Medication Errors in Newborn Intensive Care Unit
Introduction
Medication errors can occur quite often in the neonatal care units, as in any other department. However, given the specifics of these departments and the vulnerability of young patients, such errors have much greater potential harm. Therefore, the topic of medical errors in the NICU deserves special attention and study. Reporting medical errors contributes to a better understanding of the time, place, and types of such errors. The PICO question related to the topic is: “For neonates in the NICU, does the use of proper medication administration reduce the future risk of medication errors compared with the improper use of medication administration?” This paper presents the evidence table observing the studies regarding the medication errors in the NICU that discover the medication threat neonates face in the NICU environment. The paper also includes the analysis of the literature discussed and recommendations on how to overcome the stated problem.
Evidence Table
Background / Problem
Patients who are admitted to intensive care units are much more vulnerable to medical errors, including errors associated with prescribing the correct doses and names of drugs. At the same time, scientists note that patients in pediatric intensive care units are seven times more likely to face the listed errors (Alghamdi et al., 2019). The National Institute for Care Excellence suggests that “when deciding on the appropriate care setting for a baby, take into account the baby’s clinical needs and the competencies necessary to ensure safe and effective care” (Quinton-Shapcott & Knights, p. 197).
Purpose
The PICO question is: “For neonates in the NICU, does the use of proper medication administration reduce the future risk of medication errors compared with the improper use of medication administration?” The population is neonates in the NICU, the intervention is proper medication administration, the issue of control is not ensuring proper medication administration, and the desired outcome is reduced medication errors. The purpose of the literature review was to study the types and circumstances of the medication errors in NICU to prevent future errors.
Search Methods
The univariate search method was used to find and analyze the literature, and the CINHAL and Cochrane Library databases were used to gather the proper articles. The search terms used were medication errors, medication drugs prescription, proper dosages, NICU, neonates, intensive care, PICU. The initially located number of articles was 40 articles, of which 22 articles were reviewed, and this number was then reduced to 9 articles that met the research expectations. Noteworthy, only scholarly, peer-reviewed journals were considered, and only those that met the criteria of inclusion for the project. These were the criteria of limitation – no more than five years, compliance with the topic and more narrowly defined topic of medical errors in NICU, and publication in official medical journals. At the same time, the exclusion criteria for the project were the absence of specific data and the use of qualitative research methods without an evidence base confirming the reliability of the collected data.
Research Methods
Out of nine studies analyzed, three studies were descriptive and qualitative, five studies were quantitative, three studies were prospective, and two studies used both qualitative and quantitative methods. The research samples were mostly neonates and their mothers, as well as nurses and medical personnel prescribing the medications in the NICU settings.
Results
In most researches, the data prove the connection between medication errors and neonates’ health risks and recovery time. Moreover, a greater number of medication errors that are not recorded and not evaluated is associated with a subsequent increase in such errors. Overall, high levels of errors were reported by nurses, with issues concerning administration and ordering being the most common, while the errors concerning dosing were most often reported. In some NICUs, the medication error rate reached 41%, which speaks of the urgent necessity of adequate measures. One more popular error was inappropriate dose selection, which led to a sub-optimal effect. Bar code technologies were also common causes for the medication errors, and many nurses reported the workarounds that distracted them from patients ’requests and caused the missed care events. Another issue that should be addressed was the workload concerns since the nurses had to attend to both neonates and their mothers and felt the doubled responsibility for not separating mother and baby.
Recommendations
Given the information presented above, the recommendations following should be applied to change the situation. Firstly, it is necessary by any means to reduce the number and frequency of medication errors since there is an excessive number of them in all ICUs, including NICUs, which can be called a general negative trend requiring immediate solutions. Then, particular attention should be paid to the errors involving prescription and administration of medication, as well as inappropriate dose selections. At the same time, the nurses should solve the bar code-related problem and be more attentive to the bar codes. Finally, the hospital management should consider the problems related to workarounds, supposedly by improving the staffing ratios. Workload concerns in mother and baby units should be addressed as well. The listed recommendations should be implemented to reduce the potential threats and dangers faced by the neonates and bring some clarity and order in the working processes with the critical amounts of patients.
Summary
The paper presents the report and analysis of evidence regarding the errors involving medication which took place in neonatal intensive care units in various settings worldwide. The population studied is nurses who work with neonates, and the problem discussed is the errors concerning medication occurring in NICUs. The literature review results showed there is a constantly increasing number of errors related to medication, especially those concerning administration and prescription, which is an overall general tendency in NICUs around the world. Moreover, there is a problem of workarounds and overloads related to providing care for mother and baby wards. The specific recommendations were stated to be implemented by nurses and managers in hospital settings.
References
Alghamdi, A. A., Keers, R. N., Sutherland, A., & Ashcroft, D. M. (2019). Prevalence and nature of medication errors and preventable adverse drug events in Pediatric and neonatal intensive care settings: a systematic review. Drug Safety, 42(12), 1423-1436.
Cernadas, J. M. C., Bogado, L., & Galletti, M. F. (2019). Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics. Archivos Argentinos de Pediatria, 117(6), e592-e597.
Duarte, S. D. C. M., Azevedo, S. S. D., Muinck, G. D. C. D., Costa, T. F. D., Cardoso, M. M. V. N., & Moraes, J. R. M. M. D. (2020). Best Safety Practices in nursing care in Neonatal Intensive Therapy. Revista Brasileira de Enfermagem, 73.
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Labib, J. R., Youssef, M. R. L., & Abd El Fatah, S. A. (2018). High alert medications administration errors in neonatal intensive care unit: A pediatric tertiary hospital experience. Turkish Journal of Pediatrics, 60(3).
Leopoldino, R. D., Santos, M. T., Costa, T. X., Martins, R. R., & Oliveira, A. G. (2019). Drug-related problems in the neonatal intensive care unit: Incidence, characterization and clinical relevance. BMC Pediatrics, 19(1), 1-7.
Martins da Rocha, C., Calcagno Gomes, G., Portella Ribeiro, J., Capa Verde Almeida de Mello, M., Netto de Oliveira, A. M., & Batista da Silva Maciel, J. (2018). Safe administration of medication in neonatology and pediatrics: Nursing care. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 12(12).
Quinton-Shapcott, S., & Knights, S. (2020). Waving goodbye to the baby train: reducing mother-infant separation and drug errors by collaborative working. Infant, 16(5).
Tubbs-Cooley, H. L., Mara, C. A., Carle, A. C., Mark, B. A., & Pickler, R. H. (2019). Association of nurse workload with missed nursing care in the neonatal intensive care unit. JAMA Pediatrics, 173(1), 44-51.