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  • The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care

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The effect of a multifaceted educational intervention on medication preparation and administration errors in neonatal intensive care
  1. Indra Chedoe1,
  2. Harry Molendijk2,
  3. Wobbe Hospes1,
  4. Edwin R Van den Heuvel3,
  5. Katja Taxis4
  1. 1Department of Clinical Pharmacy, Isala Clinics, Zwolle, The Netherlands
  2. 2Princess Amalia Department of Pediatrics, Isala Clinics, Zwolle, The Netherlands
  3. 3Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
  4. 4Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Katja Taxis, Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Ant Deusinglaan 1, 9713AV Groningen, The Netherlands; k.taxis{at}rug.nl

Abstract

Objective To examine the effect of a multifaceted educational intervention on the incidence of medication preparation and administration errors in a neonatal intensive care unit (NICU).

Design Prospective study with a preintervention and postintervention measurement using direct observation.

Setting NICU in a tertiary hospital in the Netherlands.

Intervention A multifaceted educational intervention including teaching and self-study.

Main outcome measures The incidence of medication preparation and administration errors. Clinical importance was assessed by three experts.

Results The incidence of errors decreased from 49% (43–54%) (151 medications with one or more errors of 311 observations) to 31% (87 of 284) (25–36%). Preintervention, 0.3% (0–2%) medications contained severe errors, 26% (21–31%) moderate and 23% (18–28%) minor errors; postintervention, none 0% (0–2%) was severe, 23% (18–28%) moderate and 8% (5–12%) minor. A generalised estimating equations analysis provided an OR of 0.49 (0.29–0.84) for period (p=0.032), (route of administration (p=0.001), observer within period (p=0.036)).

Conclusions The multifaceted educational intervention seemed to have contributed to a significant reduction of the preparation and administration error rate, but other measures are needed to improve medication safety further.

https://doi.org/10.1136/fetalneonatal-2011-300989

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    Footnotes

    • Funding This study was partly funded by the Netherlands association of hospital pharmacists (NVZA). The sponsor did not have a role in the study design; in the collection, analysis and interpretation data; in the writing of the report; and in the decision to submit the paper for publication.

    • Competing interests KT received funding from Astra Zeneca for a project unrelated to this work. KT also received speaker's fees from Hospira and BBraun.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We could provide access to the primary data.