serious medication errors resulted from mistakes in the identification of the NBs (23) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the identification protocol for newborns in a private hospital

Quadrado¹,

Tronchin

2012

Rev. Latino-Am. Enfermagem

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This exploratory-descriptive quantitative study aimed to evaluate the protocol for identifying newborns admitted to the Neonatal Intensive and Semi-intensive Therapy Unit of a private hospital. The case series was made up of 540 observation opportunities, selected by simple random probability sampling. The data was collected between May and August 2010 according to a form and analyzed by descriptive statistic. The protocol's general performance had a conformity index of 82.2%. There were three stages to the protocol: identification components, the identification wristbands' condition and the number of identification wristbands. The highest percentage of conformity (93%) was attributed to the second stage and the lowest (89.3%) to the third, presenting a statistically significant difference of p= 0.046. In the group of 'special' neonates, 88.5% conformity was achieved. These results will make it possible to restructure the protocol for identifying newborns and to establish care and managerial goals so as to improve the quality of care and the patients' safety. Evaluación del protocolo de identificación de los recién nacidos en un hospital privado.El objetivo de este estudio exploratorio-descriptivo, cuantitativo fue evaluar protocolo de identificación de recién nacidos ingresados en Unidad de Cuidados Intensivos y Semiintensiva Neonatal de hospital privado. La muestra consistió de 540 oportunidades de observaciones, seleccionados por muestreo probabilístico aleatorio simple. Datos colectados entre mayo y agosto 2010, según formulario y analizados por estadística descriptiva y con significación 5%. Referente desempeño global del protocolo, índice de conformidad fue de 82,2%. Referente tres etapas del protocolo, porcentaje más alto de conformidad (93%) se atribuyó a la manera correcta de hacer pulseras de identificación y el más bajo (89,3%) referente a presencia de tres pulseras de identificación, con diferencia estadística significativa p = 0,046. En el grupo especial de recién nacidos, se obtuvo índice 88,5% conformidad. Estos resultados permitirán restructurar protocolo de identificación de recién nacidos y establecer metas de cuidado y gestión para mejorar calidad y seguridad del paciente.

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“…Feedback interventions can include informal ward-based teaching, one-to-one specialised education, repeated peer review or feedback during teaching rounds. 43,76,125,126,[167][168][169][170][171] Consistent with wider literature on audit and feedback interventions, effectiveness is deemed to be associated with mode of delivery, source of feedback and whether or not feedback is tied to specific actions and targets. [172][173][174] When education and feedback interventions are disconnected from how prescribing decisions are made in the workplace, they are less likely to result in meaningful and sustainable change, as a result of the important influence of clinical hierarchies.…”

Section: Education and Feedback Interventionsmentioning

confidence: 97%

“…Previous literature has also suggested that education programmes need to be rethought to include training on teamwork, such as communication in hierarchical teams, as well as error awareness and management. 73,105,125,155 However, this has not yet translated into concrete changes to the way antimicrobial prescribing training is managed, as focus still primarily lies on technical knowledge, rather than on negotiating prescribing decisions and maximising learning from everyday interactions. 36 …”

Section: Education and Feedback Interventionsmentioning

confidence: 99%

“…The educational role of pharmacists 43,60,64,125,171,181 and infectious disease specialists 102 has been extensively discussed in the literature as critical for appropriate antimicrobial prescribing. Accepting antimicrobial prescribing more widely as 'a specialised act' 102 could significantly legitimise the input of antimicrobial specialists and contribute to their meaningful involvement.…”

Section: Input From Other Professional Groupsmentioning

confidence: 99%

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Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Papoutsi

Mattick

Pearson

et al. 2018

Health Serv Deliv Res

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BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Reducing medication errors in the neonatal intensive care unit

Cited by 156 publications

References 11 publications

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Evaluation of the identification protocol for newborns in a private hospital

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

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