Targeting zero medication administration errors in the pediatric intensive care unit: A Quality Improvement project

Ghezaywi, Zahra; Alali, Hamza; Kazzaz, Yasser; Ling, Cheam Mei; Esabia, Jannet; Murabi, Iris; Mncube, Octavia; Menez, Alexander; Alsmari, Abeer; Antar, Mohannad

doi:10.1016/j.iccn.2023.103595

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Therefore, various risk reduction strategies are recommended to reduce harm when high-alert medications are used during medication administration. Examples of these strategies include standardising the preparation and administration of these medications with the involvement of a clinical pharmacist [ 46 , 49 ], implementing barcode medication administration safety and limiting the administration of high-alert medications to special authorised staff [ 46 , 50 ], improving access to information about these medications [ 46 ] and enforcing double checking when administering medications [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units

Henry Basil,

Mohd Tahir,

Menon Premakumar

et al. 2024

PLoS ONE

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Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert’s input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22–22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units

Henry Basil,

Mohd Tahir,

Menon Premakumar

et al. 2024

PLoS ONE

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Implementation of bedside medication preparation in intensive care: post-improvement cycle

Barcellos,

Silva,

Wegner

et al. 2024

Rev. Gaúcha Enferm.

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Objective: To assess the implementation of the bedside medication preparation process in an Intensive Care Unit, following a quality improvement cycle. Method: A quasi-experimental study with non-paired samples, pre- and post-implementation, conducted in an Intensive Care Unit of a public hospital in southern Brazil, from September 2022 to April 2023, following the guidelines of the Standards for Quality Improvement Reporting Excellence 2.0. Adherence to bedside medication preparation, interruptions during preparation, adequate storage, identification and validity of multidose medications, and recording of storage refrigerator temperature were evaluated. Shapiro-Wilk and Mann-Whitney U tests were used for data analysis, and Carter's Positivity Index was used to determine compliance with observed practices. Results: Forty-five audits were conducted pre-intervention and 122 audits three months after the implementation of the improvement cycle. All variables showed significant improvements. Overall compliance increased from 46% to 80% in the pre- and post-implementation periods, respectively, indicating a transition from "undesirable" to "safe" care stratum. Conclusion: The study revealed a positive relationship between the implementation of a quality improvement cycle focused on medication preparation and improvements in patient safety.

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Implementação do preparo de medicação à beira-leito em terapia intensiva: auditorias clínicas pós-ciclo de melhoria

Barcellos,

Silva,

Wegner

et al. 2024

Rev. Gaúcha Enferm.

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RESUMO Objetivo: Avaliar a implementação do processo de preparo de medicamentos à beira-leito em um Centro de Terapia Intensiva, após um ciclo de melhoria. Método: Estudo quase-experimental com amostras não pareadas, pré e pós-implementação, realizado em um Centro de Terapia Intensiva de um hospital público no sul do Brasil, de setembro de 2022 a abril de 2023, seguindo as diretrizes do Standards for Quality Improvement Reporting Excellence 2.0. Avaliou-se a adesão à preparação do medicamento à beira-leito, interrupções durante o preparo, acondicionamento adequado, identificação e validade de medicamentos multidose, e registro da temperatura da geladeira de armazenamento. Para análise dos dados utilizaram-se os testes de Shapiro-Wilk e Teste U de Mann-Whitney, e para determinar a conformidade das práticas observadas, utilizou-se o Índice de Positividade de Carter. Resultados: Realizaram-se 45 auditorias pré intervenção e 122 três meses após a implementação do ciclo de melhoria. Todas as variáveis apresentaram melhorias significativas. A conformidade geral aumentou de 46% para 80% nos períodos pré e pós-implementação, respectivamente, indicando a transição do estrato de assistência “indesejada” para “segura”. Conclusão: O estudo revelou uma relação positiva entre a implementação de um ciclo de melhoria da qualidade, centrado no preparo de medicamentos, e melhorias na segurança do paciente.

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Targeting zero medication administration errors in the pediatric intensive care unit: A Quality Improvement project

Cited by 4 publications

References 15 publications

Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units

Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units

Implementation of bedside medication preparation in intensive care: post-improvement cycle

Implementação do preparo de medicação à beira-leito em terapia intensiva: auditorias clínicas pós-ciclo de melhoria

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