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Published in:

01-02-2016 | Original Article

Medicine preparation errors in ten Spanish neonatal intensive care units

Authors: Ainara Campino, Casilda Arranz, Maria Unceta, Miguel Rueda, Beatriz Sordo, Pilar Pascual, Ion Lopez-de-Heredia, Elena Santesteban

Published in: European Journal of Pediatrics | Issue 2/2016

Abstract

This study assessed the rate of errors in intravenous medicine preparation at the bedside in neonatal intensive care units vs the preparation error rate in a hospital pharmacy service. We conducted a prospective observational study between June and September 2013. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered: calculation errors and accuracy errors. A total of 522 samples were collected: 238 of vancomycin, 139 of gentamicin, 39 of phenobarbital and 88 of caffeine citrate preparations. Of these, 444 samples were collected by nurses in neonatal intensive care units, and 60 were provided by the hospital pharmacy service. Overall, 18 samples were excluded from the analysis. We detected calculation errors in 6/444 (1.35 %) and accuracy errors in 243/444 (54.7 %) samples from the neonatal intensive care units. In contrast, in samples from the hospital pharmacy service, no calculation errors were detected, but there were accuracy errors in 23/60 (38.3 %) samples.

Conclusion: While calculation errors can be eliminated using protocols based on standard drug concentrations, accuracy error rates depend on several variables that affect both neonatal intensive care units and hospital pharmacy services.

What is Known:

• Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients.

• Lack of knowledge of drug pharmacokinetics and pharmacodynamics in relation to physiological immaturity makes neonates more vulnerable to medication errors.

What is New:

• Calculation errors are avoided using concentration standard preparation protocols.

• Accuracy in the preparation process depends mainly on the degree to which commercial drug preparations meet current legal requirements and the syringes and preparation techniques used.

AENOR. Sterile hypodermic syringes for single use. Part 1: syringes for manual use (ISO 7886-1:1993, including technical corrigendum 1:1995). http://www.aenor.es/aenor/normas/normas/fichanorma.asp?tipo=N&codigo=N0013672&pdf=. Accessed 11 August 2014

Aguado-Lorenzo V, Weeks K, Tunstell P, Karen T, Watts T, Arenas-Lopez S (2013) Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit. Arch Dis Child 98:975–979CrossRefPubMed

Allegaert K, Anderson BJ, Vrancken M, Debeer A, Desmet K, Cosaert K et al (2006) Impact of a paediatric vial on the magnitude of systematic medication errors in neonates. Paediatr Perinat Drug Ther 7(2):59–63CrossRef

Allegaert K, Langhendries JP, Van den Anker JN (2013) Do we need clinical pharmacologists? Eur J Pediatr 172:429–435PubMedCentralCrossRefPubMed

Avenel S, Bomkratz A, Dassieu G, Janaud JC, Danan C (2000) The incidence of prescriptions without marketing product license in a neonatal intensive care unit. Arch Pediatr 7(2):143–147CrossRefPubMed

Campino A, Lopez Herrera MC, Garcia M, Lopez de Heredia Goya I, Valls i Soler A (2006) Medication prescription and transcription errors in a neonatal unit. An Pediatr (Barc) 64(4):330–335CrossRef

Campino A, Santesteban E, Garcia M, Rueda M, Valls i Soler A (2013) Intravenous drug preparation errors in a neonatal intensive care unit. A potential source of adverse events. An Pediatr (Barc) 79(1):21–24CrossRef

Chedoe I, Molendijk HA, Dittrich ST, Jansman FG, Harting JW, Brouwers JR et al (2007) Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety—a review of the current literature. Drug Saf 30(6):503–513CrossRefPubMed

Conroy S (2011) Association between licence status and medication errors. Arch Dis Child 96(3):305–306CrossRefPubMed

10.

Cote DD, Torchia MG (1989) Robotic system for i.v. antineoplastic drug preparations: description and preliminary evaluation under simulated conditions. Am J Hosp Pharm 46:2286–2293PubMed

11.

Fahimi F, Ariapanah P, Faizi M, Shafaghi B, Namdar R, Ardakani MT (2008) Errors in preparation and administration of intravenous medications in the intensive care unit of a teaching hospital: an observational study. Aust Crit Care 21:110–116CrossRefPubMed

12.

Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC (2006) Systematic review of medication errors in pediatric patients. Ann Pharmacother 40:1766–1776CrossRefPubMed

13.

