Abstract
Background
Improvement in the quality of the medication management process is a crucial component of twenty-first-century medicine.
Aim
To improve the quality of medication management process within pediatric specialty through designing a quality improvement project for the pharmaceutical care services in a children’ hospital to solve the drug-related problems during drug prescribing, administration, and monitoring.
Methods
A total of 900 medical files were evaluated (100 file/month) from the pediatric medical ward to detect any medication errors during prescribing, administration, or monitoring of the drugs. Three pharmacy quality indicators were designed to detect any medication errors during prescribing, administration, or monitoring of the drugs, then a collective datasheet was designed to record any defect in the system during drug management process within the hospital. A quality improvement project was designed using many quality improvement techniques to decrease the rates of medication errors in each drug handling stage. Brainstorming, fishbone chart, questionnaire, and voting were the main quality tools used to detect the causes of medication errors problem in pediatric patients. Certain actions were implemented which included educational program, implementation of clinical pharmacy, intravenous admixture, and drug information services.
Results
The quality improvement interventions succeeded in decreasing the rates of medication errors in each stage. These interventions succeeded in decreasing the rates of medication errors in prescribing, administration, and monitoring stages from 47, 60, and 56% respectively to ≤ 15% within 9 months.
Conclusion
Pharmacists can have a key role in improving the health-care system’s quality in developing countries’ health-care systems.
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References
Hughes RG (2008) Patient safety and quality: an evidence-based handbook for nurses https://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/nurseshdbk.pdf. Accessed 17 April 2017
The ASHP Discussion Guide on the pharmacist’s role in quality improvement, American Society of Health-System Pharmacists (ASHP) http://pharma-smart.com/wp-content/uploads/2015/03/ASHP-The-Pharmacists-Role-in-Quality-Improvement.pdf. Accessed 1 April 2017
Karthikeyan M, Balasubramanian T, Khaleel MI, Sahl M, Rashifa P (2015) A systematic review on medication errors. Int J Drug Dev Res 7:009–011
Department of the Navy (1992) Fundamentals of total quality leadership: student guide. U.S. Government Printing Office http://www.dtic.mil/dtic/tr/fulltext/u2/a278327.pdf Accessed 10 April 2017
Plsek PE (1999) Section 1: evidence-based quality improvement, principle, and perspectives. Quality improvement methods in clinical medicine. Pediatrics 103:203–214
Beecroft GD, Grace LD, John WM (2003) The executive guide to improvement and change. ASQ press, Milwaukee, pp 17–19
Kozer E, Scolnik D, MacPherson A, Rauchwerger D, Koren J (2005) Using a preprinted order sheet to reduce prescription errors in a pediatric emergency department: a randomized controlled trial. Pediatrics 116:1299–1302
Myers CE (1993) ASHP guidelines for preventing medication errors. Am J Hosp Pharm 50(2):305-314
Miller M, Robinson K, Lubomski L, Rinke M, Pronovost P (2007) Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 16:116–126
Sangera N, Chan PY, Khaki ZF, Planner C, Lee KKC, Cranswick NE et al (2006) Interventions of hospital pharmacists in improving drug therapy in children. A systematic literature review. Drug Saf 29:1031–1047
Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federicoet F et al (2001) Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114–2120
Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F et al (2003) Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 111:722–729
Wang JK, Herzog NS, Kaushal R, Park C, Mochizuki C, Weingarten SR (2007) Prevention of pediatric medication errors by hospital pharmacists and the potential benefit of computerized physician order entry. Pediatrics 119:e77–e85
Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH (2004) Assessing medication prescribing errors in pediatric intensive care units. Pediatr Crit Care Med 5:124–132
Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC (2006) Systematic review of medication errors in pediatric patients. Ann Pharmacother 40:1766–1776
Franklin BD, O’Grady K, Parr J, Walton I (2006) Using the internet to deliver education on drug safety. Qual Saf Health Care 15:329–333
Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, Bates DW (1999) Pharmacists participation on physician rounds and adverse drug events in the intensive care unit. JAMA 282:267–270
King WJ, Paice N, Rangrej J, Forestell GJ, Swatrz R (2003) The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 112:506–509
Fontan JE, Maneglier V, Nguyen VX, Brion F, Loirat C (2003) Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system. Pharm World Sci 25:112–117
Rothschild JM, Lee TH, Bae T, Bates DW (2002) Clinician use of a palmtop drug reference guide. JAMIA 9:223–229
Leonard MS, Cimino M, Shaha S, McDougal S, Pilliod J, Brodsky L (2006) Risk reduction for adverse drug events through sequential implementation of patient safety initiatives in a children’s hospital. Pediatrics 118:24–29
Simpson JH, Lynch R, Grant J, Alroomi L (2004) Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 89:F480–F482
Acknowledgements
The author would like to acknowledge the pharmacy practice department and the quality department of the maternity and children’s hospital for supporting this study.
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Abuelsoud, N. Pharmacy quality improvement project to enhance the medication management process in pediatric patients. Ir J Med Sci 188, 591–600 (2019). https://doi.org/10.1007/s11845-018-1860-8
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DOI: https://doi.org/10.1007/s11845-018-1860-8