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Yalçın N, Kaşıkcı M, Çelik HT, Allegaert K, Demirkan K, Yiğit Ş. Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial. Front Pharmacol 2023; 14:1242779. [PMID: 37645440 PMCID: PMC10461390 DOI: 10.3389/fphar.2023.1242779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
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 Registration ClinicalTrials.gov, identifier NCT04899960.
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Affiliation(s)
- Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Merve Kaşıkcı
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hasan Tolga Çelik
- Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Department of Development and Regeneration, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Şule Yiğit
- Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Chachlioutaki K, Gioumouxouzis C, Karavasili C, Fatouros DG. Small patients, big challenges: navigating pediatric drug manipulations to prevent medication errors - a comprehensive review. Expert Opin Drug Deliv 2023; 20:1489-1509. [PMID: 37857515 DOI: 10.1080/17425247.2023.2273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Medication errors during drug manipulations in pediatric care pose significant challenges to patient safety and optimal medication management. Epidemiological studies have revealed a high prevalenceof medication errors throughout the medication process. Due to the lack of age-appropriate dosage forms, medication manipulation is common in pediatric drug administration. The consequences of these manipulations on drug efficacy and safety could be devastating, highlighting the need for evidence-based guidelines and standardized compounding practices. AREAS COVERED This review focuses on examining medication errors in pediatric care and delving into the manipulation of medicinal products. EXPERT OPINION The observed prevalence of medication errors and manipulations underscores the importance of addressing these issues to enhance patient safety and improve medication outcomes in pediatric care. Overall, the development of age-appropriate formulations and the dissemination of comprehensive clinical guidelines are essential steps toward improving medication safety and minimizing manipulations in pediatric healthcare settings.
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Affiliation(s)
- Konstantina Chachlioutaki
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
| | - Christos Gioumouxouzis
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karavasili
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Fatouros
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Mohamed Shah N. Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Drug Saf 2022; 45:1457-1476. [PMID: 36192535 DOI: 10.1007/s40264-022-01236-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonates are at greater risk of preventable adverse drug events as compared to children and adults. OBJECTIVE This study aimed to estimate and critically appraise the evidence on the prevalence, causes and severity of medication administration errors (MAEs) amongst neonates in Neonatal Intensive Care Units (NICUs). METHODS A systematic review and meta-analysis was conducted by searching nine electronic databases and the grey literature for studies, without language and publication date restrictions. The pooled prevalence of MAEs was estimated using a random-effects model. Data on error causation were synthesised using Reason's model of accident causation. RESULTS Twenty unique studies were included. Amongst direct observation studies reporting total opportunity for errors as the denominator for MAEs, the pooled prevalence was 59.3% (95% confidence interval [CI] 35.4-81.3, I2 = 99.5%). Whereas, the non-direct observation studies reporting medication error reports as the denominator yielded a pooled prevalence of 64.8% (95% CI 46.6-81.1, I2 = 98.2%). The common reported causes were error-provoking environments (five studies), while active failures were reported by three studies. Only three studies examined the severity of MAEs, and each utilised a different method of assessment. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis estimating the prevalence, causes and severity of MAEs amongst neonates. There is a need to improve the quality and reporting of studies to produce a better estimate of the prevalence of MAEs amongst neonates. Important targets such as wrong administration-technique, wrong drug-preparation and wrong time errors have been identified to guide the implementation of remedial measures.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
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Holgate SL, Bekker A, Pillay-Fuentes Lorente V, Dramowski A. Errors in Antimicrobial Prescription and Administration in Very Low Birth Weight Neonates at a Tertiary South African Hospital. Front Pediatr 2022; 10:838153. [PMID: 35311044 PMCID: PMC8927727 DOI: 10.3389/fped.2022.838153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antimicrobial prescription and administration-related errors occur frequently in very low birth weight (VLBW; <1,500 g) neonates treated for bloodstream infections (BSI). METHODS Antimicrobial prescriptions for the treatment of laboratory-confirmed BSI were retrospectively analyzed for VLBW neonates at Tygerberg Hospital, Cape Town, South Africa (1 July 2018 - 31 December 2019), describing antimicrobial type, indication, duration of therapy and BSI outcomes. The prevalence of, and risk factors for prescription (dose, interval) and administration errors (hang-time, delayed/missed doses) were determined. RESULTS One hundred and sixty-one BSI episodes [16 (9.9%)] early-onset, 145 [90.1%] healthcare-associated) affected 141 neonates (55% male, 25% born to mothers living with HIV, 46% <1,000 g birth weight) with 525 antimicrobial prescription episodes [median 3.0 (IQR 2-4) prescriptions/BSI episode]. The median duration of therapy for primary BSI, BSI-associated with meningitis and BSI-associated with surgical infections was 9, 22, and 28 days, respectively. The prevalence of dose and dosing interval errors was 15.6% (77/495) and 16.4% (81/495), respectively with prescription errors occurring most commonly for piperacillin-tazobactam and vancomycin given empirically. Administration errors were less frequent [3.8% (219/5,770) doses missed; 1.4% (78/5,770) delayed], however 64% had a hang-time (time from sepsis diagnosis to 1st dose of antimicrobial) exceeding 60 min. On multivariable analysis, postnatal age >7 days was associated with prescription errors (p = 0.028). The majority of neonates with BSI required escalation of respiratory support (52%) and 26% required intensive care admission. Despite fair concordance between empiric antimicrobial/s prescription and pathogen susceptibility (74.5%), BSI-attributable mortality in this cohort was 30.4%. CONCLUSION VLBW neonates with BSI's were critically ill and had high mortality rates. Hang-time to first antimicrobial administration was delayed in two-thirds of BSI episodes and prescription errors affected almost 1 in 6 prescriptions. Targets for intervention should include reducing hang-time, use of standardized antimicrobial dosing guidelines and implementation of antimicrobial stewardship recommendations.
