The impact of the introduction of a gentamicin pathway

Abstract

Introduction Medication errors are the commonest critical incidents in neonatal care. NPSA report frequent errors with gentamicin prescription, administration and monitoring. We developed a pathway to promote the safe use of gentamicin in our unit. Abstract PF.40 Table 1 Pre-pathway Post-pathway p* Dose given within 1 h of prescribed time 39 (73%) 46 (82%) 0.02 Documentation of gentamicin level 33 (62%) 41 (78%) 0.04 Appropriate action following gentamicin level result 32 (61%) 43 (77%) 0.04 Documentation of length of gentamicin therapy 22 (42%) 34 (61%) 0.045 *χ2 or Fisher's Exact test. Aim The aim of the project was to compare standards of prescription, administration and monitoring of gentamicin before and after implementation of the pathway. Standards were derived from national NPSA recommendations and local guidelines. Methodology We studied two time periods, before and after the introduction of the pathway. The dosing regimen was similar during both periods. Data was obtained from the electronic patient data management system, the drug prescription chart (pre-pathway) or the dedicated pathway documentation (post-pathway). Results 53 cases (pre-pathway) and 56 cases (post-pathway) were analysed. There were 418 doses of gentamicin administered over the two time periods. Median gestation and birth weight was lower in pre-pathway infants compared to those in post-pathway (30 vs 31 weeks, p=0.04; 1.24 vs 1.51 kg, p=0.04). Conclusion The introduction of a dedicated antibiotic pathway enhanced practice around gentamicin therapy with fewer delays in antibiotic administration, improved documentation and better practice around monitoring of gentamicin levels.

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

“…Identified studies were grouped according to their intervention type and are presented in Table 1, together with an example of an intervention within that group. The six intervention types included: technology ( n = 38), 18 –55 organizational ( n = 16), 56 –71 personnel ( n = 13), 72 –84 pharmacy ( n = 9), 85 …”

“…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).…”

“…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,…”