Reducing antimicrobial prescribing errors, in the neonatal intensive care unit, Women's Hospital, Hamad Medical Corporation

Abstract

Background and objective: Neonatal intensive care unit (NICU) is the unit rendering healthcare service for ill or premature newborn infants. Neonates are considered very high-risk patients and consequently they are more impacted by any prescribing error. On the other hand, prescribing errors are more common in pediatrics and in particular in NICU due to frequent changes in medication's dose and frequency based on postnatal age/weight; or due to immature organ function that alters drugs' absorption or excretion rate 1. Accordingly, identifying and reducing potential causes of prescribing errors in NICUs is a major patient safety priority. The objective is to reduce the frequency of antimicrobial prescribing errors in NICU, Women's Hospital, HMC by 50% versus base line (NICU medication error reported not to exceed 10% of total Women's Hospital medication errors reported) in 10 months (May 2015–January 2016). Methodology: We implemented quality improvement methodology PDSA to make improvements in the prescribing process, focusing on making an entire NICU quality outcome better consistently. Our quality improvement principle focused on the systems that created the current outcome. What NICU prescribers are doing is getting us what we are getting. To GET something different, we have to DO something different. Two PDSA cycles have been performed: PDSA 1 (April–May 2015) *NICU medication errors data have been shared with Quality and Patient Safety Committee and NICU department. * Improvement team was formed to initiate quality improvement intervention for NICU antimicrobial prescribing error trending. * Schedule Series of interactive educational sessions were provided by NICU clinical pharmacist. To NICU physicians, the aim of those sessions was to ensure full understanding of the Antimicrobial Dosing Chart by physicians. * Studying the quality improvement, the team decided to roll out PDSA 2 cycle. PDSA 2 (July–September 2016) * Creating a Mini Quick reference of the antimicrobial chart to be easily referred by the physician if needed in any prescribing issue. * Sharing the chart with NICU physicians. Result: Intervention led to a slight primary progress. Studying this progress 10 month projection, the team identified low probability to reach the improvement forecasted. PDSA 2 intervention significantly enhanced the progress leading to 50% less reports including antimicrobial prescribing errors – coming from NICU. Significant reduction of NICU antimicrobial prescribing errors reflected improvement in total NICU medication error reports as a percentage of the hospital reports. Conclusion: Antimicrobial prescribing errors reporting trend has negatively impacted the overall NICU service quality. Implementing quality improvement project: two cycles of PDSA have reduced not only the antimicrobial prescribing error reports, but also the overall medication error reports in NICU.