Intravenous drug use in neonatal intensive care units

Basagoiti, Amaya De; Fernández, Alba; Mendiola, Silvia; Miguel, Monike De; Guerra, Eneritz; Loureiro, Begoña; Campino, Ainara

doi:10.1136/ejhpharm-2019-001939

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…In fact, in our research we were able to validate the value of neonatal DDD for four of the five top antimicrobials. Even the combination of aminoglycosides with beta-lactams, the most commonly used in neonates with sepsis or suspected sepsis according to published data [ 22 ], coincides with the data for the two antibiotics (gentamicin and ampicillin) with the highest number of prescriptions in hospitalised neonates in our study centres [ 23 ].…”

Section: Discussionsupporting

confidence: 87%

Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice

et al. 2023

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Background: Currently, there is no validated method for estimating antimicrobial consumption in the neonatal population, as it exists for adults using Defined Daily Doses (DDD). In neonatology, although there are different methods, each one with advantages and disadvantages, there is no unified criterion for use. The aim of this study is to validate the neonatal DDD designed as a new standardised form of antimicrobial consumption over this population. Methods: The validation of the neonatal DDD, Phase II of the research project, was carried out through a descriptive observational study. Periodic cut-offs were performed to collect antimicrobial prescriptions of neonates admitted to the neonatology and intensive care units of nine Spanish hospitals. The data collected included demographic variables (gestational age, postnatal age, weight and sex), antimicrobial dose, frequency and route of administration. The selection of the optimal DDD value takes into account power value, magnitude obtained from the differences in the DDD, statistical significance obtained by the Wilcoxon test and degree of agreement in the stipulated doses. Results: Set of 904 prescriptions were collected and finally 860 were analysed based on the established criteria. The antimicrobials were mostly prescribed in the intensive care unit (63.1%). 32 different antimicrobials were collected, and intravenous administration was the most commonly used route. Neonatal DDD were defined for 11 different antimicrobials. A potency > 80% was obtained in 7 antibiotics. The 57.1% of the selected DDD correspond to phase I and 21.4% from phase II. Conclusion: DDD validation has been achieved for the majority of intravenously administered antimicrobials used in clinical practice in the neonatal population. This will make it possible to have an indicator that will be used globally to estimate the consumption of antimicrobials in this population, thus confirming its usefulness and applicability.

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Section: Discussionsupporting

confidence: 87%

Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice

et al. 2023

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

Section: Discussionmentioning

confidence: 99%

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

Henry Basil,

Mohd Tahir,

Menon Premakumar

et al. 2024

PLoS ONE

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

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“…Intravenous drug use in NICUs is defined as a high-risk process. In a multicenter study conducted by NICU, it was found that 33% of 69 different intravenous drugs used in NICUs were not approved for neonates, 38% were high-risk, and only 63.5% were prepared and administered in standardized concentrations [ 14 ]. In our study, it is estimated that the administration of intravenous high-risk drugs may have an effect on the incidence of ADRs.…”

Section: Discussionmentioning

confidence: 99%

An Artificial Intelligence Approach to Support Detection of Neonatal Adverse Drug Reactions Based on Severity and Probability Scores: A New Risk Score as Web-Tool

et al. 2022

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Background: Critically ill neonates are at greater risk for adverse drug reactions (ADRs). The differentiation of ADRs from reactions associated with organ dysfunction/immaturity or genetic variability is difficult. Methods: In this prospective cohort study, each ADR was assessed using newborn-specific severity and probability scales by the clinical pharmacist. Subsequently, a machine learning-based risk score was designed to predict ADR presence in neonates. Results: In 98/412 (23.8%) of (56.3%; male) neonates included, 187 ADRs (0.42 ADR/patient) were determined related to 49 different drugs (37.12%). Drugs identified as high risk were enoxaparin, dexmedetomidine, vinblastine, dornase alfa, etoposide/carboplatin and prednisolone. The independent variables included in the risk score to predict ADR presence, according to the random forest importance criterion, were: systemic hormones (2 points), cardiovascular drugs (3 points), diseases of the circulatory system (1 point), nervous system drugs (1 point), and parenteral nutrition treatment (1 point), (cut-off value: 3 points). This risk score correctly classified 91.1% of the observations in the test set (c-index: 0.914). Conclusions: Using the high-performing risk score specific to neonates, it is expected that high-risk neonatal ADRs can be determined and prevented before they occur. Moreover, the awareness of clinicians of these drugs can be improved with this web-tool, and mitigation strategies (change of drug, dose, treatment duration, etc.) can be considered, based on a benefit-harm relationship for suspected drugs with a newborn-centered approach.

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Intravenous drug use in neonatal intensive care units

Cited by 8 publications

References 23 publications

Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice

Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice

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

An Artificial Intelligence Approach to Support Detection of Neonatal Adverse Drug Reactions Based on Severity and Probability Scores: A New Risk Score as Web-Tool

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