1
|
Park J, You SB, Ryu GW, Kim Y. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 2023; 12:230. [PMID: 38093372 PMCID: PMC10717502 DOI: 10.1186/s13643-023-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar. RESULTS A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs. CONCLUSIONS Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.
Collapse
Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Sang Bin You
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea.
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
| |
Collapse
|
2
|
Cho JE, Yeo JH. Risk factors for unplanned extubation in ventilated neonates in South Korea. J Pediatr Nurs 2022; 62:e54-e59. [PMID: 34301441 DOI: 10.1016/j.pedn.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Although unplanned extubation (UE) is a common occurrence in neonatal intensive care units (NICUs), the factors influencing UE have not been clearly identified in South Korea. Therefore, we investigated the incidence of UE along with its risk factors among neonates in the NICU. DESIGN AND METHODS This retrospective cohort study was conducted in a single NICU in B city. The electronic medical records of 137 ventilated neonates admitted between January 2017 and June 2018 were analyzed using an audit tool on extubation. Kaplan-Meier estimation and univariate and multivariate Cox proportional hazards models were used for statistical analyses. RESULTS The rate of UE was 32.1%, with an incidence of 6.56 per 100 ventilation days during the 18-month study period. Risk factors for UE were the use of sedatives or analgesics; no re-fixation of the endotracheal tube (ETT); suction frequency; a high nurse-patient ratio; and working night shifts (weekdays 5 p.m. to 8 a.m.), weekends, or holidays. CONCLUSIONS The rate of UE among neonates was found to be considerably higher than that of other countries. Among the various factors, nursing-related factors were most commonly associated with the risk of UE. APPLICATION TO PRACTICE Various prevention strategies, including complete ETT fixation, maintaining ETT placement, a low nurse-patient ratio, and close observation of the ETT may help reduce UE in the NICU.
Collapse
Affiliation(s)
- Jung Eun Cho
- Neonatal Intensive Care Unit, Dong-A University Hospital, South Korea
| | - Jung Hee Yeo
- College of Nursing, Dong-A University, South Korea.
| |
Collapse
|
3
|
Short-term complications and long-term morbidities associated with repeated unplanned extubations. J Perinatol 2021; 41:562-570. [PMID: 33547405 PMCID: PMC7862843 DOI: 10.1038/s41372-021-00927-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/06/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe characteristics associated with repeated unplanned extubations, short-term complications and outcomes, and longer-term morbidities including acquired subglottic stenosis. STUDY DESIGN Cohort study including neonates admitted to a tertiary care neonatal intensive care unit who experienced an unplanned extubation in a 5-year period. RESULTS We reviewed 588 events involving 300 patients. Ten percent had airway trauma with reintubation, 42% required ≥2 reintubation attempts, and 39% led to increased baseline oxygen. Increased odds of repeated events were seen in patients with bronchopulmonary dysplasia and were associated with higher rates of tracheostomy and longer length of stay. The 9% of patients diagnosed with acquired subglottic stenosis had more unplanned extubations, higher rates of airway trauma and tracheitis, and were an older gestational age at birth. CONCLUSION Unplanned extubations lead to short- and long-term morbidities. Certain patient characteristics are associated with increased odds of repeated events and the development of acquired subglottic stenosis.
Collapse
|
4
|
Reducing Unplanned Extubations in a Level IV Neonatal Intensive Care Unit: The Elusive Benchmark. Pediatr Qual Saf 2020; 5:e337. [PMID: 33575517 PMCID: PMC7870211 DOI: 10.1097/pq9.0000000000000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/27/2020] [Indexed: 01/15/2023] Open
Abstract
Unplanned extubation (UE) is a common adverse event in the neonatal intensive care unit (NICU). At our level IV NICU, we initiated a quality improvement project in 2012 to reduce UE rates from 7.47 to below 100 intubated days. We describe the strategies used.
