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Nurse-Led Quality Improvement Initiative to Reduce Medication Errors in Pediatric ICU
Shivani Kumari1, Arun Bansal2, Meenakshi Agnihotri1
1College of Nursing, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
A nurse-led medication errors bundle significantly reduced medication errors in a pediatric intensive care unit (PICU). This quality improvement initiative demonstrated a sustained decrease in medication errors (MEs), enhancing patient safety.
Area of Science:
- Pediatric Intensive Care
- Medication Safety
- Quality Improvement
Background:
- Medication errors (MEs) pose a significant risk in pediatric intensive care units (PICUs).
- Effective interventions are needed to reduce the incidence and severity of MEs in this vulnerable population.
Purpose of the Study:
- To evaluate a nurse-driven, context-specific medication errors bundle for reducing MEs by at least 50% in a PICU.
- To assess the impact of the intervention on different categories of medication errors and staff awareness.
Main Methods:
- A prospective, before-and-after quality improvement study was conducted in a 15-bedded multidisciplinary PICU in northern India.
- The intervention involved a structured prescription format, nursing observation and administration charts, and drug incompatibility charts, implemented through Plan-Do-Study-Act (PDSA) cycles.
- Medication errors were categorized and assessed for severity using the NCC MERP Index.
Main Results:
- The overall medication error rate decreased from 8.5% to 2.9%.
- Significant reductions were observed across prescription (13.1% to 3.8%), dispensing (12.2% to 5.2%), administration (3.8% to 1.9%), and monitoring errors (1.7% to 0%).
- Most errors were intercepted before patient harm (NCC MERP Category B), and staff quality improvement awareness increased from 55.5% to 84%.
Conclusions:
- A low-cost, nurse-led medication errors bundle effectively reduced MEs in a PICU setting.
- The intervention demonstrated sustained improvement and has potential applicability in similar pediatric intensive care environments.
- This study highlights the critical role of nursing leadership in implementing successful quality improvement initiatives for medication safety.
Objective:
To evaluate the effectiveness of a context-specific, nurse-driven medication errors bundle in reducing the incidence of medication errors (MEs) by ≥ 50% in a pediatric intensive care unit (PICU).
Methods:
We conducted a prospective, before-and-after quality improvement study, between February and November 2023, in a 15-bedded multidisciplinary PICU of a tertiary public hospital in northern India. Prescriptions advised to children hospitalized during the study period were analyzed. The intervention comprised of a structured prescription format, nursing observation and administration charts, and drug incompatibility charts. The bundle was implemented through four sequential Plan-Do-Study-Act (PDSA) cycles. Medication errors were categorized into prescription, dispensing, administration, and monitoring errors and assessed for severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index. The primary outcome was change in the overall ME rate. The secondary outcomes included category-specific error rates and improvement in staff awareness of quality improvement principles.
Results:
A total of 968 prescriptions were evaluated during the pre-assessment phase and 1,386 during the intervention. The overall ME rate declined from 8.5% to 2.9%, prescription errors dropped from 13.1% to 3.8%, dispensing errors from 12.2% to 5.2%, administration errors from 3.8% to 1.9%, and monitoring errors from 1.7% to 0%. Most errors were intercepted and corrected before reaching the patient (NCC MERP Category B). Quality improvement awareness among staff improved from 55.5% to 84%.
Conclusion:
A low-cost, nurse-led, multidisciplinary medication errors bundle led to a sustained reduction in MEs, demonstrating its potential for use in comparable PICU settings.
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