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Affiliation(s)
- Sandi L Holgate
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Veshni Pillay-Fuentes Lorente
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Marufu TC, Bower R, Hendron E, Manning JC. Nursing interventions to reduce medication errors in paediatrics and neonates: Systematic review and meta-analysis. J Pediatr Nurs 2022; 62:e139-e147. [PMID: 34507851 DOI: 10.1016/j.pedn.2021.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication errors are a great concern to health care organisations as they are costly and pose a significant risk to patients. Children are three times more likely to be affected by medication errors than adults with medication administration error rates reported to be over 70%. OBJECTIVE To identify nursing interventions to reduce medication administration errors and perform a meta-analysis. METHODS Online databases; British Nursing Index (BNI), Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and MEDLINE were searched for relevant studies published between January 2000 to 2020. Studies with clear primary or secondary aims focusing on interventions to reduce medication administration errors in paediatrics, children and or neonates were included in the review. RESULTS 442 studies were screened and18 studies met the inclusion criteria. Seven interventions were identified from included studies; education programmes, medication information services, clinical pharmacist involvement, double checking, barriers to reduce interruptions during drug calculation and preparation, implementation of smart pumps and improvement strategies. Educational interventional aspects were the most common identified in 13 out of 18 included studies. Meta-analysis demonstrated an associated 64% reduction in medicine administration errors post intervention (pooled OR 0.36 (95% Confidence Interval (CI) 0.21-0.63) P = 0.0003). CONCLUSION Medication safety education is an important element of interventions to reduce administration errors. Medication errors are multifaceted that require a bundle interventional approach to address the complexities and dynamics relevant to the local context. It is imperative that causes of errors need to be identified prior to implementation of appropriate interventions.
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Affiliation(s)
- Takawira C Marufu
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Rachel Bower
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Elizabeth Hendron
- Library Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joseph C Manning
- Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
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Badr M, Goulard M, Theret B, Roubertie A, Badiou S, Pifre R, Bres V, Cambonie G. Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report. BMC Pediatr 2021; 21:584. [PMID: 34930217 PMCID: PMC8686371 DOI: 10.1186/s12887-021-03064-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/08/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). CASE PRESENTATION Twenty-four hours after birth, a 30 weeks' gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. The infant's condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. CONCLUSIONS Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure.
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Affiliation(s)
- Maliha Badr
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Marion Goulard
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Bénédicte Theret
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Agathe Roubertie
- Department of Neuropaediatrics, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry and Hormonology, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Roselyne Pifre
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Virginie Bres
- Department of Medical Pharmacology and Toxicology, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
- Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
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Abdel-Qader DH, Saadi Ismael N, Al Meslamani AZ, Albassam A, El-Shara' AA, Lewis PJ, Hamadi S, Al Mazrouei N. The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study. Hosp Pharm 2021; 56:681-689. [PMID: 34732922 DOI: 10.1177/0018578720942231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians' acceptance of clinical pharmacists' interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians' acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.
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Affiliation(s)
- Derar H Abdel-Qader
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Ahmad Z Al Meslamani
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Asma' A El-Shara'
- Department of Clinical Sciences, Philadelphia University, Amman, Jordan
| | - Penny J Lewis
- Division of Pharmacy & Optometry, The University of Manchester, UK
| | - Salim Hamadi
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, UAE
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Grover R, Shubham S, Upadhyay J, Digal KC, Singh P, Basu S. Reduction of Prescription Errors in Neonatal Intensive Care Unit:A Quality Improvement Initiative. Indian J Pediatr 2021; 88:94. [PMID: 32780349 DOI: 10.1007/s12098-020-03470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Jaya Upadhyay
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Kanhu Charan Digal
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Ibrahim CH, Ofoegbu B, Yahya L, Catroon K, Al Masri D, Saliba A, Ghassa L. Reducing medication errors on a busy tertiary neonatal intensive care unit using a quality improvement approach. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Conn RL, Tully MP, Shields MD, Carrington A, Dornan T. Characteristics of Reported Pediatric Medication Errors in Northern Ireland and Use in Quality Improvement. Paediatr Drugs 2020; 22:551-560. [PMID: 32627136 DOI: 10.1007/s40272-020-00407-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To protect children from harm, clinicians, educators, and patient safety champions need information to direct improvement efforts. Critical incident data could provide this but are often disregarded as a source of evidence because under-reporting makes them an inaccurate measure of error rates. OBJECTIVE Our aim was to identify key targets for pediatric healthcare quality improvement. The objective was to evaluate the types, characteristics, and areas of risk within reported medication errors in pediatric patients. METHODS We conducted a retrospective study of a large regional dataset of 1522 pediatric medication errors reported from secondary care between 2011 and 2015, including all hospitals and community pediatric settings in Northern Ireland. The following characteristics were included: error severity, patient age, drug involved, error type, and area of practice. Two academic pediatricians, a senior medicines governance pharmacist, a Reader in Pharmacy Practice, and a Professor of Medical Education analyzed the data. Validity checks included comparing the findings against key published literature and discussion by a practitioner panel representing five multidisciplinary stakeholder groups. RESULTS Neonates, particularly in intensive care, were implicated in 19% of all errors. The medications most represented in risk were antimicrobials, paracetamol, vaccines, and intravenous fluids. The error types most implicated were dosing errors (32%) and omissions (21%). CONCLUSIONS Incident reports identified neonates, a shortlist of drugs, and specific error types, associated with modifiable behaviors, as priority improvement targets. These findings direct further study and inform intervention development, such as specific training in calculations to prevent dosing errors. Involving experienced practitioners both endorsed the findings and engaged the practice community in their future implementation. The utility of incident reports to direct improvement efforts may offset the limitations in their representativeness.
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Affiliation(s)
- Richard L Conn
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK.
| | - Mary P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Michael D Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Angela Carrington
- Medicines Governance Team, Belfast Health and Social Care Trust, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK
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Affiliation(s)
- Sook Hee An
- College of Pharmacy, Wonkwang University, Jeonbuk 55338, Republic of Korea
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12
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Besagar S, Robles PLA, Manzano W, Applebaum JR, Goffman D, Adelman JS. A National Survey on the Use of Temporary Naming Conventions for Newborns: 5-Year Follow-up. Clin Pediatr (Phila) 2020; 59:925-928. [PMID: 32425119 DOI: 10.1177/0009922820922534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sonya Besagar
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | - Dena Goffman
- Columbia University Irving Medical Center, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jason S Adelman
- Columbia University Irving Medical Center, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
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13
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Caeymaex L, Lebeaux C, Roze JC, Danan C, Reynaud A, Jung C, Audureau E. Study on preventing adverse events in neonates (SEPREVEN): A stepped-wedge randomised controlled trial to reduce adverse event rates in the NICU. Medicine (Baltimore) 2020; 99:e20912. [PMID: 32756081 PMCID: PMC7402760 DOI: 10.1097/md.0000000000020912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.