Collapse
|
5
|
Khan MA, Soteriades ES, King J, Govender R, Hashim MJ, Masood-Husain S, Javaid SF, Debaib Mohammed Saeed Al Darei S, Dahi Al Sheryani S, Nauman J. Global Trends and Forecast of the Burden of Adverse Effects of Medical Treatment: Epidemiological Analysis Based on the Global Burden of Disease Study. Cureus 2020; 12:e7250. [PMID: 32195068 PMCID: PMC7071843 DOI: 10.7759/cureus.7250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim To quantify and update the years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) due to the adverse effects of medical treatment (AEMT) between 1990 and 2017. Subject and methods We analyzed the latest dataset from the Global Burden of Disease (GBD) 2017 study. We described the burden of AEMT based on the number of DALY. We additionally evaluated the global age and sex-specific DALY and compared the age-standardized rates of DALY across the World Health Organization (WHO) regions from 1990 to 2017. Results Worldwide, the total DALYs due to AEMT were 84.93 [95% uncertainty interval (UI), 62.52 to 102.21] in 1990 and 62.79 (52.09 to 75.45) in 2017 per 100,000 population. The global percentage of change in DALY showed a negative trend of −26.06 % (−41.52 to −10.59) across all WHO regions between 1990 and 2017. The YLD has increased during the period from 1997 to 2017 by 29.47% (17.87 to 41.06). In 2017, men were affected more than women with a DALY of 66.78 in comparison to 58.91 DALY in women. DALY rates per 100,000 were highest across all the WHO regions in the first years of life. The predicted DALY rates were 59.92 (57.52 to 62.32) in the year 2020, 50.36 (32.03 to 68.70) in 2030, and 40.8 (−1.33 to 82.93) in 2040. Conclusion Using the GBD 2017 study data, we found a decrease in the DALY rate due to AEMT between 1990 and 2017 with a varying range of DALY between different WHO regions. DALY also differed by age and sex. The forecasting analyses showed a decrease in DALY due to AEMTs with a significant drop in the European region when compared to the African and American regions. However, the increasing trend for YLD signifies an increasing burden of people living with poor health due to AEMT. Our study proposes to identify disability due to AEMT as a significant public health crisis and calls for policymakers to create a robust revised policy.
Collapse
Affiliation(s)
- Moien Ab Khan
- Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| | - Elpidoforos S Soteriades
- Epidemiology and Public Health, Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| | - Jeff King
- Family Medicine, United Arab Emirates University, Al Ain, ARE
| | - Romona Govender
- Family Medicine, United Arab Emirates University, Al Ain, ARE
| | - Muhammad Jawad Hashim
- Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| | | | - Syed Fahad Javaid
- Psychiatry and Behavioral Science, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| | | | | | - Javaid Nauman
- Epidemiology and Public Health, Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
| |
Collapse
|
6
|
Palmero D, Di Paolo ER, Stadelmann C, Pannatier A, Sadeghipour F, Tolsa JF. Incident reports versus direct observation to identify medication errors and risk factors in hospitalised newborns. Eur J Pediatr 2019; 178:259-266. [PMID: 30460407 DOI: 10.1007/s00431-018-3294-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
Newborns are often exposed to medication errors in hospitals. Identification and understanding the causes and risk factors associated with medication errors will help to improve the effectiveness of medication. We sought to compare voluntary incident reports and direct observation in the identification of medication errors. We also identified corresponding risk factors in order to establish measures to prevent medication errors. Medication errors identified by a clinical pharmacist and those recorded in our incident reporting system by caregivers were analysed. Main outcomes were rates, type and severity of medication error, and other variables related to medication errors. Ultimately, 383 medication errors were identified by the clinical pharmacist, and two medication errors were declared by caregivers. Prescription errors accounted for 38.4%, preparation errors for 16.2%, and administration errors for 45.4%. The two variables significantly related to the occurrence of medication errors were gestational age < 32.0 weeks (p = 0.04) and the number of drugs prescribed (p < 0.01).Conclusion: Caregivers underreported the true rate of medication errors. Most medication errors were caused by inattention and could have been limited by simplifying the medication process. Risk of medication errors is increased in newborns < 32.0 weeks and increases with the number of drugs prescribed to each patient. What is Known: • Newborns in hospitals are particularly susceptible to medication errors. • Identification and understanding the reasons for medication errors should help us to establish preventive measures to reduce the occurrence of such errors. What is New: • Direct observation of the medication process, though time consuming, is essential to accurately assess the frequency of medication errors, which are underreported by caregivers. Most medication errors are caused by inattention and could be limited by simplifying the medication process. • The risk of medication errors was significantly increased in very preterm newborns (< 32 weeks) and when the number of prescription per patient increased.
