Table 4.
Selected new activities to address high-risk failure modes affecting the five paediatric drug-delivery processes
| Process phase | New activities of improvement plans | Unit |
|---|---|---|
| Supplying | Change the collection point for Kanban card* | General Ped |
| Supplying | Check consistency and sign delivery note. Preprinted label to identified patient with barcode. New form for re-ordering galenic drugs | General Ped |
| Prescription | Quiet place for preparing prescriptions without distraction. Single formulary. Prescription of active ingredient, in mg. Tables for standard doses and dilutions. Healthcare worker involved to get daily weight of patients | NICU, PICU, PED.Acute Care, Onco-haematology |
| Prescription | Doctors doublecheck and double-sign | NICU, PICU, PED.Acute Care, Onco-haematology, General Ped |
| Prescription | Clearly understandable written prescription. Preventive written prescription necessary or written prescription by doctor on duty | PICU, PED. Acute Care, Onco-haematology |
| Prescription | Daily discussion of clinical situation and ongoing therapy between resident and attending physicians. Daily notes by attending physician | NICU |
| Prescription | Yellow Post-it on therapy folder. Nurse signs | NICU, PICU |
| Prescription | Green label for chemotherapy. Nurse doublechecks and doublesigns for preparation; and nurse signs for drug administration | Onco-haematology |
| Prescription | List of medication available prior to patient's transfer. (medication reconciliation) | Onco-haematology |
| Preparation | Write clearly and comprehensibly. Nurse doublechecks and doublesigns. Easy-to-read therapy form. Pre-printed label with barcode | PED. Acute Care, General Ped, Onco-haematology |
| Preparation | Pre-printed label briefly reports the essential notes for correct dilution, compatibility, rate of administration and the sign of the nurse who prepared the medication | NICU, PED. Acute Care |
| Preparation | Facsimile of the proportions required on hand in the room | NICU |
| Preparation | All diluted drugs are discarded once used | NICU, PICU |
| Administering | Written instructions for parents involved in drug administration | General Ped |
| Monitoring | Check vital signs and site of infusion for certain drugs | PED. Acute Care |
*The Kanban card is a message that alerts to the depletion of product stocks and triggers their replenishment.
General Ped, general paediatric ward; NICU, neonatal intensive care unit; PICU, paediatric intensive care unit.