Quality improvement initiative: reducing harmful medication errors in a children’s intensive care unit

Abstract

Introduction: Medication errors are associated with increased length of stay, high health care costs and are an avoidable cause of morbidity and mortality. Infants and children in the intensive care unit (ICU) are especially vulnerable to medication error-related harm due to their susceptible disease state, frequent administration of high-risk medications and complexities in medication dosing and calculations. In our unit, medication errors were consistently the most common category of reported incidents. Objectives/Aims: The specific aim of the study was to reduce the number of potentially harmful medication errors reported in the children’s intensive care unit by 50%. Methods: A multidisciplinary team was formed, and quality improvement methodology utilised. Medication incident data analysis was conducted and supplemented with observational audit data. The errors identified primarily related to administration, including pump programming errors. Multiple solutions were identified and tested: 1) Development of an innovative medication safety workshop for all new nursing staff 2) Implementation of a systematic daily round to prepare and administer continuous opioid and sedation infusions led by an experienced ICU nurse. 3) Improved access and availability of approved medication resources. The project was supported by multidisciplinary monthly unit-based medication safety meetings. Results: Medication incidents were categorised, pre and post study, utilising the NCC MERP Medication Error Index. The number of serious reported medication errors that caused harm, or required monitoring or intervention to preclude harm, decreased post project commencement by over 30%. Specifically, intravenous pump programming errors significantly reduced post project by over 60%. Analysis of staff confidence attending the workshops also significantly increased in all areas of medication safety. Conclusion: The multidisciplinary project resulted in sustained improvements in medication safety in the children’s ICU. The confidence of new staff in medication safety has increased and the number of serious harmful, or potentially harmful, medication errors has significantly reduced.