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What Nurses Can Do Right Now to Reduce Medication Errors in the Neonatal Intensive Care Unit

https://doi.org/10.1053/j.nainr.2008.03.008Get rights and content

Recent medication error events involving newborns in California and Indiana highlight the complex nature of medication use in hospitals and the importance of the nurse's role in preventing medication errors. Patients in the neonatal intensive care unit are especially vulnerable to medication errors, experiencing more medication errors and more potentially serious medication errors when compared to other patients in the hospital. Several studies cite specific technology such as computerized physician order entry, bar-code medication administration, computerized methods that promote easy access to patient information, and pharmacists participating in patient care rounds as effective methods to significantly reduce medication errors in the neonatal population. Unfortunately, owing to a variety of organizational barriers, the majority of hospitals nationwide have not implemented these recommendations completely. Due to the complexity of medication errors and how they occur, technology improvements alone will not prevent all medication errors and may create new and different errors. Technology in concert with an aware, safety-minded healthcare professional provides a comprehensive approach to medication error reduction. Nurses can reduce medication errors by implementing important changes to their individual practice including reporting medication errors, reducing distractions, implementation of safe medication double checks (comprehensive, consistent, and independent) before medication administration, and promoting a safety culture.

Section snippets

Medication Errors in the NICU

“Despite our best efforts, medication errors happen every day, to every kind of person, in every health care setting” Michael R. Cohen, Institute for Safe Medication Practices (ISMP)

Although there are a variety of medication error definitions, a commonly accepted definition is as follows:

A medication error is any preventable event that occurs during any stage of the medication use process that may cause or lead to inappropriate medication use or patient harm.13

In 1999, the Institute of

What Works to Reduce Medication Errors in the NICU?

“Begin at the beginning…” Lewis Carroll

Medication errors are rarely the result of one, single individual action. More commonly, multiple mistakes during the medication use process occur, resulting in an error. Due to errors in multiple steps of the process, many studies recommend a systems approach to reduce medication errors including adopting technology, using pharmacists on rounds, standardizing processes, having easy and reliable access to patient information, and implementing methods to

Reporting Errors Helps to Begin the Medication Safety Process

“We cannot fix what we do not know is wrong” (author unknown)

In the hospital setting, errors often go unreported. Multiple studies over the past decade have demonstrated that hospital personnel do not report errors in general, and only 5% of significant errors are reported.17 In one study in which nurses used journaling to describe errors made during patient care, one third reported making at least one error or near error during a 28-day period, yet very few were reported through the

Distractions and Medication Errors

“We are what we repeatedly do. Excellence then, is not an act, but a habit” Aristotle

Distractions are events that draw a health care provider's attention somewhere else and an interruption stops the person's current action. There has been increasing attention on the effects distractions and interruptions have on patient safety events including medication errors. Psychological studies have documented that distractions reduce performance of various mental and cognitive tasks.35 Distractions of

Implementing Safe Double Check of Medications Before Administration: Using a Human Factors Approach and Building a Redundant System

“We are causing harm, and we need to stop it” Donald Berwick, Institute for Healthcare Improvement

Bedside bar coding of medications demonstrates a potential safety net (or double check) in assuring that nurses are giving the right drug, the right the majority of dose, at the right time, to the right patient using the right route. However, the use of bedside bar coding is not a reality for the majority of NICU nurses as less than 2% of hospitals have instituted this technology nationwide.46 Use

Creating a Safety Culture: One Nurse at a Time

“Things do not happen. Things are made to happen” John F. Kennedy

Culture, when referred to a workplace environment, can be defined as “how things are done here.” The culture of a work environment is a powerful force in how work gets performed and how accepted behaviors are reinforced. A safety culture has specific characteristics, behaviors, and processes (Table 4) in place that promote a single-minded focus on patient safety, actively seeking out error-prone processes and working toward

Culture of Safety and Individual Accountability: A Balance of Factors

“Never doubt that a small group of thoughtful citizens can change the world: indeed it's the only thing that ever has” Margaret Mead

Although the promotion of a nonpunitive culture is advocated and reporting of errors is encouraged, a unit with a safety culture also has a well-established system of accountability. A nonpunitive approach to errors is not equated with a lack of accountability for breech of safety standards. As health care professionals, nurses are accountable to providing safe

Conclusion

“Knowing is not enough; we must apply. Willing is not enough; we must do” Johann Wolfgang von Goethe

To significantly reduce medication errors in the NICU, clear and concise changes must happen in a multidisciplinary, multifaceted fashion (see Table 7). Hospital leadership and NICU team leaders must make the evidence-based system changes that directly affect medication error rates such as CPOE (best with a clinical decision support), pharmacists on rounds, and easy access to patient information.

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