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Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units

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Abstract

This study assessed the rate of errors in intravenous medicine preparation at bedside in neonatal intensive care units versus preparation error rate in a hospital pharmacy service before and after several strategies were implemented. We performed a prospective observational study during 2013–2015. 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. The study was carried out over three consecutive phases: (1) pre-intervention phase, when medicine preparation samples were collected from neonatal intensive care units and hospital pharmacy service according to their normal clinical practice; (2) intervention phase, when protocol standardisation and educational strategy took place; and (3) post-intervention phase, when new medicine samples were collected after strategy implementation. In neonatal intensive care units, 1.35 % of samples registered calculation errors in pre-intervention phase; no calculation errors were registered in hospital pharmacy service samples. In post-intervention phase, no calculation errors were registered in either group. Accuracy error rate decreased both in neonatal intensive care units (54.7 vs 23 %) and hospital pharmacy service (38.3 vs 14.6 %).

Conclusion: Calculation errors can disappear with good standardisation protocols. Decrease in accuracy error depends on good preparation technique and environmental factors.

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 commercial drug formulations adapted to newborn infants makes medicine preparation process more prone to error.

What is New:

• Calculation errors are minimising using concentration standard protocols. Preparation rules are essential to ensure the accuracy process.

• Environmental conditions affect the accuracy process.

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Abbreviations

HPS:

Hospital pharmacy service

NICU:

Neonatal intensive care unit

OEC-HPS:

Optimal environmental conditions-hospital pharmacy service

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Acknowledgments

We would like to dedicate this study in memoriam to 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 also wish to thank A Aguirre and D Herce (Basurto University Hospital); S de las Heras and F. Muñoz (Fuenlabrada Hospital); MM Diezama and M Moral (12 de Octubre University Hospital); MN Egues and MC Goñi (Hospital Complex of Navarre); MD Elorza and A Zugasti (Donostia University Hospital); P Fernandez, MF Sanchez and M Riaza (Puerta de Hierro University Hospital); E Gomez, ML Manzanos and C Olalde (Araba University Hospital); FJ Hernangomez and SJ Quevedo (Severo Ochoa University Hospital); MD Lozano and R Ortiz (Getafe University Hospital); and MP Arce, MP Fernandez, Y Fraga, M Garcia, MI Gonzalez, MM Humada, A Jimeno and RM Rodriguez (Cruces University Hospital) for their contribution in sample collections.

Authors’ contributions

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.

Author information

Authors and Affiliations

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

    Ainara Campino, Pilar Pascual & Beatriz Sordo

  2. Neonatal Epidemiology Unit, Cruces University Hospital, Barakaldo, Spain

    Elena Santesteban

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

    Maria Unceta

  4. Neonatal Intensive Care Unit, Paediatrics Department, Cruces University Hospital, Barakaldo, Spain

    Casilda Arranz & Ion Lopez-de-Heredia

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

Correspondence to Ainara Campino.

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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.

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Additional information

Communicated by Patrick Van Reempts

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Campino, A., Santesteban, E., Pascual, P. et al. Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units. Eur J Pediatr 175, 755–765 (2016). https://doi.org/10.1007/s00431-015-2679-1

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  • DOI: https://doi.org/10.1007/s00431-015-2679-1

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