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Medicine preparation errors in ten Spanish neonatal intensive care units

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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.

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Abbreviations

HPS:

Hospital pharmacy service

NICU:

Neonatal intensive care unit

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Acknowledgments

We would like to dedicate this study to the memory of the late Adolf Valls i Soler (1942–2013), a key contributor to patient safety in the neonatal area. Prof. Valls i Soler was a co-leader of the Global Research in Paediatrics (GRIP) project.

Participating investigators

We wish to thank A Aguirre and D Herce (Hospital Universitario Basurto), S de las Heras and F Muñoz (Hospital Fuenlabrada), MM Diezama and M Moral (Hospital Universitario 12 Octubre), MN Egues and MC Goñi (Complejo Universitario Navarra), MD Elorza and A Zugasti (Hospital Universitario Donostia), P Fernandez, MF Sanchez and M Riaza (Hospital Universitario Puerta del Hierro), E Gomez, ML Manzanos and C Olalde (Hospital Universitario Araba), FJ Hernangomez and SJ Quevedo (Hospital Universitario Severo Ochoa), MD Lozano and R Ortiz (Hospital Universitario Getafe) and MP Arce, MP Fernandez, Y Fraga, M Garcia, MI Gonzalez, MM Humada, A Jimeno and RM Rodriguez (Hospital Universitario Cruces) for their help with sample collection.

Contributors

All authors made substantial contributions to conception and design of the study, and/or acquisition of data, and/or analysis and interpretation of data; all authors participated in drafting or critically revising the manuscript for important intellectual content; all authors gave final approval of the version submitted; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Competing interests

The authors declare that they have no competing interests.

Funding

This work was supported by the Basque Foundation for Health Innovation and Research (BIOEF), BioCruces Health Research Institute and the SAMID network (RD12/0026/0001). The research leading to these results received funding from the European Commission Seventh Framework Programme (FP7 HEALTH-F5-2010) under grant agreement number 261060, the Spanish Ministry of Science and Innovation under grant agreement number PI11/01606 and European Funds for Regional Development.

Author information

Authors and Affiliations

  1. Hospital Pharmacy, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain

    Ainara Campino, Beatriz Sordo & Pilar Pascual

  2. Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Universitario Cruces, Barakaldo, Spain

    Casilda Arranz & Ion Lopez-de-Heredia

  3. Hospital Biochemistry Laboratory, Hospital Universitario Cruces, Barakaldo, Spain

    Maria Unceta & Miguel Rueda

  4. Neonatal Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Spain

    Elena Santesteban

Authors
  1. Ainara Campino
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  2. Casilda Arranz
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  3. Maria Unceta
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  4. Miguel Rueda
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  5. Beatriz Sordo
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  6. Pilar Pascual
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  7. Ion Lopez-de-Heredia
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  8. Elena Santesteban
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Corresponding author

Correspondence to Ainara Campino.

Additional information

Communicated by Patrick Van Reempts

Revisions received: 15 July 2015/04 August 2015

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Campino, A., Arranz, C., Unceta, M. et al. Medicine preparation errors in ten Spanish neonatal intensive care units. Eur J Pediatr 175, 203–210 (2016). https://doi.org/10.1007/s00431-015-2615-4

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  • DOI: https://doi.org/10.1007/s00431-015-2615-4

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