Abstract
Background In 2022, An EPR system was rolled out across a multi-site NHS trust including a level three and two level two neonatal units. This created a need to provide clear and accessible prescribing and administration information for all neonatal medicines to reduce the risk of error from incorrect doses, formulations, or concentrations.
Aim To establish a neonatal formulary that could be used as a reliable reference source for safe and timely prescribing and administration of all neonatal medication.
Method A neonatal formulary multidisciplinary group was established consisting of neonatal consultants, neonatal matrons and pharmacists with representation from each hospital site. A standardised drug monograph template was created, and a suitable platform was selected to hold the neonatal formulary. Established practice was reviewed and harmonised across three hospital sites and aligned to include standard paediatric concentrations.1 A monograph was written for each medication routinely used on the neonatal units. Each monograph was discussed and ratified at the neonatal multidisciplinary group. Necessary amendments were made before final validation and publishing on the formulary.
Results A neonatal formulary consisting of 170 different monographs was published. This is accessible via a mobile phone app, the internet, the hospital intranet, or at the point of prescribing or administration from the electronic patient record. A 3-month snapshot audit of medication incidents from 2021 and 2022 after implementation of the formulary demonstrated an overall 4% reduction in reported medication incidents. 10% reduction in prescribing incidents and 5% increase in administration incidents.
Conclusion The neonatal formulary multidisciplinary group is ongoing with several new monographs currently awaiting review. While the audit provides a snapshot of the reported medication incidents over the selected 3-month period from 2021 and 2022. A significant amount of change to practice occurred on the unit due to the implementation of neonatal standard concentrations and EPR at the same time. Future work includes seeking feedback from users of the neonatal formulary across each hospital site to optimise the monographs further and to continually promote and educate new staff on the neonatal unit to the formulary.
Reference
Neonatal and Paediatric Pharmacist Group: Standardising intravenous infusion concentrations for neonates and children in the UK, A proposal for a national approach [February 2023] https://www.rcpch.ac.uk/sites/default/files/2023-12/standard_infusions_feb_2023.pdf
