Utility of a clinical pharmacist in the pediatric intensive care unit to identify and prevent medication errors

Abstract

Background: Medication errors (MEs) in the pediatric intensive care units (PICUs) are common, predictable, serious, and preventable. Patients in the intensive care unit (ICU) are more vulnerable to increased MEs due to the complexity of underlying critical illness. Aim: The aim of the study was to determine the incidence, types, adverse effects, and outcome of MEs identified by a clinical pharmacist in the PICU. Subjects and Methods: This prospective observational study was conducted in the PICU of Dr. Bidari's Ashwini Hospital, Vijayapura, using daily observation of medical records from February 17, 2018, to November 30, 2019, using NCC-MERP guidelines to define the ME. Results: The incidence of MEs was 250/1000 patient days. Prescription errors were most common with 59.3% (3007), followed by administration errors with 21% (1100). Dispensing and transcription errors were 10.4% (528) and 8.6% (441), respectively. In prescription error, dosage error was predominant with 76% (2286), followed by documentation error in 15% (451), In transcription errors, incorrect drug dose was the most common error with 47% (208), followed by the wrong drug in 23% (102). In the case of dispensing errors, a supply of incorrect medicines was most common with 61% (321), followed by the unavailability of medicines with 24% (126). In administration errors, medicines given at the wrong time duration were observed in 55% (603), followed by orders not carried by nurses at an appropriate time in 23% (255). National coordination committee for ME reporting and prevention index severity classification includes Category B, the most common with 61% (3096) incidence, followed by Category C with 34% (1725).Total 23 patients developed probable adverse side effects. The mortality was only 1% (28) in this study, which was crude mortality of our PICU. Conclusions: (i) Prescription errors were the most common MEs followed by administration errors. (ii) The role of the clinical pharmacist was vital in identifying and avoiding the existing burden of MEs in the PICU. (iii) Reinforcement of structured training of the medical and paramedical staff is essential regarding the safe medication practices.

Keywords

• clinical pharmacist
• medication errors
• pediatric intensive care unit