Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands.

Background Medication errors occur frequently in intensive care units (ICU). Voluntarily reported medication errors form an easily available source of information. Objective This study aimed to characterize prescribing, monitoring and medication transfer errors that were voluntarily reported in the ICU, in order to reveal medication safety issues. Setting This retrospective data analysis study included reports of medication errors from eleven Dutch ICU's from January 2016 to December 2017. Method We used data extractions from the incident reporting systems of the participating ICU's. The reports were transferred into one database and categorized into type of error, cause, medication (groups), and patient harm. Descriptive statistics were used to calculate the proportion of medication errors and the distribution of subcategories. Based on the analysis, ICU medication safety issues were revealed. Main outcome measure The main outcome measure was the proportion of prescribing, monitoring and medication transfer error reports. Results Prescribing errors were reported most frequently (n = 233, 33%), followed by medication transfer errors (n = 85, 12%) and monitoring errors (n = 27, 4%). Other findings were: medication transfer errors frequently caused serious harm, especially the omission of home medication involving the central nervous system and proton pump inhibitors; omissions and dosing errors occurred most frequently; protocol problems caused a quarter of the medication errors; and medications needing blood level monitoring (e.g. tacrolimus, vancomycin, heparin and insulin) were frequently involved. Conclusion This analysis of voluntarily reported prescribing, monitoring and medication transfer errors warrants several improvement measures in these processes, which may help to increase medication safety in the ICU.

Analysis of methadone and its primary metabolite in meconium.

Methods for analysis of methadone and its principal metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in meconium, based on fluorescence polarization immunoassay (FPIA) and high-performance liquid chromatography (HPLC) and diode array detection were developed. Meconium and urine samples of 16 neonates from 15 methadone-using mothers were analyzed. Because of the lower detection limit and the possibility of coanalyzing EDDP, meconium analysis with HPLC for detecting methadone use is very much preferable to FPIA. Identical results were obtained with HPLC analysis for both matrices: methadone or EDDP or both could be detected in the urine and meconium samples from 15 children. The amount of EDDP in meconium was much higher than the amount of methadone (ratio, 9.6). EDDP only was detected in eight of the meconium samples. A positive correlation was found between the methadone dose of the mothers and the methadone concentration in meconium, but not with the EDDP concentration in meconium.