Reducing antimicrobial dosing errors in a neonatal intensive care unit

Gard, John W; Starnes, Howard M.; Morrow, Elizabeth L.; Sánchez, Pablo J.; Perlman, Jeffrey M.

doi:10.1093/ajhp/52.14.1508

Cited by 3 publications

(4 citation statements)

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“…Both Neofax and PDH are commonly used worldwide by pediatricians when prescribing antibiotics for preterm infants. 7 Neofax may be easier to use than PDH, and estimation of GA and PNA were more comfortable for pediatricians in this NICU. However, which dosage is optimal for infants should be evaluated.…”

Section: Discussionmentioning

confidence: 95%

“…The confusion resulting from this inconsistency could be prevented if only one source for prescribing guidance is adopted, which the neonatal intensive care unit (NICU) pharmacists of a Texas hospital did in developing a computer-generated antimicrobial dosing protocol. 7 However, since there is yet no consensus on which antibiotic prescribing guideline for neonates should be considered ''the gold standard,'' this approach might not be easily implemented in the larger medical community. For instance, previous studies have employed different references for guidance while evaluating the pharmacokinetic parameters of amikacin.…”

Section: Introductionmentioning

confidence: 99%

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Compliance with dosing recommendations from common references in prescribing antibiotics for preterm neonates

Cheng

Yang

Lin

et al. 2009

Pharmacoepidemiology and Drug

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Compliance with dosing recommendations from common references in prescribing antibiotics for preterm neonates

Cheng

Yang

Lin

et al. 2009

Pharmacoepidemiology and Drug

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“…A total of 24 nonrandomized studies were also retrieved and evaluated 14, 19, 24–45 . Their characteristics are summarized in Table 4.…”

Section: Resultsmentioning

confidence: 99%

Evidence on interventions to reduce medical errors

Ioannidis

Lau

2001

J Gen Intern Med

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OBJECTIVE:To critically review the existing evidence on interventions aimed at reducing errors in health care delivery.DESIGN: Systematic review of randomized trials on behavioral, educational, informational, and management interventions relating to medical errors. Pertinent studies were identified from MEDLINE, EMBASE, the Cochrane Clinical Trials Registry, and communications with experts.SETTING: Both inpatients and outpatients qualified. No age or disease restrictions were set. MEASUREMENTS:Outcomes were medical errors, including medication, prescription, and diagnostic errors, and excluding preventive medicine errors and simple ordering of redundant tests. MAIN RESULTS:Thirteen randomized studies qualified for evaluation. The trials varied extensively in their patient populations (mean age, 2 weeks to 83 years), study setting, definition of errors, and interventions. Most studies could not afford masking and rigorous allocation concealment. In 9 of 13 studies, error rates in the control arms were very high (10% to 63%), and large treatment benefits from the studied interventions were demonstrated for the main outcome. Interventions were almost always effective in a sample of 24 nonrandomized studies evaluated for comparison. Actual patient harm from serious errors was rarely recorded.CONCLUSIONS: Medical errors were very frequent in the studies we identified, arising sometimes in more than half of the cases where there is an opportunity for error. Relatively simple interventions may achieve large reductions in error rates. Evidence on reduction of medical errors needs to be better categorized, replicated, and tested in study designs maximizing protection from bias. Emphasis should be placed on serious errors. M edical errors are a common cause of morbidity and mortality in a variety of health care settings. 1±3 Their importance has been increasingly recognized, as reflected in a recent report by the Institute of Medicine that drew widespread public attention. 4,5 It is estimated that in the United States alone, medical errors result in 44,000 to 98,000 unnecessary deaths and approximately 1 million excess injuries each year. 4,6 Extremes of age, complex and/ or urgent care, and prolonged hospital stay are associated with more errors, but significant errors may also occur in the outpatient setting and for patients of all ages. 4,6 Despite the increasing recognition of the importance of this phenomenon, there is limited knowledge of which interventions may be used to effectively reduce the incidence and impact of errors on medical care. There is optimism that both simple behavioral interventions, system approaches, and information technology-based approaches may alter the incidence and consequences of medical errors. 5,7 However, much of the data pertaining to medical error have been generated using epidemiologic observational studies or intervention studies with before-after comparisons. Randomized evidence has not been carefully scrutinized.In the present systematic review, we undertook to retrieve and crit...

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“…In previous studies, computerized physician order entry (CPOE) with decision support functionalities has reduced dosing errors of antibiotics among inpatient neonates [ 10 , 11 ]. Despite promising results, only about 2% to 20% of the hospitals in high-income countries have successfully implemented CPOE [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Physician Order Entry Or Nurse Order Entry? Comparison of Two Implementation Strategies for a Computerized Order Entry System Aimed at Reducing Dosing Medication Errors

Kazemi

Fors²,

Tofighi³

et al. 2010

J Med Internet Res

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Background Despite the significant effect of computerized physician order entry (CPOE) in reducing nonintercepted medication errors among neonatal inpatients, only a minority of hospitals have successfully implemented such systems. Physicians' resistance and users' frustration seem to be two of the most important barriers. One solution might be to involve nurses in the order entry process to reduce physicians’ data entry workload and resistance. However, the effect of this collaborative order entry method in reducing medication errors should be compared with a strictly physician order entry method.Objective To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital.Methods A four-month prospective study was designed with two equal periods. During the first period POE was used and during the second period NOE was used. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. Physicians’ responses to the warnings were recorded in a database and subsequently analyzed. Relevant paper-based and electronic medical records were reviewed to increase credibility.Results Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40% lower than during the POE period (rate ratio 0.60; 95% confidence interval [CI] .50, .71;P < .001). During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3% during the POE period to 4.6% during the NOE period (P < .001), and the number of warnings with which physicians complied increased from 44% to 68% respectively (P < .001). Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P = .005). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. The rate of nonintercepted overdose errors remained constant between the two periods. However, the severity of overdose errors was lower in the NOE period (P = .02).ConclusionsNOE can increase physicians' compliance with warnings and recommended dose and frequency and reduce nonintercepted medication dosing errors in the neonatal ward as effectively as POE or even better. In settings where there is major physician resistance to implementation of CPOE, and nurses are willing to participate in the order entry and are capable of doing so, NOE may be considered a beneficial alternative order entry method.

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Reducing antimicrobial dosing errors in a neonatal intensive care unit

Cited by 3 publications

References 0 publications

Compliance with dosing recommendations from common references in prescribing antibiotics for preterm neonates

Compliance with dosing recommendations from common references in prescribing antibiotics for preterm neonates

Evidence on interventions to reduce medical errors

Physician Order Entry Or Nurse Order Entry? Comparison of Two Implementation Strategies for a Computerized Order Entry System Aimed at Reducing Dosing Medication Errors

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