Collapse
Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland.
| | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Corinne Stadelmann
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Farshid Sadeghipour
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | | |
Collapse
|
7
|
Ferraz P, Barros M, Miyoshi M, Davidson J, Guinsburg R. Bundle to reduce unplanned extubation in a neonatal intensive care unit. J Matern Fetal Neonatal Med 2019; 33:3077-3085. [DOI: 10.1080/14767058.2019.1568981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Priscila Ferraz
- Pediatric Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marina Barros
- Pediatric Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Milton Miyoshi
- Pediatric Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Josy Davidson
- Pediatric Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | |
Collapse
|
8
|
Lunevicius R, Haagsma JA. Incidence and mortality from adverse effects of medical treatment in the UK, 1990-2013: levels, trends, patterns and comparisons. Int J Qual Health Care 2018; 30:558-564. [PMID: 29659841 PMCID: PMC6094799 DOI: 10.1093/intqhc/mzy068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 03/21/2018] [Indexed: 12/21/2022] Open
Abstract
Objective To present an update on incidence and mortality from adverse effects (AEs) of medical treatment in the UK, its four countries and nine English regions between 1990 and 2013. Design Descriptive epidemiological study on AEs of medical treatment. AEs are shown as a single cause-of-injury category from the Global Burden of Disease (GBD) 2013 study. Data sources The GBD 2013 interactive data visualisation tools ‘Epi Visualisation’ and ‘GBD Compare’. Outcome measures The means of incidence and mortality rates with 95% uncertainty intervals (UIs). The estimates are age-standardised. Results Incidence rate was 175 and 176 cases per 100 000 men, 173 and 174 cases per 100 000 women in 1990 and 2013, in the UK (UI 170–180). The mortality from AEs declined from 1.33 deaths (UI 0.99–1.5) to 0.92 deaths (UI 0.75–1.2) per 100 000 individuals in the UK between 1990 and 2013 (30.8% change). Although mortality trends were descending in every region of the UK, they varied by geography and gender. Mortality rates in Scotland, North East England and West Midlands were highest. Mortality rates in South England and Northern Ireland were lowest. In 2013, age-specific mortality rates were higher in males in all 20 age groups compared with females. Conclusions Despite gains in reducing mortality from AEs of medical treatment in the UK between 1990 and 2013, the incidence of AEs remained the same. The results of this analysis suggest revising healthcare policies and programmes aimed to reduce incidence of AEs in the UK.
Collapse
Affiliation(s)
- Raimundas Lunevicius
- General Surgery Department, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.,University of Liverpool, School of Medicine, Liverpool, UK
| | - Juanita A Haagsma
- Erasmus MC, Erasmus University Medical Center, Rotterdam CA, The Netherlands.,Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Seattle, WA, USA
| |
Collapse
|
9
|
August DL, New K, Ray RA, Kandasamy Y. Frequency, location and risk factors of neonatal skin injuries from mechanical forces of pressure, friction, shear and stripping: A systematic literature review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2017.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
10
|
Kugelman A, Borenstein-Levin L, Jubran H, Dinur G, Ben-David S, Segal E, Haddad J, Timstut F, Stein I, Makhoul IR, Hochwald O. Less is More: Modern Neonatology. Rambam Maimonides Med J 2018; 9:RMMJ.10344. [PMID: 30089091 PMCID: PMC6115478 DOI: 10.5041/rmmj.10344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies.
