Nurse-Led Quality Improvement Initiative to Reduce Medication Errors in Pediatric ICU.

Abstract

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.