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Affiliation(s)
- Laurence Caeymaex
- Faculty of Health and CEDITEC, University Paris East Creteil
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Creteil, Créteil
| | - Cecile Lebeaux
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil
| | - Jean Christophe Roze
- Pediatric Intensive Care Unit Nantes, University Hospital Centre Nantes, Pays de la Loire
| | - Claude Danan
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Creteil, Créteil
| | | | - Camille Jung
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Creteil, Créteil
| | - Etienne Audureau
- Faculty of Health and CEDITEC, University Paris East Creteil
- IMRB INSERM U 955 Team CEpiA (Clinical Epidemiology and Ageing Unit), Creteil, Val de Marne
- Assistance Publique Hôpitaux de Paris (APHP), Hôpital Henri-Mondor, Clinical Research Unit (URC), Public Health Department, Créteil, France
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Aldiania Carlos Balbino, Silva ANS, Queiroz MVO. El impacto de las tecnologías educativas en la formación de profesionales a cargo de la atención neonatal. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Se observa el avance existente en la producción de tecnologías educativas para facilitar el aprendizaje, la formación y la solución a las necesidades que surgen del proceso de trabajo de los profesionales que prestan servicios en las unidades neonatales. Objetivo: Evaluar el impacto de las tecnologías educativas utilizadas en la formación de profesionales a cargo de la atención neonatal. Materiales y métodos: Se llevó a cabo una revisión integradora de la literatura en PubMed, CINAHL, Scopus, Web of Science, ScienceDirect y LILACS en el periodo entre agosto y septiembre de 2017. Se cruzaron los descriptores de aplicaciones móviles “personal de salud, niños, recién nacidos, multimedia, aprendizaje, salud móvil, aplicaciones, neonatos y educación sanitaria” y se analizaron 12 artículos en total. Resultados: En los estudios se utilizaron diferentes tecnologías de enseñanza, desde las metodologías tradicionales hasta las metodologías activas, con la exposición de materiales educativos impresos junto con las tecnologías de la información y la comunicación. La mayoría de los estudios mostraron una mejora en el conocimiento, las habilidades y el cumplimiento de las directrices relacionadas con el cuidado crítico del recién nacido. Discusión: Las tecnologías educativas de corta y mediana duración que se emplearon para la atención neonatal permitieron ampliar los conocimientos y las habilidades profesionales. Las tecnologías impresas favorecieron el desarrollo de un enfoque comunicativo horizontal, lo que repercutió en el empoderamiento y la autonomía de los participantes. Los dispositivos móviles, por su parte, brindaron un apoyo inmediato al cuidador mediante el acceso a una gran diversidad de contenidos educativos desde cualquier lugar, lo que ayudó a aclarar las dudas relacionadas con la aplicación de procedimientos. Conclusión: Las tecnologías educativas utilizadas en la formación de los profesionales se encuentran diversificadas y son aplicables en diferentes escenarios de la atención neonatal, lo que repercute en el aprendizaje y los resultados en materia de salud del recién nacido
Como citar este artículo: Balbino, Aldiania Carlos; Silva, Amanda Newle Sousa; Queiroz, Maria Veraci Oliveira. O impacto das tecnologias educacionais no ensino de profissionais para o cuidado neonatal. Revista Cuidarte. 2020; 11(2): e954. http://dx.doi.org/10.15649/cuidarte.954
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Umar L, Isah A, Musa S, Umar B. Outpatient prescribing and antibiotic use for children in a tertiary hospital. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_27_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eslami K, Aletayeb F, Aletayeb SMH, Kouti L, Hardani AK. Identifying medication errors in neonatal intensive care units: a two-center study. BMC Pediatr 2019; 19:365. [PMID: 31638939 PMCID: PMC6805622 DOI: 10.1186/s12887-019-1748-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/25/2019] [Indexed: 12/19/2022] Open
Abstract
Background This study aimed to assess the types and frequency of medication errors in our NICUs (neonatal intensive care units). Methods This descriptive cross-sectional study was conducted on two neonatal intensive care units of two hospitals over 3 months. Demographic information, drug information and total number of prescriptions for each neonate were extracted from medical records and assessed. Results A total of 688 prescriptions for 44 types of drugs were checked for the assessment of medical records of 155 neonates. There were 509 medication errors, averaging (SD) 3.38 (+/− 5.49) errors per patient. Collectively, 116 neonates (74.8%) experienced at least one medication error. Term neonates and preterm neonates experienced 125 and 384 medication errors, respectively. The most frequent medication errors were wrong dosage by physicians in prescription phase [WU1] (142 errors; 28%) and not administering medication by nurse in administration phase (146 errors; 29%). Of total 688 prescriptions, 127 errors were recorded. In this regard, lack of time and/or date of order were the most common errors. Conclusions The most frequent medication errors were wrong dosage and not administering the medication to patient, and on the quality of prescribing, lack of time and/or date of order was the most frequent one. Medication errors happened more frequently in preterm neonates (P < 0.001). We think that using computerized physician order entry (CPOE) system and increasing the nurse-to-patient ratio can reduce the possibility of medication errors.
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Affiliation(s)
- Kaveh Eslami
- Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fateme Aletayeb
- Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyyed Mohammad Hassan Aletayeb
- Department of Pediatrics, Faculty of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR, Iran.
| | - Leila Kouti
- Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Kamal Hardani
- Department of Pediatrics, Faculty of Medicine, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Adelman JS, Applebaum JR, Southern WN, Schechter CB, Aschner JL, Berger MA, Racine AD, Chacko B, Dadlez NM, Goffman D, Babineau J, Green RA, Vawdrey DK, Manzano W, Barchi D, Albanese C, Bates DW, Salmasian H. Risk of Wrong-Patient Orders Among Multiple vs Singleton Births in the Neonatal Intensive Care Units of 2 Integrated Health Care Systems. JAMA Pediatr 2019; 173:979-985. [PMID: 31449284 PMCID: PMC6714004 DOI: 10.1001/jamapediatrics.2019.2733] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Multiple-birth infants in neonatal intensive care units (NICUs) have nearly identical patient identifiers and may be at greater risk of wrong-patient order errors compared with singleton-birth infants. OBJECTIVES To assess the risk of wrong-patient orders among multiple-birth infants and singletons receiving care in the NICU and to examine the proportion of wrong-patient orders between multiple-birth infants and siblings (intrafamilial errors) and between multiple-birth infants and nonsiblings (extrafamilial errors). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted in 6 NICUs of 2 large, integrated health care systems in New York City that used distinct temporary names for newborns per the requirements of The Joint Commission. Data were collected from 4 NICUs at New York-Presbyterian Hospital from January 1, 2012, to December 31, 2015, and 2 NICUs at Montefiore Health System from July 1, 2013, to June 30, 2015. Data were analyzed from May 1, 2017, to December 31, 2017. All infants in the 6 NICUs for whom electronic orders were placed during the study periods were included. MAIN OUTCOMES AND MEASURES Wrong-patient electronic orders were identified using the Wrong-Patient Retract-and-Reorder (RAR) Measure. This measure was used to detect RAR events, which are defined as 1 or more orders placed for a patient that are retracted (ie, canceled) by the same clinician within 10 minutes, then reordered by the same clinician for a different patient within the next 10 minutes. RESULTS A total of 10 819 infants were included: 85.5% were singleton-birth infants and 14.5% were multiple-birth infants (male, 55.8%; female, 44.2%). The overall wrong-patient order rate was significantly higher among multiple-birth infants than among singleton-birth infants (66.0 vs 41.7 RAR events per 100 000 orders, respectively; adjusted odds ratio, 1.75; 95% CI, 1.39-2.20; P < .001). The rate of extrafamilial RAR events among multiple-birth infants (36.1 per 100 000 orders) was similar to that of singleton-birth infants (41.7 per 100 000 orders). The excess risk among multiple-birth infants (29.9 per 100 000 orders) appears to be owing to intrafamilial RAR events. The risk increased as the number of siblings receiving care in the NICU increased; a wrong-patient order error occurred in 1 in 7 sets of twin births and in 1 in 3 sets of higher-order multiple births. CONCLUSIONS AND RELEVANCE This study suggests that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. This excess risk appears to be owing to misidentification between siblings. These results suggest that a distinct naming convention as required by The Joint Commission may provide insufficient protection against identification errors among multiple-birth infants. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.
