Every NICU faces challenges. It just comes with the territory. After doing some research I feel like the following three challenges are pretty universal. Can anyone tell me how important these three issues are in your NICU? What solutions has your unit found to address them?

Medication Errors

Infection Control

Tubing Misconnections

Thanks!

I would top-rank medication errors and infection control as major challenges in our daily practise.

As the third most important issue - nutrition (enterally & parenterally). I have a strong feeling (supported by prelim data from a well-designed study ) that malnutrition is a big problem for our preterm babies on the ward.

infection control 1 and 2 and 3 then malnutrition medication error came late because of triple chick by doctor ,nurse ,and pharmacist

infection control comes first, then tubal misconnection and medications errors are now rare in our unit because on double check.

I believe neonatal infection is always a huge issue in any neonatal intensive care unit because of the morbidity and mortality caused by it. Neonatal intensive care units want and hope to bring their neonatal infection rates down. So, infection control always comes first. there are other incident which might happen in NICUs and wouldn't be categorized under medication errors. Example is mixing up babies EBM. Its a major issue when it happens. I think medication error and tube misconnection should all come under incidents.Each incident should be addressed as a morbidity and should be brought up anonymously and discussed putting in mind the degree of harm that might have happened to the patient.furthermore, immediate disclosure to parents should be instituted .Ways to reduce the rates of these incidents should be implemented and feed back given so it will not happen again.

In my opinion , its two issue; How to prevent and reduce infection rates in neonatal intensive care units and how to reduce various incidents and their morbidity/mortality related events through a way of risk assessment.

Omer Hamud

Toronto.

Edited August 1, 201014 yr by Omer

All great feedback. Thank you!

I would top-rank medication errors and infection control as major challenges in our daily practise.

As the third most important issue - nutrition (enterally & parenterally). I have a strong feeling (supported by prelim data from a well-designed study ) that malnutrition is a big problem for our preterm babies on the ward.

The major problems in our NICU are control of infection, but I agree with Stefan about another problem- nutrition. In my opinion it is a big problem particular in hospital without the milk bank. Snjezana

I agree with medication errors and infection control but have no experience of tubing misconnections occuring in practice. I am currently searching for strategies adopted by NICUs to minimise drug errors for my next assignment. Would be grateful to hear if anyone has ideas about why drug errors are more common in NICU and how you think we can change this?

jriley - Med errors occur because we need to dilute meds & the draw the correct doses for neonates. There are few unit doses avail for this population because we are such a small part of the market. We have a standardized procedure for diluting meds listed on sheets in the unit. Double checks are always encouraged, but if a med is not on a standard procedure we absolutely perform a double check. We have minimal med errors. We rely on Pharmacy when we can, but sometimes we need to move faster. The traditional 5 Rs should be observed & I think we have gotten away from that. We do ourselves a disservice when we are multitasking or over-lulled into a routine when we are preparing meds. The Heparin errors were caused by not looking at the vial label closely. Do you have the ability to scan med labels? Scanning does verify that the correct med was taken from the storage system, but does not help with diluting at the bedside. Smart pumps? They are only as helpful as the info programed into them.