Utilization of neonatal medication error prevention strategies: a clinical practice survey of Australian and New Zealand neonatal units.

BACKGROUND: Medication errors are common in neonatal care and can lead to significant harm. We sought to explore utilization of various medication error prevention strategies across Australian and New Zealand neonatal units (NNUs) through a clinical practice survey. METHODS: An electronic survey was distributed in October 2016 to relevant staff at each of the 29 level III NNUs identified as members of the Australian and New Zealand Neonatal Network (ANZNN). The survey contained questions relating to a range of medication error prevention strategies identified from a previous systematic review on the topic. The evaluated interventions targeted different aspects of the medication-use process including prescribing, evaluation/checking of orders by clinical pharmacists, transmission, preparation and dispensing of orders, storage of medications, and medication administration. RESULTS: From the 20 respondents, the evidence-based strategies most commonly utilized were use of smart pumps (n = 18; 90%), and ward-based clinical pharmacists (n = 17; 85%). Interventions least commonly utilized included barcode scanning with medication administration (n = 0; 0%), electronic prescribing and clinical decision support (n = 1; 5%), and dedicated medication administration nurse (n = 2; 10%). The total number of evidence-based medication error prevention strategies utilized in each NNU ranged from 2 to 10 (median = 7), 10 of 16 strategies were utilized by less than 50% of NNUs. CONCLUSION: While evidence supports utilization of a number of medication error prevention strategies, these appear inconsistently utilized across current practice settings.

Differential expression of focimatrix and steroidogenic enzymes before size deviation during waves of follicular development in bovine ovarian follicles.

During the growth of bovine follicles, one emerges from a wave as the largest and dominant follicle. What regulates dominance is not known but candidates include oestradiol, transforming growth factor beta beta1 (TGFB1), and recently CYP11AI (cholesterol side-chain cleavage) and focal intra-epithelial matrix (focimatrix). To examine this, pairs of bovine ovaries with 2 or more follicles of equal size (>5mm) and hence in a wave before deviation, were collected at an abattoir (6.7+/-SEM 0.1mm diameter; n=14 animals, 35 follicles in total). These follicles were dissected and follicular fluid collected to measure progesterone and oestradiol concentrations. A portion of the follicle wall was processed for histological classification of health or atresia and granulosa cells were harvested for quantitative RT-PCR of focimatrix components [COL4A1 (collagen type IV alpha1), LAMB2 (laminin beta2) and HSPG2 (perlecan)], steroidogenic enzymes [CYP11A1 and CYP19A1] and TGFB1. For statistical analyses follicles within each animal were grouped into either the highest (oestradiol, CYP11A1) or lowest (TGFB1) expression (n=14) for comparison with the remaining follicles (n=21). When grouped on oestradiol no other parameters differed significantly, and when grouped on TGFB1 some parameters were different however the levels were also lower, and not higher as expected. When grouped on CYP11A1 other parameters were significantly elevated in the high CYP11A1 group (COL4A1P<0.05; LAMB2P<0.01; HSPG2P<0.01 and CYP19A1P<0.001). This suggests that steroidogenesis and focimatrix might be important in a follicle attaining dominance.