Collapse
Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Elena Segal
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Julie Haddad
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Fanny Timstut
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Iris Stein
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Imad R. Makhoul
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
11
|
Nguyen MNR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf 2017; 9:123-155. [PMID: 29387337 DOI: 10.1177/2042098617748868] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023] Open
Abstract
Background Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.
Collapse
Affiliation(s)
| | - Cassandra Mosel
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Level 6, AHMS, Adelaide, SA 5000, Australia
| |
Collapse
|
12
|
Kaufmann J, Wolf A, Becke K, Laschat M, Wappler F, Engelhardt T. Drug safety in paediatric anaesthesia. Br J Anaesth 2017; 118:670-679. [DOI: 10.1093/bja/aex072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Csoma ZR, Meszes A, Ábrahám R, Kemény L, Tálosi G, Doró P. Iatrogenic Skin Disorders and Related Factors in Newborn Infants. Pediatr Dermatol 2016; 33:543-8. [PMID: 27595870 DOI: 10.1111/pde.12960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Recent technological advances and diagnostic and therapeutic innovations have resulted in an impressive improvement in the survival of newborn infants requiring intensive care. Consequently, with the use of modern invasive diagnostic and therapeutic procedures, the incidence of iatrogenic events has also increased. The aim of this study was to assess various iatrogenic complications in neonates requiring intensive care and determine possible contributing factors to the injuries. METHODS Our prospective cross-sectional cohort survey was conducted in a central regional level III neonatal intensive care unit (NICU). Correlations between intensive therapeutic interventions, complications, factors influencing attendance and prognosis, and the prevalence of iatrogenic skin injuries (ISIs) were investigated over a 2-year study period. RESULTS Between January 31, 2012, and January 31, 2014, 460 neonates were admitted to the NICU, 83 of whom exhibited some kind of ISI. The major risk factors for ISIs were low birthweight, young gestational age, long NICU stay, use of the intubation-surfactant-extubation (INSURE) technique, surfactant use, mechanical ventilation, insertion of an umbilical arterial catheter, circulatory and cardiac support with dopamine or dobutamine, pulmonary hemorrhage, intracranial hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, and positive microbiology culture results. CONCLUSION To prevent ISIs, careful consideration of risk factors and the creation of protocols ensuring efficient treatment of injuries are needed.
Collapse
Affiliation(s)
- Zsanett Renáta Csoma
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
| | - Angéla Meszes
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Rita Ábrahám
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, Szeged, Hungary
| | - Gyula Tálosi
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Péter Doró
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| |
Collapse
|
14
|
Santesteban E, Arenas S, Campino A. Medication errors in neonatal care: A systematic review of types of errors and effectiveness of preventive strategies. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2015.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
15
|
Esqué Ruiz M, Moretones Suñol M, Rodríguez Miguélez J, Parés Tercero S, Cortés Albuixech R, Varón Ramírez E, Figueras Aloy J. Towards a safety culture in the neonatal unit: Six years experience. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
16
|
Riskin A, Erez A, Foulk TA, Kugelman A, Gover A, Shoris I, Riskin KS, Bamberger PA. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics 2015; 136:487-95. [PMID: 26260718 DOI: 10.1542/peds.2015-1385] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies, with individuals exposed to rude behavior being less helpful and cooperative. Our objective was to explore the impact of rudeness on the performance of medical teams. METHODS Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert's comments included mildly rude statements completely unrelated to the teams' performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking. RESULTS The composite diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams (2.6 vs 3.2 [P = .005] and 2.8 vs 3.3 [P = .008], respectively). Rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance. A model specifying information-sharing and help-seeking as mediators linking rudeness to team performance explained an even greater portion of the variance in diagnostic and procedural performance (R(2) = 52.3 and 42.7, respectively). CONCLUSIONS Rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance.
