Incidence and Nature of Medication Errors in Neonatal Intensive Care with Strategies to Improve Safety

Abstract

Neonates are highly vulnerable to medication errors because of their extensive exposure to medications in the neonatal intensive care unit (NICU), the general lack of evidence on pharmacotherapeutic interventions in neonates and the lack of neonate-specific formulations. We searched PubMed and EMBASE to identify relevant original studies published in the English language. Eleven studies were identified on the frequency of medication errors in the NICU. The highest rate was 5.5 medication errors per 100 prescriptions; however, medication error rates varied widely between studies, partly due to differences in the definition of an error and the rigor of the method used to identify medication errors. Furthermore, studies were difficult to compare because medication error rates were calculated differently. Most studies did not assess the potential clinical impact of the errors. The majority of studies identified dose errors as the most common type of error. Computerised physician order entry and interventions by clinical pharmacists (e.g. the participation of pharmacists in ward rounds and review of patients' prescriptions prior to dispensing) were the most common interventions suggested to improve medication safety in the NICU. However, only very limited data were available on evaluation of the effects of such interventions in NICUs. More research is needed to determine the frequency and types of medication errors in NICUs and to develop evidence-based interventions to improve medication safety in the NICU setting. Some of these research efforts need to be directed to the establishment of clear definitions of medication errors and agreement on the methods that should be used to measure medication error rates and their potential clinical impact.

Prescribing errors in a Brazilian neonatal intensive care unit

“…In accordance with the findings of several authors 1,3,7,8,11,13,22 , this study also shows that medication errors are common in a Brazilian neonatal ICU. Although most of these errors do not cause damage and are preventable within the neonatal unit 3,7,8,20 , some of them can cause severe injury and even death 13,23 .…”

“…Although most of these errors do not cause damage and are preventable within the neonatal unit 3,7,8,20 , some of them can cause severe injury and even death 13,23 . Studies of medication errors are extremely important because they help to identify the most vulnerable stages of the process 11 and may contribute to the development of actions to promote their reduction. However, comparisons between the results of the studies are not always possible due to the use of different definitions of medication errors and different methods of analysis 11,24,25,26 .…”

“…One of the challenges of the prescription process is that most drugs are available only in formulations and concentrations for adults and must be diluted or modified for use in children, requiring a larger number of calculations and thereby increasing the likelihood of errors 10,11 . In addition, some medications used in the neonatal ICU have complex doses, with very strict intervals and a narrow therapeutic index 12 , and if they are not properly prescribed can cause severe injury or even death 13 .…”

Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt

“…Thus, we found wide variation between our own and other results. Such variation was confirmed by Chedoe et al, who suggested that the differences were due to variation in the definition of errors and the accuracy of the method used to identify them (17). Also, it is reported that studies of errors in the NICU are rare and most focus on medication errors (5).…”

Standard 6: Age Groups for Pediatric Trials

“…Consequently, medication dosages and administration intervals must be adjusted frequently and individualized for each patient. 9 For procedural pain management, oral sucrose has been shown to be very effective for neonates and somewhat effective for young infants; however, effectiveness for older infants and children is still unsupported in many instances. 10,11 In general, bronchodilators are less effective at younger ages for a variety of etiologic and physiologic reasons.…”