National Survey of Neonatal Intensive Care Unit Medication Safety Practices

Abstract

Objective We conducted a detailed survey to identify medication safety practices among a large network of United States neonatal intensive care units (NICUs).

Methods We created a 53-question survey to assess 300 U.S. NICU's demographics, medication safety practices, adverse drug event (ADE) reporting, and ADE response plans.

Results Among the 164 (55%) NICUs that responded to the survey, more than 85% adhered to practices including use of electronic health records, computerized physician order entry, and clinical decision support; fewer reported adopting barcoding, formal safety surveys, and formal culture training; 137 of 164 (84%) developed at least one NICU-specific order-set with a median of 10 order-sets.

Conclusion Among our survey of 164 NICUs, we found that many safety practices remain unused. Understanding safety practice variation is critical to prevent ADEs and other negative infant outcomes. Future efforts should focus on linking safety practices identified from our survey with ADEs and infant outcomes.

Keywords

neonatal intensive care unit - medication safety practices - adverse drug event - adverse drug event response plan

Authors' Contributions

All authors have been involved in the study design, analysis, and manuscript revision. All authors read and approved the final manuscript. Dr. Greenberg is the guarantor who accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. Dr. Greenberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Greenberg contributed to the conception and design of the study, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. Dr. Smith contributed to the conception and design of the study, the data interpretation, and the critical revision of the manuscript. Dr. Bose contributed to the conception and design of the study, the data interpretation and the critical revision of the manuscript. Dr. Clark contributed to the conception and design of the study, the data acquisition, the data interpretation, and the critical revision of the manuscript. Dr. Cotten contributed to the conception and design of the study, the data interpretation, and the critical revision of the manuscript. Dr. DeRienzo contributed to the conception and design of the study, and both supervised and contributed to the data acquisition and interpretation, manuscript drafting, and critical revision of the manuscript.

• References

• 1 de Bie S, Ferrajolo C, Straus SM. , et al; GRiP network. Pediatric drug safety surveillance in FDA-AERS: a description of adverse events from GRiP project. PLoS One 2015; 10 (06) e0130399
• 2 Kaushal R, Bates DW, Landrigan C. , et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001; 285 (16) 2114-2120
• 3 Institute of Medicine. Preventing Medication Errors: Quality Chasm Series. Washington, DC: The National Academies Press; 2007
• 4 Morriss Jr FH. Adverse medical events in the NICU: epidemiology and prevention. Neoreviews 2008; 9 (01) e8-e23
• 5 Suresh G, Horbar JD, Plsek P. , et al. Voluntary anonymous reporting of medical errors for neonatal intensive care. Pediatrics 2004; 113 (06) 1609-1618
• 6 Morriss Jr FH, Abramowitz PW, Nelson SP. , et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr 2009; 154 (03) 363-368
• 7 Ferranti JM, Horvath MM, Jansen J. , et al. Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model. BMC Med Inform Decis Mak 2011; 11: 14
• 8 Ethington P, Hornik CD, Canale M, Tanaka D. Intervention in pharmacy processes reduces medication errors. Pediatric Academic Societies Meeting, Vancouver, Canada; May 2010
• 9 Morriss Jr FH, Abramowitz PW, Nelson SP, Milavetz G, Michael SL, Gordon SN. Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system. Am J Health Syst Pharm 2011; 68 (01) 57-62
• 10 Dabliz R, Levine S. Medication safety in neonates. Am J Perinatol 2012; 29 (01) 49-56
• 11 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 12 United States Census Bureau. Census Regions and Divisions of the United States. United States Census Bureau web site. Available at: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf . Accessed February 28, 2018
• 13 Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med 2007; 356 (21) 2165-2175
• 14 Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006; 355 (01) 41-50
• 15 Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997; 277 (04) 301-306
• 16 Phillips DP, Christenfeld N, Glynn LM. Increase in US medication-error deaths between 1983 and 1993. Lancet 1998; 351 (9103): 643-644
• 17 Moore TJ, Weiss SR, Kaplan S, Blaisdell CJ. Reported adverse drug events in infants and children under 2 years of age. Pediatrics 2002; 110 (05) e53
• 18 Cuzzolin L, Atzei A, Fanos V. Off-label and unlicensed prescribing for newborns and children in different settings: a review of the literature and a consideration about drug safety. Expert Opin Drug Saf 2006; 5 (05) 703-718
• 19 Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology--drug disposition, action, and therapy in infants and children. N Engl J Med 2003; 349 (12) 1157-1167
• 20 Institute for Safe Medication Practices (ISMP). ISMP list of high-alert medications in acute care settings. ISMP web site. Available at: https://www.ismp.org/tools/institutionalhighAlert.asp . Accessed February 28, 2018
• 21 Christensen RD, Henry E, Wiedmeier SE, Burnett J, Lambert DK. Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease. J Perinatol 2007; 27 (05) 284-290
• 22 Hsieh EM, Hornik CP, Clark RH, Laughon MM, Benjamin Jr DK, Smith PB. ; Best Pharmaceuticals for Children Act—Pediatric Trials Network. Medication use in the neonatal intensive care unit. Am J Perinatol 2014; 31 (09) 811-821
• 23 Feltman DM, Du H, Leuthner SR. Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol 2012; 32 (11) 886-892
• 24 Pollack LD, Ratner IM, Lund GC. United States neonatology practice survey: personnel, practice, hospital, and neonatal intensive care unit characteristics. Pediatrics 1998; 101 (3 Pt 1): 398-405
• 25 Chedoe I, Molendijk HA, Dittrich ST. , et al. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Drug Saf 2007; 30 (06) 503-513