Kids need more protection from medication errors
Important safeguards are underused
Greater protections are needed to shield pediatric patients from potentially tragic medication errors, according to the nonprofit Institute for Safe Medication Practices (ISMP) in Fulton, MD.
The ISMP reached that conclusion after surveying hospitals about practices they follow in pediatrics. The group surveyed hospitals through a newsletter and received 312 responses. The survey disclosed that while a number of safety practices were used fairly consistently, other important safeguards were greatly underutilized.
The most prevalent safety practices reported by all respondents included entering the patient’s age into the pharmacy computer system before processing orders, providing specialized training to nurses who work with pediatric patients, and requiring a pharmacist to double-check all pharmacy-prepared parenteral solutions. However, there were significant gaps in full implementation of even the most prevalent safety practices and variations between care settings.
Differences noted between departments
While 95% of pediatric intensive care unit (PICU) respondents noted that orders always require entry of the patient’s age before processing, only 80% of general pediatric unit (GPU) respondents reported they always do so. Further, only about half of all respondents reported that the patient’s weight is always entered into the computer before processing orders to allow the system to warn practitioners about drug doses that exceed safe limits.
While 88% to 89% of PICU and neonatal intensive care unit (NICU) respondents always require specialized training for pediatric nurses, only 66% of GPU respondents had similar training requirements. Respondents also noted that specialized training for pharmacy staff who prepare pediatric parenteral solutions is dangerously inconsistent.
Two of the least prevalent safety practices included listing the mg/kg dose as part of the drug order and having clinical pharmacists actively participate on units. Three quarters of all respondents said that prescribers inconsistently or never list the mg/kg dose with pediatric drug orders. Although about two-thirds of NICU and PICU respondents reported that pharmacists always verify the mg/kg dose and recalculate the specific patient dose before dispensing drugs, only half reported that such safety measures are consistently carried out for all pediatric drug orders, regardless of the setting of care.
In addition, a large proportion of pediatric doses are obtained from floor stock, which typically bypasses pharmacy double-check processes to verify the correct dose. While it may be expected that noncritical care units would report less participation of clinical pharmacists, only about two-thirds of NICU and PICU respondents reported strong clinical pharmacy involvement. Further, more than a third of NICU respondents reported the total absence of clinical pharmacists in those high-risk patient care units.
Most hospitals report that they have fully implemented a unit dose drug distribution system, but respondents reported that pharmacy dispenses an average of only 81% of pediatric drugs in unit doses and 84% of all pediatric parenteral solutions. With the exception of drugs with stability issues, all pediatric IV admixtures should occur in pharmacies that provide 24-hour service, the ISMP says. Yet less than half of respondents reported that essentially all parenteral solutions were dispensed by pharmacy.
While about two-thirds of all respondents noted that standard dosing/infusion rate tables are frequently or always available for reference, 32% of NICU respondents noted a complete absence of such guidelines. Further, only about 30% of all respondents noted that nursing calculations and parenteral medications are independently verified by another nurse before drug administration. Respondents also reported that about a quarter of all products are obtained from floor stock. Even though nursery and NICU respondents frequently obtain most products (75%) from floor stock, at least a quarter of them reported obtaining less than 5% of all products from floor stock.
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