Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units.

Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews.

Medication Safety Gaps in English Pediatric Inpatient Units: An Exploration Using Work Domain Analysis.

Objectives: Medication is a common cause of preventable medical harm in pediatric inpatients. This study aimed to examine the sociotechnical system surrounding pediatric medicines management, to identify potential gaps in this system and how these might contribute to adverse drug events (ADEs).

Methods: An exploratory prospective qualitative study in pediatric wards in three hospitals in the north of England was conducted between October 2020 and May 2022.

Supplementations of industrial multichamber parenteral nutrition bags in critically ill children: Safety of the practice.

Background: Parenteral nutrition (PN) is sometimes required in critically ill children because of contraindication or intolerance to full enteral nutrition. European guidelines recommend favoring multichamber bag PN (MCB PN), when possible, for quality purposes and ease of use. The prescribers may adjust the MCB PN through supplementations to better fulfill patient needs.

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety.

Avoidable harm associated with medication is a persistent problem in health systems and the use of preprogrammed infusion devices ('smart pumps') and data monitoring is seen as a core approach to mitigating and reducing the incidence of these harms. However, smart pumps are costly to procure, configure and maintain (in both human and financial terms) and are often poorly implemented. Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, and a strategic human-centred approach is needed to support their implementation.

The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study.

Introduction: The use of intravenous administration systems with dose error reduction software (DERS) is advocated to mitigate avoidable medication harm. No large-scale analysis of UK data has been attempted. This retrospective descriptive study aimed to estimate the prevalence of hard limit events and to estimate the potential severity of DERS events.

Incidence and nature of adverse drug events in paediatric intensive care units: A prospective multicentre study.

Aims: The aim of this study was to assess the incidence, nature, preventability and severity of adverse drug events (ADEs) across three paediatric intensive care units (PICUs) in England.

Methods: A prospective observational cohort study was conducted across three PICUs over a three-month period during 2019. Included patients were aged ≤18 years and stayed in PICU for a minimum of 24 hours.

A Mixed-Methods Analysis of Medication Safety Incidents Reported in Neonatal and Children's Intensive Care.

Background: Critically ill neonates and paediatric patients may be at a greater risk of medication-related safety incidents than those in other clinical areas.

Objective: This study aimed to examine the nature of, and contributory factors associated with, medication-related safety incidents reported in neonatal and paediatric intensive care units (ICUs).

Methods: We carried out a mixed-methods analysis of anonymised medication safety incidents reported to the National Reporting and Learning System that involved children (aged ≤ 18 years) admitted to ICUs across England and Wales over a 9-year period (2010-2018).

Incidence and prevalence of intravenous medication errors in the UK: a systematic review.

Objectives: Medication error is the most common type of medical error, and intravenous medicines are at a higher risk as they are complex to prepare and administer. The WHO advocates a 50% reduction of harmful medication errors by 2022, but there is a lack of data in the UK that accurately estimates the true rate of intravenous medication errors. This study aimed to estimate the number of intravenous medication errors per 1000 administrations in the UK National Health Service and their associated economic costs.

Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review.

Background: Problems arising from medicines usage are recognised as a key patient safety issue. Children are a particular concern, given that they are more likely than adults to experience medication-related harm. While previous reviews have provided an estimate of prevalence in this population, these predate recent developments in the delivery of paediatric care.

Prevalence and Nature of Medication Errors and Preventable Adverse Drug Events in Paediatric and Neonatal Intensive Care Settings: A Systematic Review.

Introduction: Children admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events.

Objective: The objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units.

Data Sources: Seven electronic databases were searched between January 2000 and March 2019.

Exploring the human factors of prescribing errors in paediatric intensive care units.

Objective: To explore the factors contributing to prescribing error in paediatric intensive care units (PICUs) using a human factors approach based on Reason's theory of error causation to support planning of interventions to mitigate slips and lapses, rules-based mistakes and knowledge-based mistakes.

Methods: A hierarchical task analysis (HTA) of prescribing was conducted using documentary analysis. Eleven semistructured interviews with prescribers were conducted using vignettes and were analysed using template analysis.

