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Interventions used to minimuse prescribing errors in neonatal units
  1. S Pradhan1,
  2. N Gooding2,
  3. W Kelsall1
  1. 1Neonatal Intensive Care, Cambridge University Hospital, Cambridge, UK
  2. 2Pharmacy Department, Cambridge University Hospital, Cambridge, UK

Abstract

Introduction The incidence of paediatric medication errors is estimated to be 500 000 per year in England.1 Neonates are particularly vulnerable and potentially suffer more harm. There is an urgent need to minimise such errors and several measures have been recommended.1 2Broadly these fall into three categories: trust policies including incident reporting, computerised prescriptions and guidance on neonatal dosing; intervention by pharmacists and education and training of prescribers. Some of these recommendations have been implemented in our tertiary neonatal unit. The purpose of this study was to determine whether or not any of these interventions were in use in other neonatal units across the East of England Perinatal network.

Methods A telephone questionnaire survey was conducted with the 18 neonatal units (17 Trusts) across the East of England neonatal network to review procedures implemented to minimise drug errors.

Results Responses were obtained from staff on all 18 units. All units had prescription policies, antimicrobial policies and risk management strategies including incident reporting. Units used different formularies for drug dosages, with the majority of the units 13 (73%) using the BNF for children. 15 (83%) of the units had individual intravenous monographs to assist with preparation and administration of intravenous drugs. 95% of the units regularly audited prescribing practices and fed results back to prescribers. Computerised prescribing or electronic dose calculators are not widely used, with only three units (17%) across the region generating weekly drug dose from a current weight using a computerised system. Pharmacists attended neonatal ward rounds at least once a week in 50% of units. They gave feedback on prescriptions in 95% of units. 60% of units had a pharmacist session at new doctors' induction. 17% of units formally assessed prescribing skills of doctors at hospital induction. Only 17% of units gave out laminated dose reminder cards with doses of most commonly used drugs to all new doctors.

Conclusions Trust wide policies and risk management strategies are widely used. Pharmacists and electronic computerised prescribing are underutilised. Training and assessment of doctors' prescribing skills needs to be strengthened. The results of this brief survey will be shared with colleagues within the East of England Perinatal network at a governance meeting so that a standardised approach to prescribing, electronic prescribing and education can be implemented across the network to minimise drug errors. Our own centre is the only unit within the region to have implemented the weekly dose calculator and precalculated intubation prescription chart which we value as the most significant intervention implemented following a number of near misses related to prescribing and administration of morphine during intubation. Since introduction of this intervention no further incidents relating to prescribing of morphine have been reported. Specific prescription charts for gentamicin and vancomycin have also resulted in a reduction in incident reports following introduction several years ago. We plan to conduct a similar survey nationally among other neonatal units to see if any other interventional strategies are being used and whether these have had any impact on prescribing practice.

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