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Affiliation(s)
- Jason S. Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York,Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York,New York–Presbyterian Hospital, New York
| | | | - William N. Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Judy L. Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York,Hackensack Meridian Health School of Medicine, Seton Hall University, Nutley, New Jersey
| | - Matthew A. Berger
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York,Montefiore Health System, Bronx, New York
| | - Andrew D. Racine
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York,Montefiore Health System, Bronx, New York
| | | | - Nina M. Dadlez
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Dena Goffman
- New York–Presbyterian Hospital, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - John Babineau
- New York–Presbyterian Hospital, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Robert A. Green
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York,New York–Presbyterian Hospital, New York
| | - David K. Vawdrey
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York,New York–Presbyterian Hospital, New York
| | | | | | | | - David W. Bates
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hojjat Salmasian
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Krzyżaniak N, Pawłowska I, Bajorek B. Quality pharmaceutical care in the neonatal intensive care unit: identification of essential pharmacy services and key performance indicators for the Australian setting. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Natalia Krzyżaniak
- Graduate School of Health (Pharmacy) University of Technology Sydney Sydney Australia
| | - Iga Pawłowska
- Department of Pharmacology Medical University of Gdansk Gdańsk Poland
| | - Beata Bajorek
- Graduate School of Health (Pharmacy) University of Technology Sydney Sydney Australia
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Leopoldino RD, Santos MT, Costa TX, Martins RR, Oliveira AG. Drug related problems in the neonatal intensive care unit: incidence, characterization and clinical relevance. BMC Pediatr 2019; 19:134. [PMID: 31027487 PMCID: PMC6485091 DOI: 10.1186/s12887-019-1499-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Any event involving drug therapy that may interfere in a patient's desired clinical outcome is called a drug related problem (DRP). DRP are very common in intensive therapy, however, little is known about DRP in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to determine the incidence of DRPs in NICU patients and to characterize DRPs according to type, cause and corresponding pharmaceutical conducts. METHODS Prospective observational study conducted in the NICU at a teaching hospital in Brazil from January 2014 to November 2016. The data were collected from the records of the clinical pharmacy service, excluding neonates admitted for less than 24 h and those who had no drugs prescribed. DRPs were classified according to the Pharmaceutical Care Network Europe system and evaluated for relevance-safety. RESULTS Six hundred neonates were included in the study, with mean gestational age of 31.9 ± 4.1 weeks and mean birth weight of 1779 ± 885 g. The incidence of DRPs in the NICU was 6.8% patient-days (95%CI 6.2-7.3%) and affected 59.8% of neonates (95% CI 55.8-63.8%). Sub-optimal effect (52.8%) and inappropriate dose selection (39.75%) were the most common problem and cause, respectively. Anti-infectives was the medication class most involved in DRPs. More than one-third of neonates were exposed to DRP of significant or high safety-relevance. Most of the pharmaceutical interventions were related with drug prescription, with over 90% acceptance by attending physicians. CONCLUSION DRP are common in NICU, predominating problems of sub-optimal treatment, mainly due to inappropriate dose selection.
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Affiliation(s)
- Ramon Duarte Leopoldino
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil.
| | - Marco Tavares Santos
- Maternity School Januário Cicco, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Tatiana Xavier Costa
- Maternity School Januário Cicco, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Rand Randall Martins
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - António Gouveia Oliveira
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
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Krzyżaniak N, Pawłowska I, Pawłowski L, Kocić I, Bajorek B. Pharmaceutical care in the neonatal intensive care unit: Perspectives of Polish medical and pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:361-372. [PMID: 31040012 DOI: 10.1016/j.cptl.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/20/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The concepts of ward-based pharmaceutical care as well as collaborative practice are still relatively novel in Poland, particularly in specialty areas of practice such as the neonatal intensive care unit (NICU). The purpose of this study was to identify the opinions and perceptions of Polish medical and pharmacy students towards the provision of pharmaceutical care services in the NICU as well as pharmacist integration into the ward-based multi-disciplinary NICU treating team. METHODS A cross-sectional, mixed-method survey was distributed among medical and pharmacy students at a large Polish medical university. RESULTS A total of 147 students completed the survey (74 pharmacy and 73 medical). Overall, there were statistically significant differences between the perspectives of medical and pharmacy students towards the provision of pharmaceutical care services in the NICU. For 11 out of 15 proposed clinical roles, a significantly lower proportion of medical students (M) agreed that pharmacists should perform these in the NICU compared to pharmacy students (P). These roles included participation in ward rounds (P = 82.4%, M = 38.4%, p < 0.001), therapeutic drug monitoring (P = 98.6%, M = 78.1%, p < 0.001), and monitoring total parenteral nutrition (P = 87.8%, M = 37%, p ≤ 0.001). CONCLUSIONS Further investigation is needed to develop educational strategies directed at clinical, patient-centered, collaborative roles, particularly for specialty areas of practice such as the NICU, that have the potential to facilitate the provision of a more advanced and comprehensive level of pharmaceutical care.
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Affiliation(s)
- Natalia Krzyżaniak
- University of Technology Sydney, Graduate School of Health (Pharmacy), PO Box 123, Broadway, NSW 2007, Australia.
| | - Iga Pawłowska
- Medical University of Gdansk, Department of Pharmacology, Dębowa Str. 23, 80-204, Gdańsk, Poland.
| | - Leszek Pawłowski
- Medical University of Gdansk, Department of Palliative Medicine, Dębinki 2, 80-211, Gdańsk, Poland.
| | - Ivan Kocić
- Medical University of Gdansk, Department of Pharmacology, Dębowa Str. 23, 80-204, Gdańsk, Poland.
| | - Beata Bajorek
- University of Technology Sydney, Graduate School of Health (Pharmacy), PO Box 123, Broadway, NSW 2007, Australia.
