Medications In Neonatal Intensive Care Units Research Articles

Development and evaluation of a neonatal intensive care unit medication safety simulation for nursing students in South Korea: a quasi-experimental study.

Nursing students are susceptible to medication safety incidents in the neonatal intensive care unit (NICU) related to a lack of communication experience. The purpose of the present study was to investigate the impact of a NICU medication safety simulation (NMSS) focusing on communication clarity, patient hand-off confidence, and patient safety competency in senior-year nursing students. The study utilized a nonequivalent control group pretest-posttest design. In total, 60 nursing students were assigned to two groups. The experimental group participated in the NMSS, which included three medication error scenarios. Pairs of students completed the scenarios together in 10 to 20 minutes. Data were analyzed using the chi-squared test, independent t test, and ANCOVA. The experimental group showed significant improvements in communication clarity (p=.015), and patient safety competency (p<.001) compared to the control group. Using the pretest values as covariates, patient hand-off confidence scores significantly increased (p=.027). Implementing the NMSS focusing on communication in the pediatric nursing curriculum helped students to communicate clearly and concisely about medication errors, and its use is recommended to promote patient safety competency in the NICU.

Association between neonatal intensive care unit medication safety practices, adverse events, and death.

Determine the associations between neonatal intensive care unit (NICU) medication safety practices, laboratory-based adverse events (lab-AEs), and death. We combined data from a 2016 survey of Pediatrix NICUs on use of medication safety practices with 2014-2016 infant data. We grouped NICUs based on the number of safety practices used (≤5, 6-7, and 8-10) and evaluated the association between the number of safety practices used and lab-AEs and deaths using logistic regressions. Of the 94 NICUs included, 17% used ≤5 medication safety practices, 51% used 6-7, and 32% used 8-10. NICUs with more safety practices did not have a difference in lab-AEs or death. In this cohort, the use of more medication safety practices was not associated with fewer lab-AEs or decreased death.

Medication errors in neonatal intensive care unit of a tertiary care hospital in South India: A prospective observational study.

INTRODUCTION:Medication errors (MEs) can prolong hospital stay and are a cause of morbidity and mortality. Studies evaluating MEs and its determinants in Indian neonatal intensive care units (NICUs) are limited. Therefore, this study was done to assess the prevalence, characteristics, determinants, and outcomes of MEs in an Indian NICU setting.METHODOLOGY:A prospective observational study was conducted over a 1-year period (January–December 2016) among neonates receiving medications in NICU. Systematic random sampling was done, and data were collected using a semi-structured questionnaire after obtaining informed consent from the mother. An ME self-reporting system was also established. Data were analyzed using Chi-squared test and Student's t-test. Binary logistic regression was used to analyze the determinants of MEs.RESULTS:Among 269 babies included in the study, 57% (n = 154) were male babies with mean (standard deviation [SD]) birth weight of 2.59 kg (0.701). About 79% (n = 213/269) of the neonates were appropriate for gestational age. The mean (SD) duration of stay in NICU was 7.58 (5.07) days, and 67% of the babies had polypharmacy (use of ≥5 medications). The prevalence of MEs was 22% (95% confidence interval [CI]: 16.96%, 26.84%, n = 108) of all babies, of which only 2% (n = 2) were life threatening. Seventy-seven percent (n = 83) of these errors occurred during administration/preparation and 18% (n = 19) while prescribing. The significant determinants of MEs (adjusted odds ratio [95% CI]) include polypharmacy (4.126 [1.917–8.880]), duration of stay >7 days (1.335 [1.198–1.488]), and babies referred from outside (2.592 [1.217–5.521]).CONCLUSIONS:MEs were common in NICU setting. The occurrence of life-threatening MEs was minimal. Longer duration of hospital stay, polypharmacy, and babies born outside were significantly associated with occurrence of MEs.

National Survey of Neonatal Intensive Care Unit Medication Safety Practices.

We conducted a detailed survey to identify medication safety practices among a large network of United States neonatal intensive care units (NICUs). We created a 53-question survey to assess 300 U.S. NICU's demographics, medication safety practices, adverse drug event (ADE) reporting, and ADE response plans. Among the 164 (55%) NICUs that responded to the survey, more than 85% adhered to practices including use of electronic health records, computerized physician order entry, and clinical decision support; fewer reported adopting barcoding, formal safety surveys, and formal culture training; 137 of 164 (84%) developed at least one NICU-specific order-set with a median of 10 order-sets. Among our survey of 164 NICUs, we found that many safety practices remain unused. Understanding safety practice variation is critical to prevent ADEs and other negative infant outcomes. Future efforts should focus on linking safety practices identified from our survey with ADEs and infant outcomes.

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

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.

Errores en la preparación de fármacos intravenosos en una Unidad de Cuidados Intensivos Neonatal. Una potencial fuente de eventos adversos

IntroductionTo determine the rate of errors during preparation of intravenous drugs in a regional Neonatal Intensive Care Unit (NICU). MethodsA prospective observational study was performed on 24 non-consecutive working days. The vancomycin and tobramycin solutions administered were analysed to determine drug concentrations. We defined 2 types of error: 1) calculation error, when the deviation between the dose prescribed by the physician and theoretical dose administered, according to calculations performed by the nurse, was greater than ±10%, and 2) precision error, when the deviation between the theoretical concentration and that determined by the laboratory was greater than ±10%. ResultsA total of 91 samples were collected, 52 of vancomycin and 39 of tobramycin. Calculation errors were detected in 4.6% of samples. Precision errors were identified in 37.9% of the total sample. ConclusionsAlthough the errors reported did not produce adverse clinical consequences, our findings point out a potential source of severe complications. Better methods in the preparation of intravenous medications in NICU are needed.

NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit

To identify a risk profile for harmful medication errors in the neonatal intensive care unit (NICU). A retrospective cross-sectional study on NICU medication error reports submitted to MEDMARX between 1 January 1999, and 31 December 2005. The Rao-Scott modified chi(2) test was used for analysis. 6749 NICU medication error reports were submitted by 163 health-care facilities. Administering errors accounted for approximately one half of errors, and human factors were the most frequently cited cause of error. Patient age was not associated with an increased likelihood of an error being harmful (P=0.11). Error reports involving Institute for Safe Medication Practices (ISMP) High-Alert Medications, occurring in the prescribing phase of medication processing, or involving equipment/delivery device failures were more likely to be harmful (P< or =0.05). Risk factors for harmful medication error reports include use of ISMP High-Alert Medications, the prescribing phase of the medication use process, and failure of equipment/delivery devices.