Collapse
Affiliation(s)
- Arieh Riskin
- Recanati School of Business, Faculty of Management, and Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel;
| | - Amir Erez
- Warrington College of Business Administration, University of Florida, Gainesville, Florida; and
| | - Trevor A Foulk
- Warrington College of Business Administration, University of Florida, Gainesville, Florida; and
| | - Amir Kugelman
- Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ayala Gover
- Neonatology, Lady Davis Carmel Medical Center, Haifa, and Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Irit Shoris
- Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | | |
Collapse
|
17
|
Esqué Ruiz MT, Moretones Suñol MG, Rodríguez Miguélez JM, Parés Tercero S, Cortés Albuixech R, Varón Ramírez EM, Figueras Aloy J. [Towards a safety culture in the neonatal unit: Six years experience]. An Pediatr (Barc) 2015; 83:236-43. [PMID: 25639166 DOI: 10.1016/j.anpedi.2014.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nosocomial infections, as well as information on the work done and its assessment. RESULTS A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies.
Collapse
Affiliation(s)
- M T Esqué Ruiz
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España.
| | - M G Moretones Suñol
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| | - J M Rodríguez Miguélez
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| | - S Parés Tercero
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| | - R Cortés Albuixech
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| | - E M Varón Ramírez
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| | - J Figueras Aloy
- Departamento de Neonatología, Institut Clínic Ginecologia Obstetrícia i Neonatologia, Hospital Clínic sede Maternitat, Barcelona, España
| |
Collapse
|
18
|
[Iatrogenic skin lesions: a prospective study in premature infants born at less than 33 weeks of amenorrhea at Besançon university hospital]. Ann Dermatol Venereol 2015; 142:3-9. [PMID: 25600788 DOI: 10.1016/j.annder.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/24/2014] [Accepted: 09/01/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Advances in neonatology have markedly improved prognosis for premature babies in recent years. However, they have also entailed the need for recourse to considerable intensive care involving potentially iatrogenic diagnostic and therapeutic acts. Among the resulting iatrogenic events, cutaneous lesions are the most frequent but have been the subject of very few studies. Our own study thus aimed to assess the rate of iatrogenic cutaneous events in premature infants born at less than 33 weeks of amenorrhea and hospitalised at Besançon university hospital and to identify the factors associated with the occurrence of these events. PATIENTS AND METHODS This was a prospective study carried out in the department of paediatric intensive care and neonatology at Besançon university hospital between May 2011 and April 2012. All babies born before 33 weeks of amenorrhea hospitalised over this period were included. An iatrogenic event was defined as "an adverse event related to a medical procedure". Iatrogenic cutaneous events were reported to the dermatologist by medical and paramedical staff. RESULTS One hundred and thirthteen newborn babies were included during the study period. Twenty-six iatrogenic cutaneous events were recorded in 19 infants, representing 16.8% of the population involved: nine were associated with ventilation techniques, six with the use of intravenous catheters, five with electrodes, two involved pressure sores, two were linked to the birth, one to disinfectants and one to dressings. The main risk factor was low birth weight (P=0.016). High prematurity and the duration of ventilation increased the risk, although not significantly. The death rate was higher in children with iatrogenic events but the difference was not significant. The duration of hospitalisation was unaffected by the presence or absence of an iatrogenic event. CONCLUSION The frequency of iatrogenic cutaneous events is high in hospital departments in charge of very premature infants. Awareness by the medical and paramedical staff of the frequency of such iatrogenic events should improve the quality of care.