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Krzyżaniak N, Pawłowska I, Bajorek B. Pharmacist perceptions on the need for a quality guidance resource for pharmacy service provision in the neonatal intensive care unit: comparison between Poland and Australia. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natalia Krzyżaniak
- Graduate School of Health (Pharmacy); University of Technology Sydney; Broadway New South Wales Australia
| | - Iga Pawłowska
- Department of Pharmacology; Medical University of Gdansk; Gdańsk Poland
| | - Beata Bajorek
- Graduate School of Health (Pharmacy); University of Technology Sydney; Broadway New South Wales Australia
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Al-Kudhairi F, Kayyali R, Savickas V, Sharma N. A Qualitative Study Exploring the Role of Pharmacists in Medical Student Training for the Prescribing Safety Assessment. PHARMACY 2018; 6:pharmacy6030087. [PMID: 30134511 PMCID: PMC6164552 DOI: 10.3390/pharmacy6030087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/24/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022] Open
Abstract
Five years after the introduction of the Prescribing Safety Assessment (PSA) in the UK, the role pharmacists play to help prepare medical students for this challenge is uncertain. Our study explored pharmacists’ perceptions about their role in undergraduate medical training for the Prescribing Safety Assessment (PSA). One hundred and seventy-nine prospective participants from UK hospitals and education and training boards were emailed an interview schedule aimed at ascertaining their current involvement in undergraduate medical education, particularly the preparation for PSA. Responses received via email were thematically-analysed. A total of 27 hospital pharmacists and 3 pharmacists from local education and training boards participated in the interviews. Pharmacists were positive about their involvement in medical student training, recognising the added value they could provide in prescribing practice. However, respondents expressed concerns regarding resource availability and the need for formal educational practice mentoring. Despite a low response rate (17%), this research highlights the potential value of pharmacists’ input into medical education and the need for a discussion on strategies to expand this role to maximise the benefits from having a pharmacist skill mix when teaching safe prescribing.
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Affiliation(s)
- Fay Al-Kudhairi
- Department of Pharmacy, University Hospital Lewisham, Lewisham High St, London SE13 6LH, UK.
| | - Reem Kayyali
- Department of Pharmacy, Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames KT1 2EE, UK.
| | - Vilius Savickas
- Department of Pharmacy, Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames KT1 2EE, UK.
| | - Neel Sharma
- Division of Gastroenterology and Hepatology, National University Hospital Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore.
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Modi A, Germain E, Soma V, Munjal I, Rinke ML. Epidemiology of and Risk Factors for Harmful Anti-Infective Medication Errors in a Pediatric Hospital. Jt Comm J Qual Patient Saf 2018; 44:599-604. [PMID: 30064960 DOI: 10.1016/j.jcjq.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature is limited on pediatric anti-infective medication errors. There is a pressing need for additional research, as studies suggest high rates of overall pediatric medication errors and known harmful side effect profiles for anti-infective medications with narrow dosing ranges. This study aimed to identify risk factors related to harmful anti-infective medication errors in pediatric patients. METHODS A retrospective chart review of all voluntary error reports involving anti-infective medication errors and pediatric patients (0 to < 22 years old) reported June 2014-December 2015 was conducted. Error reports were generated using the hospital's general error reporting system and a pharmacy-based patient surveillance reporting system and were stratified based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Medication Error Index. Harmful errors were compared to nonharmful errors using Fisher's exact test. RESULTS Of 338 anti-infective medication-related error reports, 13.6% of voluntarily reported errors reached the patient and 1.5% resulted in harm to the patient and required additional monitoring, interventions, and/or prolonged hospitalization. Antibacterials comprised 93.8% of all error reports, with beta-lactams (63.0%), macrolides (6.5%) and glycopeptides (6.2%) the most common classes. When using Fisher's exact test to compare harmful and nonharmful medication errors, the risk factor significantly associated with harmful errors was anti-infective class (p = 0.001). CONCLUSION Voluntarily reported anti-infective medication errors within the pediatric patient population often reached the patient, and specific anti-infective medications are potentially of higher risk. Further investigation and additional quality and patient safety strategies may be needed for these higher-risk profile medications.
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Kugelman A, Borenstein-Levin L, Jubran H, Dinur G, Ben-David S, Segal E, Haddad J, Timstut F, Stein I, Makhoul IR, Hochwald O. Less is More: Modern Neonatology. Rambam Maimonides Med J 2018; 9:RMMJ.10344. [PMID: 30089091 PMCID: PMC6115478 DOI: 10.5041/rmmj.10344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies.
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Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Elena Segal
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Julie Haddad
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Fanny Timstut
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Iris Stein
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Imad R. Makhoul
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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Abuelsoud N. Pharmacy quality improvement project to enhance the medication management process in pediatric patients. Ir J Med Sci 2018; 188:591-600. [PMID: 30008081 DOI: 10.1007/s11845-018-1860-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improvement in the quality of the medication management process is a crucial component of twenty-first-century medicine. AIM To improve the quality of medication management process within pediatric specialty through designing a quality improvement project for the pharmaceutical care services in a children' hospital to solve the drug-related problems during drug prescribing, administration, and monitoring. METHODS A total of 900 medical files were evaluated (100 file/month) from the pediatric medical ward to detect any medication errors during prescribing, administration, or monitoring of the drugs. Three pharmacy quality indicators were designed to detect any medication errors during prescribing, administration, or monitoring of the drugs, then a collective datasheet was designed to record any defect in the system during drug management process within the hospital. A quality improvement project was designed using many quality improvement techniques to decrease the rates of medication errors in each drug handling stage. Brainstorming, fishbone chart, questionnaire, and voting were the main quality tools used to detect the causes of medication errors problem in pediatric patients. Certain actions were implemented which included educational program, implementation of clinical pharmacy, intravenous admixture, and drug information services. RESULTS The quality improvement interventions succeeded in decreasing the rates of medication errors in each stage. These interventions succeeded in decreasing the rates of medication errors in prescribing, administration, and monitoring stages from 47, 60, and 56% respectively to ≤ 15% within 9 months. CONCLUSION Pharmacists can have a key role in improving the health-care system's quality in developing countries' health-care systems.
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Affiliation(s)
- Nermeen Abuelsoud
- Department of Clinical Pharmacy Practice, Faculty of Pharmacy, The British University in Egypt, Misr-Ismalia Road, Postal No. 11837, P.O. Box 43, El Sherouk City, Cairo, Egypt.
