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Independent double-checking of high-risk medications among hospitalized pediatric patients: a best practice
Reagan McMurtery1,2, Michelle Palokas1,2
1School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.
Insights
Implementing evidence-based practices for independent double-checking of high-risk medications improved compliance by 7% in a pediatric unit. This initiative aimed to reduce medication errors in pediatric patients, who are more vulnerable to harm from such errors.
Area of Science:
- Pediatric Patient Safety
- Medication Error Reduction
- Evidence-Based Practice Implementation
Background:
- Pediatric patients face higher risks of medication errors due to weight-based dosing.
- Adverse drug events are three times more common in children than adults.
- A Mississippi pediatric unit reported four high-risk medication errors in 2023, representing 21% of all errors.
Purpose of the Study:
- To enhance evidence-based practices for independent double-checking of high-risk medications.
- To decrease medication errors within a pediatric inpatient setting.
- To improve patient safety in pediatric care.
Main Methods:
- Utilized the JBI Evidence Implementation Framework, PACES, and GRiP audit strategy.
- Conducted baseline and follow-up audits assessing nine evidence-based practices.
- Implemented targeted strategies to address identified compliance barriers.
Main Results:
- Baseline compliance with evidence-based practices was 70%.
- Key barriers included insufficient staff knowledge and unclear policies.
- Post-implementation compliance increased to 77% after implementing education and policy revisions.
Conclusions:
- Clinical audit effectively improved independent double-checking of high-risk medications.
- Evidence implementation projects can enhance pediatric medication safety.
- Sustained focus on best practices reduces pediatric medication errors.
Introduction:
Compared to adults, medication errors among pediatric patients have a greater possibility of causing harm due to weight-based, fractional doses. Potential adverse drug events occur three times more often in the pediatric population. In 2023, 3 Children's, a pediatric inpatient unit in Mississippi, had four reported high-risk medication errors, which was 21% of all reported medication errors.
Objective:
This project aimed to promote evidence-based practices regarding independent double-checking of high-risk medications to reduce medication errors in a pediatric inpatient unit.
Methods:
This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) along with the Getting Research into Practice (GRiP) audit and feedback strategy. Audit criteria included nine evidence-based practices. After completing baseline audits, strategies to address the identified barriers were developed and implemented. A follow-up audit was then conducted and compared to the baseline audit.
Results:
Baseline audits revealed 70% average compliance with the nine evidence-based practices. Barriers to compliance were identified, including a lack of nursing staff knowledge/training regarding independent double-checks and an unclear policy and procedure regarding high-risk medications and independent double-checks. Strategies to improve compliance were implemented and included an education module via the electronic learning management system, laminated reminder cards, a tip sheet, and revisions to the Children's High-Risk Medication Policy. The average follow-up post-implementation audit compliance was 77%, a 7% increase from baseline.
Conclusions:
The clinical audit process used in this evidence implementation project resulted in improvements in independent double-checking high-risk medications in the inpatient pediatric unit.
Spanish Abstract:
http://links.lww.com/IJEBH/A614.
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