Collapse
|
19
|
Neurodevelopmental impairment in preterm infants with late-onset infection: not only in extremely preterm infants. Eur J Pediatr 2014; 173:1017-23. [PMID: 24573573 DOI: 10.1007/s00431-014-2284-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late-onset infection is known to increase the risk of neurodevelopmental impairment in infants born extremely preterm. However, little data is available regarding infants born moderately preterm. The aim of this study was to determine whether late-onset infection in moderately preterm infants (<35 weeks of gestation) was associated with a non-optimal neurodevelopmental outcome at 2 years of age. We analyzed a regional, population-based cohort of infants (LIFT cohort) between January 2003 and December 2009, and we used a propensity score method to reduce bias. Among the 4,618 preterm infants assessed at 2 years, 618 had acquired late-onset infection (13.4 %), and 764 had a non-optimal outcome (16.5 %). The rate of non-optimal outcomes was significantly higher in preterm infants with late-onset infection, irrespective of subgroups of gestational age and birth weight Z-score. After adjusting for the propensity score, the relationship between late-onset infection and non-optimal neurodevelopmental outcome at 2 years among infants born before 35 weeks of gestation remained significant (aOR = 1.3; 95 % CI 1.01-1.7; p = .04). CONCLUSION Late-onset infection is associated with poor neurological outcome at 2 years of age among infants born moderately preterm before and after adjustment for the propensity score.
Collapse
|
20
|
Grinberg M. Valvular heart team. Arq Bras Cardiol 2014; 103:e15-7. [PMID: 25120089 PMCID: PMC4126767 DOI: 10.5935/abc.20140099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
|
21
|
Srulovici E, Ore L, Shinwell ES, Blazer S, Zangen S, Riskin A, Bader D, Kugelman A. Factors associated with iatrogenesis in neonatal intensive care units: an observational multicenter study. Eur J Pediatr 2012; 171:1753-9. [PMID: 23011747 DOI: 10.1007/s00431-012-1799-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/06/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
Abstract
The objective of our study was to assess factors associated with iatrogenic events in Neonatal Intensive Care Units (NICUs). This was a retrospective analysis based on a cohort of patients who participated in our previous prospective study (Pediatrics 122:550-555, 2008), conducted in four tertiary university-affiliated NICUs in Israel, that included all consecutive infants (n = 615) hospitalized during the study period. Ongoing monitoring of iatrogenic events was performed by designated "iatrogenesis advocates." The main outcome measures were the association of individual infant characteristics and NICUs' environmental characteristics with iatrogenic events assessed by univariate and multiple logistic regression analysis. We found that four infant characteristics were significantly (p < 0.001) associated with iatrogenic events in a univariate analysis: gestational age, birth weight, severity of initial illness as assessed by the Score for Neonatal Acute Physiology and Perinatal Extension (SNAPPE II), and length of stay (LOS). All four factors demonstrated a significant (p < 0.001) dose-response relationship with iatrogenic events. Univariate analysis for environmental characteristics showed that type of shift, but not nursing workload, was significantly associated with iatrogenic events (p < 0.001). In a multiple logistic regression analysis, only LOS (adjusted OR 1.02 [95 % CI, 1.01-1.03]) and type of shift, morning vs. evening (adjusted OR 3.44 [95 % CI, 2.33-5.08]) and morning vs. night (adjusted OR 6.07 [95 % CI, 3.86-9.56]), remained independently associated with iatrogenic events (p < 0.001). Prolonged LOS and morning shifts were found to be significantly associated with iatrogenic events. Further prospective research is warranted to identify the specific causes for iatrogenic events in order to target active interventions to prevent them.
Collapse
Affiliation(s)
- Einav Srulovici
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa, Israel
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Mechanical ventilation is a resource-intensive complex medical intervention associated with high morbidity. Considerable practice style variation exists in most hospitals and is not only confusing for parents, but the lack of consistently high standard of optimal ventilation deprives some infants of the benefits of state-of-the-art care. Developing a unit protocol for mechanical ventilation requires exhaustive research, inclusion of all stake-holders, thoughtful protocol development and careful implementation after a thorough educational process, followed by monitoring. A protocol for respiratory support should be comprehensive, addressing respiratory support in the delivery room, the use of non-invasive support, intubation criteria, surfactant administration, specific ventilation modes and settings, criteria for escalating therapy, weaning protocols, extubation criteria, and post-extubation management. Evidence favors the use of non-invasive support as first line treatment, progressing to assist/control or pressure support ventilation combined with volume guarantee, if needed, and high-frequency ventilation only for specific indications. The open lung strategy is crucial to lung-protective ventilation.
