title: Strategies implementation to reduce medicine preparation error rate in neonatal intensive care units.
abstract: This study assessed the rate of errors in intravenous medicine preparation at bedside in neonatal intensive care units versus preparation error rate in a hospital pharmacy service before and after several strategies were implemented. We performed a prospective observational study during 2013-2015. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered, calculation errors and accuracy errors. The study was carried out over three consecutive phases: (1) pre-intervention phase, when medicine preparation samples were collected from neonatal intensive care units and hospital pharmacy service according to their normal clinical practice; (2) intervention phase, when protocol standardisation and educational strategy took place; and (3) post-intervention phase, when new medicine samples were collected after strategy implementation. In neonatal intensive care units, 1.35 % of samples registered calculation errors in pre-intervention phase; no calculation errors were registered in hospital pharmacy service samples. In post-intervention phase, no calculation errors were registered in either group. Accuracy error rate decreased both in neonatal intensive care units (54.7 vs 23 %) and hospital pharmacy service (38.3 vs 14.6 %).
  
  
  CONCLUSIONS
  Calculation errors can disappear with good standardisation protocols. Decrease in accuracy error depends on good preparation technique and environmental factors.
  
  
  BACKGROUND
  • Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. • Lack of commercial drug formulations adapted to newborn infants makes medicine preparation process more prone to error. What is New: • Calculation errors are minimising using concentration standard protocols. Preparation rules are essential to ensure the accuracy process. • Environmental conditions affect the accuracy process.
authors.affiliation: Hospital Pharmacy, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain. ainara.campinovillegas@osakidetza.eus.
authors.forename: Ainara
authors.initials: A
authors.lastname: Campino
authors.affiliation: Neonatal Epidemiology Unit, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Santesteban
authors.affiliation: Hospital Pharmacy, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Pascual
authors.affiliation: Hospital Pharmacy, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Sordo
authors.affiliation: Neonatal Intensive Care Unit, Paediatrics Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Casilda
authors.initials: C
authors.lastname: Arranz
authors.affiliation: Hospital Biochemistry Laboratory, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Unceta
authors.affiliation: Neonatal Intensive Care Unit, Paediatrics Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Ion
authors.initials: I
authors.lastname: Lopez-de-Heredia
mesh_terms: D004339:Drug Compounding / Q000592:standards*; D054796:Drug Dosage Calculations; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital / Q000592:standards*; D011446:Prospective Studies; D014741:Video Recording
keywords: Accuracy; Intravenous medicine; Medication errors; Neonatal intensive care unit; Newborn infant; Preparation errors