title: Risk and pharmacoeconomic analyses of the injectable medication process in the paediatric and neonatal intensive care units.
abstract: OBJECTIVE
  To analyse safety risks in injectable medications. To assess the potential impact and pharmacoeconomic aspects of safety tools.
  
  
  METHODS
  The injectable drug process was prospectively assessed using a failure modes, effects and criticality analysis. Criticality indexes were estimated based on their likelihood of occurrence, detection probability and potential severity. The impact of 10 safety tools on the criticality index was calculated and extrapolated to all drugs injected daily. Yearly costs for a reduction in criticality by 1 point (=1 quali) per day were estimated.
  
  
  METHODS
  Paediatric and neonatal intensive care units in a University Hospital.
  
  
  METHODS
  Two paediatric nurses, a neonatologist, three hospital pharmacists.
  
  
  METHODS
  Qualitative and quantitative risk assessment.
  
  
  METHODS
  Failure modes, criticality indexes, cost-efficacy ratios.
  
  
  RESULTS
  Thirty-one failure modes identified, with the mean of their entire criticality indexes totalling 4540. The most critical failure mode was microbial contamination. The following gains were predicted: 1292 quali (46 500 per day by extrapolation) from ready-to-use syringes, 1201 (72 060) by employing a clinical pharmacist, 996 (59 780) from double check by nurses and 984 (59 040) with computerized physician order entry. The best cost-efficacy ratios were obtained for a clinical pharmacist (1 quali = 0.54 euros), double check (1 quali = 0.71 euros) and ready-to-use syringes (1 quali = 0.72 euros). Computerized physician order entry showed the worst cost-efficacy ratio due to a very high investment costs (1 quali = 22.47 euros).
  
  
  CONCLUSIONS
  Based on our risk and pharmacoeconomic analyses, clinical pharmacy and ready-to-use syringes appear as the most promising safety tools.
authors.affiliation: Department of Pharmacy, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Geneva 14, Switzerland.
authors.forename: Isabella
authors.initials: I
authors.lastname: De Giorgi
authors.forename: Caroline
authors.initials: C
authors.lastname: Fonzo-Christe
authors.forename: Laurence
authors.initials: L
authors.lastname: Cingria
authors.forename: Béatrice
authors.initials: B
authors.lastname: Caredda
authors.forename: Valérie
authors.initials: V
authors.lastname: Meyer
authors.forename: Riccardo E
authors.initials: RE
authors.lastname: Pfister
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
mesh_terms: D003362:Cost-Benefit Analysis; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000458:organization & administration*; D008508:Medication Errors / Q000191:economics / Q000517:prevention & control; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration*; D018570:Risk Assessment; D017751:Safety Management / Q000191:economics / Q000458:organization & administration*