Quality use of medicines in neonatal care: a review of measures of quality used to evaluate the appropriateness and rational use of medication within the NICU

With medication error rates in neonatal intensive care units (NICUs) reported to be as high as 91 medication errors per 100 patient admissions, the quality use of medicines (QUM) in this setting is important. Comprising the safe, rational, appropriate and effective use of pharmacotherapy, QUM is integral to achieving medication safety and optimal patient outcomes. To improve QUM in the NICU, the medication use process needs to undergo a quality assessment, using quality measures or indicators. As such, the objectives of this quasi-systematic literature review were to identify the measures used to evaluate QUM within the NICU and to map these against Donabedian’s traditional framework of structure, process and outcome. We searched EMBASE, PubMed, CINAHL, Google Scholar and Google for relevant published and grey literature. Overall, a total of 47 quality measures were identified and categorised: 17 structure, 19 process and 11 outcome measures. The most common measures related to the availability of medication safety technology in the NICU, written policies on the use of high-risk medications, medication error and adverse drug event reporting systems, and the provision of education for health professionals involved in the medication use process. However, there were no quality measures specifically designed for medication management in the NICU. The literature does not provide a comprehensive evaluation of the quality of care provided along the medication use process in the NICU. There is a need to develop a quality framework outlining measures that facilitate the appropriate use of medicines in the NICU. © 2016, Springer International Publishing Switzerland.