INTERVENTIONS USED TO MINIMISE PRESCRIBING ERRORS IN NEONATAL UNITS
Pradhan S
1, Gooding N 2,Kelsall W1 1Neonatal Intensive Care Unit ,2 Pharmacy Department , Cambridge University Hospital , UK

Introduction: The incidence of medication errors in paediatrics is estimated to be 500,000 per year in England (1). Neonates are a particularly vulnerable population and potentially suffer more harmful effects from medication errors. There is an urgent need to minimise such errors and several measures have been recommended to achieve this(1,2). Broadly these recommendations fall into three categories: (a) Trust wide policies, which include incident reporting, computerised prescriptions and guidance on neonatal dosing; (b) intervention by pharmacists and (c) education and training of prescribers. Some of these recommendations have been implemented in our tertiary neonatal unit. The purpose of this study was to determine whether or not any of these interventions were in use in the other neonatal units across the East of England neonatal network.

Methods: A telephonic questionnaire survey was conducted with the eighteen neonatal units across the East of England neonatal network to review procedures which they have implemented to minimise drug errors.

Results: Responses were obtained from staff on all 18 units in the region. All units had prescription policies, antimicrobial policies & risk management strategies including incident reporting. Units used different formularies for drug dosages, with the majority of the units 13 (73%) using the BNF for children publication. 15 (83%) of the units had individual IV monographs to assist with preparation and administration of intravenous drugs. 95% of the units regularly audited their prescribing practices and fed results back to the prescribers. Computerised prescribing or electronic dose calculators are not widely used, with only 3 units (17%) across the region generating weekly drug dose from a current weight using a computerized system. Pharmacists attended the neonatal ward rounds at least once a week in 50% of the units. They gave feedback on the prescriptions in 95% of the units. 60% of the units had an allocated session by the pharmacist at induction of new doctors. 17% of the neonatal units were formally assessing the prescribing skills of doctors at hospital induction. Only 17% of the units gave out laminated dose reminder cards with doses of the most commonly used drugs to all new doctors

Conclusions: Trust wide policies and risk management strategies are widely used across the regional neonatal network. Pharmacists and electronic computerised prescibing are under-utilised. Training and assessment of doctors' prescribing skills needs to be strengthened. We recommend sharing of experiences so that a standardised approach to prescribing, electronic prescribing and education can be implemented across the neonatal network to minimise drug errors.

References: 1)Wong, Ian C K; Ghaleb, Maisoon A et al. Incidence and nature of dosing errors in Paediatric medications: A systematic review: Drug Safety 2004; 27:661-670 2) Conroy S, North C, Fox T et al Educational interventions to reduce prescribing errors: Arch Dis Child 2008;93: 313-315