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Krzyżaniak N, Pawłowska I, Bajorek B. Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach. Int J Clin Pharm 2018; 40:533-542. [PMID: 29605949 DOI: 10.1007/s11096-018-0623-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/15/2018] [Indexed: 01/12/2023]
Abstract
Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.
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Affiliation(s)
- Natalia Krzyżaniak
- Graduate School of Health (Pharmacy), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia.
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdansk, Dębowa Str. 23, 80-204, Gdańsk, Poland
| | - Beata Bajorek
- Graduate School of Health (Pharmacy), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Mark Pearson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Simon Briscoe
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Krzyżaniak N, Pawłowska I, Bajorek B. The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice. Eur J Hosp Pharm 2018; 25:e7-e16. [PMID: 31157060 DOI: 10.1136/ejhpharm-2017-001432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/01/2017] [Accepted: 12/12/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives To describe and compare the pharmaceutical services and clinical pharmacy roles performed in neonatal intensive care units (NICUs) in Australian versus Polish hospitals. Methods A 26-item survey was distributed electronically to directors of pharmacy as well as neonatal pharmacists in hospitals in Poland and Australia. Most questions were fixed 'agree/disagree' answers, supplemented by open-ended questions. The survey was distributed between January and May 2017. Results Overall, 30 Australian pharmacists and 22 Polish pharmacists completed the survey. Significant differences were observed in the types of pharmaceutical care services provided to NICUs between Australia and Poland. A higher proportion of Australians than Poles performed clinical roles: for example, providing medication recommendations (Aus=96.6%, Pol=9.1%, P<0.001); pharmaceutical interventions to resolve drug therapy problems (Aus=93.1%, Pol=18.2%, P<0.001); and general patient medication chart review (Aus=96.6%, Pol=13.6%, P<0.001). All (100%) Polish pharmacists did not consider themselves members of the NICU team and the majority (59.1%) felt that pharmaceutical care on the NICU was practically non-existent. Conclusion Future research should focus on bringing practice in countries such as Poland closer in line with practice in countries such as Australia.
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Affiliation(s)
- Natalia Krzyżaniak
- Department of Pharmacy, University of Technology Sydney, Graduate School of Health (Pharmacy), Sydney, Australia
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Poland
| | - Beata Bajorek
- Department of Pharmacy, University of Technology Sydney, Graduate School of Health (Pharmacy), Sydney, Australia
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Nguyen MNR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf 2017; 9:123-155. [PMID: 29387337 DOI: 10.1177/2042098617748868] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023] Open
Abstract
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 reference-list 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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Affiliation(s)
| | - Cassandra Mosel
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Level 6, AHMS, Adelaide, SA 5000, Australia
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Adelman JS, Aschner JL, Schechter CB, Angert RM, Weiss JM, Rai A, Parakkattu V, Goffman D, Applebaum JR, Racine AD, Southern WN. Babyboy/Babygirl: A National Survey on the Use of Temporary, Nondistinct Naming Conventions for Newborns in Neonatal Intensive Care Units. Clin Pediatr (Phila) 2017; 56:1157-1159. [PMID: 28403654 DOI: 10.1177/0009922817701178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason S Adelman
- 1 NewYork-Presbyterian Hospital, New York, NY, USA.,2 Columbia University Medical Center, New York, NY, USA
| | - Judy L Aschner
- 3 Children's Hospital at Montefiore, Bronx, NY, USA.,4 Montefiore Medical Center, Bronx, NY, USA.,5 Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Robert M Angert
- 3 Children's Hospital at Montefiore, Bronx, NY, USA.,5 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey M Weiss
- 4 Montefiore Medical Center, Bronx, NY, USA.,5 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amisha Rai
- 1 NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Dena Goffman
- 1 NewYork-Presbyterian Hospital, New York, NY, USA.,2 Columbia University Medical Center, New York, NY, USA
| | | | - Andrew D Racine
- 4 Montefiore Medical Center, Bronx, NY, USA.,5 Albert Einstein College of Medicine, Bronx, NY, USA
| | - William N Southern
- 4 Montefiore Medical Center, Bronx, NY, USA.,5 Albert Einstein College of Medicine, Bronx, NY, USA
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 2017; 72:2418-2430. [PMID: 28859445 PMCID: PMC5890780 DOI: 10.1093/jac/dkx194] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. Methods The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. Results By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one's reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians' prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Conclusions This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Mark Pearson
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Peninsula Schools of Medicine & Dentistry, Plymouth University, Drake Circus Plymouth, Devon PL4 8AA, UK
| | - Simon Briscoe
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Panagos PG, Pearlman SA. Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care. Clin Perinatol 2017; 44:645-662. [PMID: 28802344 DOI: 10.1016/j.clp.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology. Unplanned extubation is an example of a neonatal safety concern that can be reduced by employing quality improvement methodology.
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Affiliation(s)
- Patoula G Panagos
- Division of Neonatology, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA; Nemours Neonatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen A Pearlman
- Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA; Division of Neonatology, Women and Children's Services, Christiana Care Health System, MAP I Suite 217, Newark, DE 19713, USA.
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Morin P, Guillois B, Gloanec L, Chatelier N, Saint-Lorant G. Évaluation des pratiques de préparation et d’administration des médicaments injectables en néonatalogie. Arch Pediatr 2017; 24:795-801. [DOI: 10.1016/j.arcped.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/02/2016] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
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Medication Safety in the Neonatal Intensive Care Unit: Big Measures for Our Smallest Patients. J Perinat Neonatal Nurs 2017; 31:15-19. [PMID: 28121754 DOI: 10.1097/jpn.0000000000000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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El-Kafrawy U, Taylor RJ. Optimizing care of ventilated infants by improving weighing accuracy on incubator scales. J Neonatal Perinatal Med 2016; 9:377-383. [PMID: 28009333 DOI: 10.3233/npm-161623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the accuracy of weighing ventilated infants on incubator scales and whether the accuracy can be improved by the addition of a ventilator tube compensator (VTC) device to counterbalance the force exerted by the ventilator tubing. STUDY DESIGN Body weights on integral incubator scales were compared in ventilated infants (with and without a VTC), with body weights on standalone electronic scales (true weight). Individual and series of trend weights were obtained on the infants. The method of Bland and Altman was used to assess the introduced bias. RESULTS The study included 60 ventilated infants; 66% of them weighed <1000 g. A total of 102 paired-weight datasets for 30 infants undergoing conventional ventilation and 30 undergoing high frequency oscillator ventilation (HFOV) supported by a SensorMedics oscillator, (with and without a VTC) were obtained. The mean differences and (95% CI for the bias) between the integral and true scale weighing methods was 60.8 g (49.1 g to 72.5 g) without and -2.8 g (-8.9 g to 3.3 g) with a VTC in HFOV infants; 41.0 g (32.1 g to 50.0 g) without and -5.1 g (-9.3 g to -0.8 g) with a VTC for conventionally ventilated infants. Differences of greater than 2% were considered clinically relevant and occurred in 93.8% without and 20.8% with a VTC in HFOV infants and 81.5% without and 27.8% with VTC in conventionally ventilated infants. CONCLUSIONS The use of the VTC device represents a substantial improvement on the current practice for weighing ventilated infants, particularly in the extreme preterm infants where an over- or underestimated weight can have important clinical implications for treatment. A large-scale clinical trial to validate these findings is needed.