A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom.

Objectives: This study aimed to explore the use of standard concentration infusions for intravenous infusions (SCI) in paediatric and neonatal units in the United Kingdom (UK). This included how many units use SCI, variation and overlap in concentrations, devices in use for administration and how the infusions were provided.

Methods: Paediatric and neonatal units in the UK were surveyed using a self-administered web-based survey tool.

THE IMPACT OF FIXED CONCENTRATIONS SEDATION INFUSIONS ON FLUID OVERLOAD IN CRITICALLY ILL CHILDREN.

Introduction: Fluid overload of 10% at 48 hrs (100 ml/kg additional fluid) is strongly associated with morbidity in critically ill children.1 Contributors include fluid resuscitation, acute kidney injury, and administration of intravenous drugs. Acute Kidney Injury has been observed to be more prevalent in infants.

ASSESSING PHARMACEUTICAL CARE NEEDS OF PAEDIATRIC IN-PATIENTS: A TEAM BASED APPROACH.

Aims: To pilot a novel approach to providing pharmaceutical care to paediatric inpatients using structured referral and assessment tools. Using standardised referral criteria to ensure patients are assessed by appropriately skilled pharmacists.

Method: Three wards of varying acuity and specialism were selected in a tertiary children's hospital in England - General Paediatric Ward (GPW), High Dependency Unit (HDU) and Haematology/Oncology Ward (HOW).

CLINICAL SUPERVISION - WHAT ABOUT THE SPECIALIST TRAINEES?

Introduction: Clinical supervision is defined by Barber and Norman as having four main functions: educational, supportive, managerial and development of self-awareness.1 It is common practice within initial pharmacy education for clinical supervision to take place at undergraduate, pre-registration and foundation level pharmacist stages. But what about the specialist trainees? It is probably a fair observation that the amount of clinical supervision provided for pharmacists undergoing their advanced level practice drops vividly.

CHANGING INFUSION PRACTICE GENERATES SIGNIFICANT EFFICIENCIES IN NURSING TIME AND RESOURCE USAGE IN PAEDIATRIC INTENSIVE CARE.

Introduction: Infusion preparation in British PICUs uses the Rule of Six (ROS) which was developed for administration without infusion devices. This method is inaccurate.1 Regulators recommend standardised approaches to IV infusions to improve patient safety and quality of care.

PROLONGED INFUSIONS OF KETAMINE AND IMPACT ON INFECTIONS AND WASTE.

Aim: Ketamine is used for post-operative analgesia. There has been recent disruption in it's supply. It is usually prescribed by patient's weight (3 mg/kg in 50 ml 0.

It is time to review how unlicensed medicines are used.

The safe and effective use of medicines is an integral part of the medicine safety agenda. We present a phenomenological topic review of the literature relating to the use of unlicensed medicines (ULM). There is evidence to demonstrate that the use of ULM is associated with increased incidence of adverse drug reactions, and that despite advances in medicine regulation and guidance from professional organisations, the use of ULM in at risk populations has not reduced.

Prospective multicentre randomised, double-blind, equivalence study comparing clonidine and midazolam as intravenous sedative agents in critically ill children: the SLEEPS (Safety profiLe, Efficacy and Equivalence in Paediatric intensive care Sedation) study.

Background: Children in paediatric intensive care units (PICUs) require analgesia and sedation but both undersedation and oversedation can be harmful.

Objective: Evaluation of intravenous (i.v.

Treatment of a critically ill child with disseminated Candida glabrata with a recombinant human antibody specific for fungal heat shock protein 90 and liposomal amphotericin B, caspofungin, and voriconazole.

Objective: To report a case of fungal sepsis treated prospectively with liposomal amphotericin, caspofungin, and a novel monoclonal antibody specific for candidal heat shock protein 90 (Mycograb, Neutec Pharma, Manchester, UK).

Design: Case report.

Setting: Pediatric intensive care unit in a tertiary care children's hospital.