Glover ML, Sussmane JB (2002) Assessing pediatrics residents’ mathematical skills for prescribing medication: a need for improved training. Acad Med 77(10):1007–1010CrossRefPubMed

14.

Hughes RG, Edgerton EA (2005) Reducing pediatric medication errors. Children are especially at risk for medication errors. Am J Nurs 105:79–84CrossRefPubMed

15.

Kaushal R, Bates D, Landrigan C, McKenna KJ, Clapp MD, Federico F et al (2001) Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114–2120CrossRefPubMed

16.

Lerner RBDM, De Carvalho M, Vieira AA, Lopes JM, Moreira ME (2008) Medication errors in a neonatal intensive care unit. J Pediatr 84(2):166–170

17.

Martin de Rosales AN, Lopez C, Pernia MS, Devila Pousa C, Vila Clerigues MN, Alonso Herrero JM et al (2014) Recommendations for the safety preparation of sterile medicines in medical wards. Farm Hosp 38(1):57–64

18.

Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ (2007) Medication errors in pediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 16:116–126PubMedCentralCrossRefPubMed

19.

Muñoz Labian MC, Pallas Alonso CR, De la Cruz Bertolo J, Lopez Maestro M, Moral Pumarega A, Balaustegui Cueto A (2001) Medication error in a neonatal unit. An Esp Pediatr (Barc) 55:535–540CrossRef

20.

National Patient Safety Agency. Patient safety alert 20: promoting safer use of injectable medicines. London 2007 http://www.nrls.npsa.nhs.uk/resources/?entryid45=59812. Accessed 11 August 2014

21.

Parshuram CS, Ng GY, Ho TK, Klein J, Moore AM, Bohn D et al (2003) Discrepancies between ordered and delivered concentrations of opiate infusions in critical care. Crit Care Med 31:2483–2487CrossRefPubMed

22.

Phelps SJ (2013) Pediatric injectable drugs. The Teddy Bear book, 10th edn

23.

Popescu M, Vialet R, Loundou A, Peyron F, Buès-Charbit M (2011) Imprecision of vancomycin prepared for intravenous administration at the bedside in a neonatal intensive care unit. Ann Fr Anesth Reanim 30(10):726–729CrossRefPubMed

24.

Real Farmacopea Española, 5th edn. AEMPS 2015

25.

Ross LM, Wallace J, Paton JY (2000) Medication errors in a paediatric teaching hospital in the UK: five years operational experience. Arch Dis Child 83:492–497PubMedCentralCrossRefPubMed

26.

Snijders C, Van Lingen RA, Molendijk A, Fetter WP (2007) Incidents and errors in neonatal intensive care: a review of the literature. Arch Dis Child Fetal Neonatal 92:391–398CrossRef

27.

Stavroudis TA, Shore AD, Morlock L, Hicks RW, Bundy D, Miller MR (2010) NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit. J Perinatol 30(7):459–468CrossRefPubMed

28.

Takemoto CK (2014–2015) Pediatric and neonatal dosage handbook. 21th edn. Lexicomp

29.

The United States Pharmacopeial Convention. United States Pharmacopeia, Rockville, MD. 1999

30.

Tuleu C, Breitkreutz J (2013) Formulation-related issues in pediatric clinical pharmacology. Eur J Pediatr 172:717–720CrossRefPubMed

31.

Uppal N, Yasseen B, Seto W, Parshuram CS (2011) Drug formulations that require less than 0.1 mL of stock solution to prepare doses for infants and children. CMAJ 183:E246–E248PubMedCentralCrossRefPubMed

32.

Watanachai A, Suprasongsin C (2003) Deadspace: a potential error in concentration of medication during dilutional process in neonates. J Med Assoc Thail 86(12):1128–1132

33.

Wheeler W, Remoundos DD, Whittlestone K (2004) Calculation of doses of drugs in solution. Are medical students confused by the different means of expressing drug concentrations? Drug Saf 27(10):729–734CrossRefPubMed

Title: Medicine preparation errors in ten Spanish neonatal intensive care units
Authors: Ainara Campino
Casilda Arranz
Maria Unceta
Miguel Rueda
Beatriz Sordo
Pilar Pascual
Ion Lopez-de-Heredia
Elena Santesteban
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 2/2016
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-015-2615-4

ACC 2024 Congress

Springer Medicine

Medicine preparation errors in ten Spanish neonatal intensive care units

Abstract

ACC 2024 Congress

Springer Medicine

Abstract

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