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Affiliation(s)
- Ula El-Kafrawy
- Neonatal Intensive Care Unit, Royal Bolton Hospital, Bolton, UK
| | - R J Taylor
- Department of Medical Physics, Salford Royal NHS Foundation Trust, Salford, UK
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Pawluk S, Jaam M, Hazi F, Al Hail MS, El Kassem W, Khalifa H, Thomas B, Abdul Rouf P. A description of medication errors reported by pharmacists in a neonatal intensive care unit. Int J Clin Pharm 2016; 39:88-94. [PMID: 27905075 DOI: 10.1007/s11096-016-0399-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/17/2016] [Indexed: 11/27/2022]
Abstract
Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.
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Affiliation(s)
- Shane Pawluk
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar. .,Pharmacy Department, Women's Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Myriam Jaam
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Fatima Hazi
- College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
| | - Moza Sulaiman Al Hail
- Pharmacy Department, Women's Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Wessam El Kassem
- Pharmacy Department, Women's Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Hanan Khalifa
- Pharmacy Department, Women's Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Binny Thomas
- Pharmacy Department, Women's Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Krzyżaniak N, Pawłowska I, Bajorek B. Review of drug utilization patterns in NICUs worldwide. J Clin Pharm Ther 2016; 41:612-620. [PMID: 27578606 DOI: 10.1111/jcpt.12440] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A-PINCH (Anti-infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high-risk medicines list, and determining whether there are any differences in medicine use between countries. METHOD Quasi-systematic literature review. SEARCH STRATEGY Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. RESULTS A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A-PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off-label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. WHAT IS NEW AND CONCLUSION Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off-label and unlicensed medicines.
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Affiliation(s)
- N Krzyżaniak
- Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia.
| | - I Pawłowska
- Pharmacology Department, Medical University of Gdansk, Gdańsk, Poland
| | - B Bajorek
- Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia
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Machado APC, Tomich CSF, Osme SF, Ferreira DMDLM, Mendonça MAO, Pinto RMC, Penha-Silva N, Abdallah VOS. Prescribing errors in a Brazilian neonatal intensive care unit. CAD SAUDE PUBLICA 2016; 31:2610-20. [PMID: 26872237 DOI: 10.1590/0102-311x00194714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/01/2015] [Indexed: 01/04/2023] Open
Abstract
Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.
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Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:107-120. [DOI: 10.1111/ijpp.12284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).
Method
Quasi-systematic review.
Search Strategy
Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.
Results
Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.
Conclusion
The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
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Affiliation(s)
- Natalia Krzyzaniak
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
| | - Beata Bajorek
- University of Technology Sydney, Graduate School of Health (Pharmacy), Broadway, NSW, Australia
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Bannan DF, Tully MP. Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review. J Clin Pharm Ther 2016; 41:246-55. [DOI: 10.1111/jcpt.12398] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/08/2016] [Indexed: 11/26/2022]
Affiliation(s)
- D. F. Bannan
- Manchester Pharmacy School; University of Manchester; Manchester UK
- Faculty of Pharmacy; King Abdulaziz University; Jeddah KSA
| | - M. P. Tully
- Manchester Pharmacy School; University of Manchester; Manchester UK
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Mackie JE, Bruce CD. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach. NURSE EDUCATION TODAY 2016; 40:146-153. [PMID: 27125165 DOI: 10.1016/j.nedt.2016.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/10/2016] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accurate calculation of medication dosages can be challenging for nursing students. Specific interventions related to types of errors made by nursing students may improve the learning of this important skill. OBJECTIVE The objective of this study was to determine areas of challenge for students in performing medication dosage calculations in order to design interventions to improve this skill. DESIGN Strengths and weaknesses in the teaching and learning of medication dosage calculations were assessed. These data were used to create online interventions which were then measured for the impact on student ability to perform medication dosage calculations. SETTING The setting of the study is one university in Canada. PARTICIPANTS The qualitative research participants were 8 nursing students from years 1-3 and 8 faculty members. Quantitative results are based on test data from the same second year clinical course during the academic years 2012 and 2013. METHODS Students and faculty participated in one-to-one interviews; responses were recorded and coded for themes. Tests were implemented and scored, then data were assessed to classify the types and number of errors. RESULTS Students identified conceptual understanding deficits, anxiety, low self-efficacy, and numeracy skills as primary challenges in medication dosage calculations. Faculty identified long division as a particular content challenge, and a lack of online resources for students to practice calculations. Lessons and online resources designed as an intervention to target mathematical and concepts and skills led to improved results and increases in overall pass rates for second year students for medication dosage calculation tests. CONCLUSION This study suggests that with concerted effort and a multi-modal approach to supporting nursing students, their abilities to calculate dosages can be improved. The positive results in this study also point to the promise of cross-discipline collaborations between nursing and education.
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Affiliation(s)
- Jane E Mackie
- Trent Fleming School of Nursing, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2, Canada.
| | - Catherine D Bruce
- School of Education, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2, Canada.
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Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf 2016; 7:102-19. [PMID: 27298721 DOI: 10.1177/2042098616642231] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum. METHOD In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients. RESULTS A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team. CONCLUSION This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards.
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Affiliation(s)
- Natalia Krzyzaniak
- University of Technology, Sydney, Graduate School of Health (Pharmacy), PO Box 123, Broadway, NSW 2007, Australia
| | - Beata Bajorek
- University of Technology, Sydney, Graduate School of Health (Pharmacy), Broadway, Sydney, NSW, Australia
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Palmero D, Di Paolo ER, Beauport L, Pannatier A, Tolsa JF. A bundle with a preformatted medical order sheet and an introductory course to reduce prescription errors in neonates. Eur J Pediatr 2016; 175:113-9. [PMID: 26272253 DOI: 10.1007/s00431-015-2607-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively. CONCLUSION Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors. WHAT IS KNOWN Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere. WHAT IS NEW Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.
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Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. .,Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland.
| | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
| | - Lydie Beauport
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland.
