Related Experiment Video

Updated: Jan 3, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

87.4K

Improving Recognition and Reporting of Adverse Drug Reactions in the NICU: A Quality Improvement Project

Betsy Cammack1, Alexandra Oschman2, Tamorah Lewis1,3

  • 1Children's Mercy Hospital, Department of Pediatrics, Division of Neonatology, Kansas City, MO.

Pediatric Quality & Safety
|November 21, 2019
PubMed

Insights

Adverse drug reactions (ADRs) in the Neonatal Intensive Care Unit (NICU) are often missed. A bedside tool improved ADR detection and the Du score better characterized neonatal ADRs compared to the Naranjo score.

Area of Science:

  • Neonatal Intensive Care Unit (NICU) research
  • Pharmacovigilance
  • Quality Improvement in Healthcare

Background:

  • Adverse drug reactions (ADRs) are significantly under-recognized and under-reported in Neonatal Intensive Care Units (NICUs).
  • Pediatric patients face a higher risk of ADRs compared to non-elderly adults, highlighting a critical need for improved monitoring.
  • The Children's Mercy NICU reported a 0.29% ADR rate in 2015, indicating substantial room for improvement in detection and characterization.

Purpose of the Study:

  • To implement a quality improvement project to increase the daily assessment of patients for ADRs.
  • To evaluate the effectiveness of a bedside monitoring tool in improving ADR recognition and reporting in the NICU.
  • To compare the utility of the Naranjo score versus the neonatal-specific Du score for characterizing ADRs in neonates.

Main Methods:

  • A quality improvement project focused on daily ADR assessment for patients receiving specific high-risk medications (indomethacin, dexmedetomidine, fentanyl, lorazepam, dexamethasone, hydrocortisone).
  • Utilized Plan-Do-Study-Act (PDSA) cycles over one year to implement and refine a bedside monitoring tool.
  • Calculated Naranjo and Du scores for recognized ADRs to compare their effectiveness in characterizing events.

Main Results:

  • The bedside monitoring tool was used 83% of the time, significantly increasing the identification of potential ADRs (28 events).
  • Three PDSA cycles were completed within one year, demonstrating iterative improvement in the process.
  • The Du score showed greater appropriateness for characterizing neonatal ADRs compared to the Naranjo score.

Conclusions:

  • A bedside monitoring tool effectively enhances ADR detection rates in the NICU setting.
  • Challenges were encountered in consistently identifying target patients and ensuring tool accessibility at the bedside.
  • The Du score is a more suitable tool for classifying ADRs in neonates than the Naranjo score.

More Related Videos

The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time06:05

The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time

Published on: February 19, 2021

1.6K
Improving IV Insulin Administration in a Community Hospital12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

19.3K

Related Concept Videos

Pharmacovigilance01:19

Pharmacovigilance

Post-marketing surveillance is a critical component of pharmaceutical regulation, often uncovering unanticipated adverse drug reactions (ADRs) once a drug is widely used over an extended period.
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
1.6K
Nursing Clinical Information System01:27

Nursing Clinical Information System

Nursing Clinical Information System (NCIS)
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
1.2K
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
177
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
218
Drug Regulation01:25

Drug Regulation

Drug regulation encompasses the management of drug usage by evaluating its safety and efficacy through assessments conducted by regulatory authorities. Regrettably, the history of drug regulation is marred by several catastrophic events. One such incident is the Elixir Sulfanilamide tragedy, in which the toxic compound diethyl glycol was included in a sweet-tasting medication, leading to numerous fatalities. This event prompted the enactment of the Food, Drug, and Cosmetic Act in 1938. Under...
2.6K
Factors Affecting Drug Response: Overview01:21

Factors Affecting Drug Response: Overview

When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
2.8K