[Medication errors. Preventive measures in neonatal intensive care].
Medications errors are one on the main problems in the National Health Service. The Neonatal Intensive Care Unit (NICU) is a very specific area and newborns are highly exposed to the risk of medication errors.


METHODS
A revision of the therapeutic process was started, involving NICU doctors, nurses and the pharmacist, to identify problems and implement adequate solutions. The main high risk areas identified were: prescription of the drug and its transcription on the drug sheet, calculation of drugs dilutions and dosages to be administered, fragmentation of tasks (drugs prepared and administered by different professionals).


RESULTS
The analysis of the process allowed different professionals to be aware of the risks and of the importance of standardized behaviours; of the implementation of protocols to prevent possible errors. The implementation of computerized calculation of dosages of drugs to be infused allowed to prevent errors and favoured personalized prescriptions. The introduction of the voluntary complaint forms will hopefully allow to have a clearer picture of the magnitude of the problem together with data on its nature, to identify future appropriate corrective measures.
Cologna
Marina
M
U.O. Neona tologia, Terapia Intensiva Neonatale, Ospedale di Trento.
Pederzini
Fabio
F
Capretta
Franco
F
Malossi
Riccardo
R
Barelli
Paolo
P
D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000592:standards; D008508:Medication Errors / Q000517:prevention & control*; D011996:Records