Collapse
Affiliation(s)
- G M Sant'Anna
- McGill University Health Center, Montreal, Québec, Canada
| | | |
Collapse
|
23
|
Abstract
Adverse drug reactions (ADRs) complicate at least 5% of all courses of therapy for children. Dealing with an ADR requires a stepwise approach in appreciation of the possibility of an ADR, assessment of whether the adverse event in question is drug-related, assessment of causality, assistance in treating the symptoms of the ADR, and dealing with the aftermath of the event. Several new developments likely will improve the ability to assess, evaluate, treat, and prevent ADRs in children. These developments include tools to evaluate causality, laboratory tests to diagnose ADRs, pharmacogenomic approaches to prevent ADRs, and new insights into treating serious ADRs.
Collapse
Affiliation(s)
- Michael Rieder
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| |
Collapse
|
24
|
Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: a systematic analysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:609-16. [PMID: 23093991 DOI: 10.3238/arztebl.2012.0609] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/05/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Errors in drug administration are among the commonest medical errors. Children are particularly at risk for such errors because of the need to calculate doses individually. Doses that are ten times the correct amount (1000% of the correct dose) are occasionally given and can be life-threatening. In a simulated resuscitation in a pediatric emergency room, an error of this type occurred for one of the 32 medications that were ordered. The highest error rates are to be expected in prehospital emergency medicine. In this review, we analyze the process of ordering medications and describe the potential interventions for lowering error rates that have been evaluated to date. METHOD Systematic literature review RESULTS We found 32 original publications that concerned the evaluation of interventions for lowering error rates in the ordering of medications for children. Error rates can be lowered by interventions that improve prescribers' knowledge of pediatric pharmacotherapy (courses, immediately accessible sources of information) and by aids to the cognitive process of ordering medication (calculators, computer programs, tables of doses by weight). They can also be lowered by raising awareness of the problem of erroneous medication ordering and by monitoring medication orders, as well as by structured communication and standardized, unambiguously labeled drug preparations. In the hospital setting, computer programs for medication orders with a built-in pediatric pharmacological database are highly recommended. In the prehospital setting, the "pediatric emergency ruler" enables accurate estimation of the patient's weight, provides age-appropriate dosage recommendations, and directly indicates the steps needed for calculation of the correct dose. CONCLUSION Children in medical emergency situations are at significant risk for medication errors. The measures described here can markedly lower the rate of dangerous errors.
Collapse
Affiliation(s)
- Jost Kaufmann
- Institute of Anesthesiology at Witten/Herdecke University, Department of Paediatric Anesthesia, Cologne Children's Hospital, Germany.
| | | | | |
Collapse
|
25
|
Gouyon JB, Cransac A, Sgro C. [Medication errors in neonatal medicine: from prescription to administration]. Arch Pediatr 2012; 19:976-83. [PMID: 22877857 DOI: 10.1016/j.arcped.2012.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/21/2012] [Indexed: 11/25/2022]
Abstract
Neonatal units have the highest incidence of medication errors (approximately 5%) compared to adult and pediatric wards. Medication errors include prescribing errors, transcription errors, dispensing errors, medication administration errors, and monitoring. Dosing error is the most common prescribing error. Prevention of medication error must be global. The implementation of a computerized physician order entry significantly reduces prescribing errors but other preventive measures remain necessary.
Collapse
Affiliation(s)
- J-B Gouyon
- Service de néonatologie du GHSR, CIC-EC, CHU de Réunion, 97448 Saint-Pierre cedex, France.
| | | | | |
Collapse
|