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
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Ameer A, Dhillon S, Peters MJ, Ghaleb M. Systematic literature review of hospital medication administration errors in children. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:153-165. [PMID: 29354530 PMCID: PMC5741021 DOI: 10.2147/iprp.s54998] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child’s weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588). It was also identified in a mean of 29% of doses observed (n=8,894). The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to the definition and method used to investigate MAEs. The review also illustrated the complexity and multifaceted nature of MAEs. Therefore, there is a need to develop a set of safety measures to tackle these errors in pediatric practice.
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Affiliation(s)
- Ahmed Ameer
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Soraya Dhillon
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - Maisoon Ghaleb
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Santesteban E, Arenas S, Campino A. Medication errors in neonatal care: A systematic review of types of errors and effectiveness of preventive strategies. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2015.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Delage E, Tourel J, Martin B, Guérin A, Moussa A, Lacroix A, Lebel D, Bussières JF. [Not Available]. Can J Hosp Pharm 2015; 68:406-411. [PMID: 26478587 PMCID: PMC4605465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Emmanuelle Delage
- D. Pharm., est assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Julien Tourel
- D. Pharm., est assistant de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Brigitte Martin
- B. Pharm., M. Sc., est pharmacienne, Département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Aurélie Guérin
- est candidate au D. Pharm. et assistante de recherche à l'Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi interne en pharmacie, Université Paris Sud XI, Paris, France
| | - Ahmed Moussa
- M. D., FRCPC, FAAP, est néonatalogiste, Département de néonatalogie, Centre hospitalier universitaire Sainte-Justine, et professeur adjoint de clinique, Université de Montréal, Montréal, Québec
| | - Annie Lacroix
- B.Sc. Inf, M. Sc., IPSNN, est chef des processus administratifs en soins infirmiers, Département de néonatalogie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Denis Lebel
- B. Pharm., M. Sc., FCSHP, est adjoint, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Jean-François Bussières
- B. Pharm., M. Sc., FCSHP, est chef, Département de pharmacie et Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, et professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec
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Guérin A, Bussières JF, Boulkedid R, Bourdon O, Prot-Labarthe S. Development of a consensus-base list of criteria for prescribing medication in a pediatric population. Int J Clin Pharm 2015; 37:883-94. [PMID: 26017398 DOI: 10.1007/s11096-015-0139-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although many people are involved in the optimal use of a medication within this process, the use of medications carries risks of adverse events, which are greater in the pediatric population because of many factors. OBJECTIVE In this context, our aim was to develop a consensus-based list of criteria for the safety of the pediatric medication-use process or circuit (referred to from now on as the CIRCUS tool: CIRcuit-of-Child-drug-USe). SETTING Multicenter with a trio of experts from eight university hospitals. METHODS A literature search (1998-2013) was conducted in order to identify the different safety practice domains for the pediatric medication use process. Twenty-six safety practice domains were identified and 48 compliance criteria were formulated. In order to reach a consensus on the most relevant compliance criteria for safety practices, an international 24 French-speaking multidisciplinary panelists (8 doctors, 8 pharmacists and 8 nurses) selected to represent a broad range of experience levels and specialties took part in a two round Delphi survey which was conducted between March and July 2013. Each panelist was asked to rate each proposed criterion on a 1-9 Likert scale in order to show their level of agreement (i.e. 1 reflects strong disagreement and 9 reflects strong agreement). MAIN OUTCOME MEASURE Development of a consensus-base list for safety practices in pediatrics. RESULTS Twenty-two of the 24 professionals invited to take part in this survey (92% participation rate) completed the two Delphi rounds. At the end of the two Delphi rounds, a total of 38/48 (79%) safety practice compliance criteria achieved consensus by the panelists. The criteria were grouped into 23 domains. CONCLUSION This study presents the development of a self-assessment tool for safety practices in the pediatric drug-use process using a Delphi method. This tool may be used in order to record and compare the prevalence of best safety practices in the pediatric drug-use process.
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Affiliation(s)
- A Guérin
- Pharmacy Practice Research Unit, Pharmacy Department, Sainte-Justine University Health Center, 3175, chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - J F Bussières
- Pharmacy Department, Sainte-Justine University Health Center, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - R Boulkedid
- Clinical Epidemiology Unit, APHP, Robert Debré University Health Center, 75019, Paris, France
- INSERM, U 1123 and CIC 1426, Robert Debré University Health Center, 75019, Paris, France
| | - O Bourdon
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- Department of Clinical Pharmacy, Faculty of Pharmacy, Université Paris Descartes, Sorbonne Paris Cité, France
- Laboratory Education and Health Practices EA 3412, Université Paris 13, Sorbonne Paris Cité, France
- French Society of Clinical Pharmacy, Paris, France
| | - S Prot-Labarthe
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- French Society of Clinical Pharmacy, Paris, France
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Lanzillotti LDS, Seta MHD, Andrade CLTD, Mendes Junior WV. Adverse events and other incidents in neonatal intensive care units. CIENCIA & SAUDE COLETIVA 2015; 20:937-46. [DOI: 10.1590/1413-81232015203.16912013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022] Open
Abstract
The occurrence of avoidable adverse events (AEs) represents a problem of quality of care that is responsible for the increase in monetary and social costs, causing suffering to the patient, their family members and the professional involved. This situation is aggravated when it involves newborns (NBs) with very low birth weights and shorter gestational ages, admitted to neonatal intensive care units (NICU). The scope of this study is to understand more about these incidents and adverse events in NICUs. The article aims to identify the occurrence of incidents, with and without injury that have occurred in NICUs in the literature and correlate this with the gestational age group of the NBs most affected. This is a systematic review of the available literature on incidents, particularly AEs as witnessed in NICUs. This study reveals that the types of incidents that occur in NICUs, with or without injury to the patient, are related to errors or failures in medication use, healthcare-associated infections (HAIs), skin injuries, mechanical ventilation and intravascular catheters. The cause of incidents and adverse events in NICUs are associated with human factors and the outcomes that are most damaging are due to HAIs. Furthermore, the study points out ways to mitigate these occurrences.
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Cassar Flores A, Marshall S, Cordina M. Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart. Int J Clin Pharm 2014; 36:1179-89. [PMID: 25311050 DOI: 10.1007/s11096-014-0014-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors. OBJECTIVE To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. SETTING Acute general hospital in Malta. METHOD A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups' response. MAIN OUTCOME MEASURE This was set at a 70% level of agreement. RESULTS Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70% consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process. CONCLUSION Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients.
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Affiliation(s)
- A Cassar Flores
- Medicines Information and Clinical Pharmacy Section, Mater Dei Hospital, Msida, Malta,
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