Drug Handling in a Paediatric Intensive Care Unit - Can Errors be Prevented by a Three-Step Intervention?

Background: Drug handling in paediatric intensive care units (PICU) is prone to medication errors. We aimed to identify type and prevalence of those errors and to assess preventative interventions. Methods: Prospective intervention study investigating a 3-step intervention for preventing errors in drug handling in a 10-bed PICU of a university hospital. Nurses' drug handling was mon-itored in daily routine to identify the number of patients affected by errors and overall prevalence and types of errors in drug handling. We implemented a comprehensive intervention consisting of an information handout, a training course, and a 76-page reference book tailored to reduce the prevalence. Results: The prevalence of errors in drug han-dling decreased from 83% (555 errors/668 pro-cesses) to 63% (554/883; p < 0.001) after the intervention. The number of affected patients remained unchanged (95% vs. 89%, p=0.370). Peroral (PO) drugs (1.33 errors/process) were more error-prone than intravenous (IV) drugs (0.64), despite being used less frequently (27% vs. 73% of all processes, p < 0.001). The interventions decreased the prevalence to 0.77 errors/process (p < 0.001) in PO and to 0.52 in IV drugs (p=0.025). Conclusion: Errors in drug handling were alarmingly frequent. PO drugs were frequently subject to errors, even though being used less frequently. The implementation of a comprehensive intervention succeeded in reducing the prevalence of errors. Yet further refinements are necessary to decrease also the number of affected patients.