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Clinical audit of the high risk medications use in pediatric and neonatal intensive care units - Pre and post intervention

Anjali Goyal, Nazima Mirza, Rhythm, Monica Gupta, Bharat Gajjar.


Background: Clinical audit is “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criterion and the implementation of change.” Prescribing of high-risk medications (HRMs) in pediatrics age group can pose a unique set of risk of medication errors, because of the need for individual dosage calculations.

Aim and Objective: The aim of the study was to evaluate the compliance to institutional guidelines while prescribing HRMs in the Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU).

Materials and Methods: This was a record based retrospective observational study carried out in the NICU and PICU of Shree Krishna Hospital, Karamsad. The standard was evaluated against the four criteria mentioned in the institutional guidelines for the use of HRMs. These criteria were whether HRMs were (1) highlighted with red color in prescription, (2) prescribed in adequate dose, (3) verified by two nurses or doctors before administration, and (4) monitored after administration to the patient.

Results: A total of 36 and 37 case files were audited during the first and follow-up audit, respectively. The targets of 100% were achieved for criterion 2, 3 and 4 in the first audit as well as follow-up audit. The target of criterion 1 improved from 0% in the first audit to 46.66% in a follow-up audit.

Conclusion: Regular follow-up audits of HRM use are required to prevent medication errors and adverse drug reactions.

Key words: Clinical Audit; High-risk Medications; Medication errors

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