Improving medication safety in a neonatal intensive care unit

Lucas, Amber J.

doi:10.1093/ajhp/61.1.33

Cited by 20 publications

(16 citation statements)

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“…Computerized physician order entry (CPOE) has been shown to reduce medication errors from 3.2 to 0.6 per 1000 patient days, with improved physician satisfaction. 17,18 However, CPOE may also create new types of errors such as the selection of an incorrect product. Standard medication concentration, smart pumps and unit-dose medication distribution can potentially reduce medication errors.…”

Section: Medication Errorsmentioning

confidence: 99%

Iatrogenic complications in the neonatal intensive care unit

Sekar

2010

J Perinatol

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With the introduction of novel technologies and approaches in neonatal care and the lack of appropriately designed and well-executed randomized clinical trials to investigate the impact of these interventions, iatrogenic complications have been increasingly seen in the neonatal intensive care unit. In addition, increased awareness and the introduction of more appropriate quality control measures have resulted in higher levels of suspicion about and increased recognition of complications associated with delivery of care. The incidence of complications also rises with the increased length of hospital stay and level of immaturity. Approximately half of the iatrogenic complications are related to medication errors. The other complications are due to nosocomial infections, insertion of invasive catheters, prolonged mechanical ventilation, administration of parenteral nutrition solution, skin damage and environmental complications. Adopting newer technologies and preventive measures might decrease these complications and improve outcomes. Quality improvement projects targeting areas for improvement are expected to build team spirit and further improve the outcomes. In addition, participation in national reporting systems will enhance education and provide an opportunity to compare outcomes with peer institutions.

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Section: Medication Errorsmentioning

confidence: 99%

Iatrogenic complications in the neonatal intensive care unit

Sekar

2010

J Perinatol

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“…23 The revisions included placing oral medications in amber syringes (as opposed to clear syringes) as a visual reminder not to inject the contents, redesigning the order entry system with NICU-specific formulary products, creating emergency medication sheets, and incorporating ongoing quality assurance activities. To measure effectiveness, the authors distributed 80 surveys to neonatology staff and 60 surveys to pharmacy staff; overall, the researchers reported a 33% response rate.…”

Section: Neonatal Medication Errorsmentioning

confidence: 99%

A Summary of NICU Fat Emulsion Medication Errors and Nursing Services

Hicks

Becker

Chuo

2007

Advances in Neonatal Care

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Intralipid infusions remain a critical part of ensuring adequate nutritional supplement and growth in premature and term infants. Managing intralipid therapy requires great care to prevent metabolic and physiological side effects. The authors sought to systematically study medication errors associated with intralipid administration in the neonatal intensive care unit (NICU). A descriptive quantitative and qualitative analysis incorporating secondary data was used. Medication error data were drawn from 54 institutions that voluntarily participated with MEDMARX, a national, Internet-accessible medication error reporting program owned and operated by the United States Pharmacopeia. These errors were associated with NICUs, and each medication error record identified nursing staff as making the initial error. A total of 257 errors were reviewed, with 3.9% resulting in harm. The mean age of the neonate was 7 days, and more errors occurred on Mondays than any other day of the week. Errors disproportionately occurred between 6 pm and midnight, with a significant difference between errors near 7 am and 7 pm (P = .002). Wrong dose errors occurred in 69% of the sample. Nearly one quarter of the errors resulted from misprogramming infusion devices (either pumps or syringes). Qualitative findings revealed that many of the errors were the result of the nurse's misinterpretation of the modes (ie, time, volume, or rate) on the infusion device or by not recognizing the decimal point on the device's display panel. Several errors involved switching the rate of infusion with total parenteral nutrition and that of intralipids. Voluntary medication error reporting offers valuable insights into intralipid errors occurring in NICUs. Secondary analysis is an ethical, economic means of studying the occurrence of such errors. MEDMARX data suggest that some of the serious errors are the result of complex care and equipment needed for these vulnerable infants.

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“…Also, many adult formulations contain additional products that can be harmful to neonates. For example, Lucas (2004) notes that the adult concentration of dexamethasone available at her institution contains 30 percent alcohol and should not be used in neonates. The extremely small doses given to premature infants increase the risk of decimal point errors.…”

Section: Ways To Prevent Medication Errorsmentioning

confidence: 99%