Increasing compliance of safe medication administration in pediatric anesthesia by use of a standardized checklist

Medication errors pose a significant risk perioperatively. In the perioperative environment, common medication administration processes are not typically performed. Given the common administration of potentially harmful medications and the potential for medication errors, patient risk is substantial. Specifically, intravenous acetaminophen has been used more frequently in the perioperative period which yielded an increase in medication administration errors reported.

This project was initiated by Cincinnati Children's Hospital after an increase in perioperative acetaminophen dosing errors was reported. After mapping the administration process of perioperative acetaminophen, we sought to reduce medication errors by the use of a safety checklist. Acetaminophen was used as a surrogate for other perioperative medications in this quality improvement project.

Use of a failure mode effects analysis assisted the team in understanding the failures of the process of safe medication administration. Subsequently, key drivers of this process were designed to include accurate understanding and documentation of medication history, consistent communication between perioperative caregivers, and an efficient checklist process. A multidisciplinary team conducted a series of tests to modify key drivers. Data were collected by utilizing data from a paper checklist, prior to the electronic medical record change that was prompted by this study. A total of 633 checklists and electronic medical records were analyzed during a 6-month period; data were analyzed using control charts and statistical process control methods.

The percentage of compliance with the safe administration checklist for acetaminophen in the preoperative period increased to 97%. Use of the paper checklist likely prompted the appropriate increase in compliance with safe administration. Additionally, provider-specific feedback produced a significant increase in compliance with the use of the checklist.

Application of quality improvement methods, specifically a safety checklist, were utilized to improve the safe administration of acetaminophen during the perioperative period. Increasing reliability of accurate delivery and administration of medication to patients are crucial in optimizing patient safety. Use of a medication safety checklist may be beneficial in reducing potential administration errors, specifically for high-risk medications.