Towards Reducing Antimicrobial Injection Preparation Errors in a Paediatric Ward, Penang Hospital
Antimicrobial injections are intended for the prevention and treatment of infections caused by microorganisms. Proper reconstitution and storage post reconstitution are crucial in maintaining the viability of multi-dose vials. Multi-dose vials are cost-effective and able to reduce medication wastage, especially in paediatrics dosage application that is according to their weight. However, incorrect reconstitution and multiple uses of single-use injections could potentially cause ineffective treatment, leading to antimicrobial resistance, thus making proper handling of these injections more essential. This study aimed to reduce antimicrobial injection preparation errors. A quality improvement project was carried out from September 2017 until May 2019 in a paediatric ward. Data on medication supply (by the pharmacy) and preparation processes (by ward) were collected. Questionnaires were distributed to assess the knowledge of persons involved in product stability. About 86.3% of all antimicrobial injection preparations contained at least one error. The contributing factors leading to the preparation errors were incomplete labelling (76.1%) as well as poor knowledge of injection stability among nurses (39.5%) and pharmacy staff (43.5%). Training and pocket guidelines were given as a reference for antimicrobial stability. Furthermore, flashcards were placed on the medication preparation trolleys to guide the reconstitution process. A reminder list on storage conditions was sticked on refrigerators in the ward. Mnemonic method and Antimicrobial Dilution Protocol (Paediatrics) were developed during the second cycle. From September 2017 to May 2019, antimicrobial injection preparation errors were successfully reduced from 86.3% (n=117) to 16.4% (n=122).