Medication errors in neonatal ICUs

2023-09-05 09:58:32

Medication errors in neonatal ICUs

“The simple fact that a patient is subjected to treatments with drugs or more or less invasive techniques can have a negative impact on people’s health,” states the Dr. Manuel Sanchez Lunahead of the Neonatology Service of the Gregorio Marañón General University Hospital.

Medication errors are the most common adverse event in hospitals and produce notable health and economic consequences for both patients and national health systems.

According to the European Medicines Agency (EMA), the rate of medication errors in the European hospital setting varies between 0.3% and 9.1% in the prescription and between 1.6% and 2.1%. in the dispensing phase.

In this sense, a 2012 report prepared by the Ministry of Health in Spain had identified that 25% of reported incidents were related to medication, constituting the most frequent class of incidents.

According to the therapeutic chain process, 34% were reported in the prescription phase and 28% in the administration phase. Approximately 16% of these medication errors caused some type of harm to the patient.

“Up to 82% of these cases were entirely preventable.“, highlights from this report Dr. Sánchez Luna, also president of the Spanish Society of Neonatology (seNeo).

The Institute for the Safe Use of Medicines (ISMP) published in 2020 a report on the most frequent medication errors with serious consequences for patients.

The ten most common mistakes according to ISMP

Errors due to omission or delay of the medication. Administration of medication to the wrong patient. Errors associated with allergies or known adverse drug effects. Errors in the calculation of the dose in pediatric patients. Errors due to similarity in the labeling or packaging of marketed medicines. Errors associated with the lack of use of intelligent infusion pumps. Errors due to accidental administration of neuromuscular blockers. Wrong oral administration of liquid medications. Errors in reconciling medication on admission and hospital discharge. Errors due to problems in the understanding of patients on how to use their medications.

The clinical eye on neonatal medication errors

“For many years we have worked very hard to reduce as much as possible the errors that can occur in the administration of drugs, even more so in those that can have a significant health impact on our neonatal ICU patients”, emphasizes the doctor from Madrid.

“Not only are they very frail babies, with complex and critical pathologies, but they also require, in many cases, multiple drugs with narrow therapeutic ranges; that is to say, that outside the indicated pattern they could have adverse effects ”, he adds.

“These errors have been described and accounted for, leaving results from relatively low percentages to very high percentages. What does it depend on? -he wonders and answers-, well, many times of their correct identification and that we are aware that they are happening”.

According to the PREVEMED report, Up to eight times more medication errors are caused in neonatal and pediatric ICUs than in adult Intensive Care Units.

In a systematic review of empirical studies on the prevalence and nature of medication errors in neonatal and pediatric ICUs, conducted between January 2000 and March 2019, the following conclusions were obtained, among others:

In neonatal ICUs there were between 5.5 and 77.9 medication errors for every 100 prescriptions and between 4 and 35.1 for every 1,000 patients/day.

In pediatric ICUs: 14.6 per 100 prescriptions and 6.4-9.1 per 1,000 patients/day.

“Errors in the prescription and administration phases were the most frequent. Dosage errors were the most prevalent in both cases”, highlights the PREVEMED report.

The dosage of the medication for this population obeys variable guidelines according to weight, gestational age and days of life.

In fact, premature patients suffer proportionally more medication errors than term newborns.

According to data from another Spanish study, in which 10 neonatal units participated, it was verified that the doses in the dilutions prepared to be administered (commonly used drugs were analyzed) did not usually coincide with the prescribed doses.

“The lack of commercial presentations of medicines adapted to the needs of this population makes it necessary to measure very small volumes of drugs, fraction units and carry out complex dilutions in intensive medicine services”, the PREVEMED report subscribes.

“In addition -they state- the bioavailability of the drugs after such manipulations is often unknown and unpredictable and could lead to the use of toxic or ineffective doses.”

“This, added to the variability of the pharmacokinetic and pharmacodynamic processes of the drugs (preservatives, stabilizers, etc.), the severity of the pathology, a longer hospital stay, the impossibility of communication with the patient, etc., increase the risk of medication errors and make it difficult to identify and recognize them”.

The PREVEMED project for the prevention of medication errors in ICUs is led by experts from the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC), the Spanish Society of Neonatology (seNeo), the Spanish Society of Medical Pediatric Intensive Care Units (SECIP) and the Spanish Society of Hospital Pharmacy (SEFH).

In addition, it has the endorsement of the General Council of Official Nursing Colleges of Spain, the Spanish Society of Neonatal Nursing and the Spanish Patient Forum.

In representation of seNeo the doctors collaborate Ester Sanz Lópezfrom the Gregorio Marañón General University Hospital in Madrid, and Monica Riaza Gomezfrom the Hospital HM de Montepríncipe in Madrid.

The objective of these societies is focused on the systematic and substantial reduction of the risk of medication errors in all Intensive Care Units, especially in hospital neonatology ICUs:

Create a general and specific safety culture.

Create security questionnaires.

Improve notification systems.

Generate educational and continuous training plans endorsed by the different Medical and Scientific Societies.

Establish strategies that favor communication between health professionals.

Develop training and awareness programs on the safe use of medicines.

Establish basic security training.

Set up advanced training programs on the safe use of the medication.

Implement a training and knowledge accreditation system backed by the Medical and Scientific Societies.

Increase training and awareness programs aimed at families.

The survey promoted by the PREVEMED project, completed by the ICUs of 112 hospitals, shows that there is a wide margin for improvement in the field of action on medication errors.

Dr. Manuel Sanchez Luna

“In short, now more than ever we are working hard to minimize medication errors as much as possible, adding efforts and knowledge to the safety protocols already established, developing three preventive measures with great social repercussions,” says the neonatologist.

“We create awareness about the true risk of having this type of error. It is essential that health personnel, patients assisted in hospital centers and their families are aware of the dangers of any poorly managed drug treatment ”, she relates in the first place.

“It should be noted that once we are aware of this risk and describe it, we will be able, at least, to identify and reduce it through security protocols and classification processes,” he points out.

“Secondly, we carry out training policies and continuous training in the knowledge of drugs, their incompatibilities, their risk doses, their adverse effects, the risks derived from the manipulation of the drugs themselves, their administration and the management of the waste generated”.

“Finally, an official accreditation of those people who have gone through these awareness and training processes will be carried out. Their degree of experience will be recognized, whose main objective will be to reduce the risks related to the administration of drugs.

The neonatal patients admitted to the ICUs, whose situation can be critical or fatal, will thus obtain the greatest possible medical benefit.

“We, who work in neonatal intensive care, are very, very sensitive, precisely because our patients are the ones who suffer the most risk with the administration of drugs. They are the babies born who face the most dangers during their stay in the ICU ”, she states bluntly.

“In the same way, I also want to convey here, in the Neonatology Videoblog, the vital importance of making the population in general and patients in particular aware of the risks derived from the improper or indiscriminate use of drugs.

In Spain, the example is worth mentioning worldwide, we have the mentality that we can freely use those drugs that have been good for our family member, friend or neighbor to cure an ailment.

Please, the use of drugs must always be left in the hands of l@s médic@s, who know the correct indications and guidelines.

In the same way, we have the dangerous habit of storing drugs that have been left over after curing a disease under medical prescription. There is no place!, they would say in the judicial sphere”.

Dr. Manuel Sánchez Luna, head of the Neonatology Service of the Gregorio Marañón General University Hospital and president of the Spanish Neonatology Society concludes.