Skip to main content
Neonatology and Intensive Care
Displaying 11 - 20 of 270
Life-Threatening Infant Overdose of Sodium Chloride
Michelle Hamline, MD, PhD, MAS, Georgia McGlynn, RN, MSN-CNL, CPHQ, Andrew Lee, PharmD, and JoAnne Natale, MD, PhD ,  
After undergoing a complete atrioventricular canal defect repair, an infant with trisomy 21 was transferred to the pediatric intensive care unit (PICU) and total parenteral nutrition (TPN) was ordered due to low cardiac output. When the TPN order expired, it was not reordered in time for cross-checking by the dietician and pediatric pharmacist and the replacement TPN order was mistakenly entered to include sodium chloride 77 mEq/100 mL, a ten-fold higher concentration than intended. The commentary explores the safety issues with ordering TPN and custom intravenous fluids in a pediatric population, and the critical role of clinical decision support systems and the healthcare team (physicians, pharmacists, nurses and dieticians) in preventing medication-related errors.


Formerly known as the Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the University of Arkansas for Medical Sciences (UAMS) High-Risk Pregnancy Program links clinicians and patients across the state with UAMS, where the vast majority of the state's high-risk pregnancy services, maternal-fetal medicine specialists, and prenatal genetic counselors are located. The program facilitates real-time telehealth consultation for patients, local physicians, and medical center specialists through a statewide telemedicine network; develops and disseminates guidelines to foster the use of best practices by obstetric providers across the state; and facilitates appropriate referrals to the medical center for tertiary care through a 24/7 patient/provider call center. The program has enhanced access to specialty perinatal care, including maternal-fetal medicine consultations and tertiary level obstetric care, which, in turn, has reduced complications, generated cost savings to the state Medicaid program, and led to high levels of patient satisfaction. The High-Risk Pregnancy Program has reduced Arkansas' 60-day infant mortality rate by 0.5 percent due to increasing the proportion of low-birthweight infants delivered at the medical center.

See the Description section for information about number of guidelines and new services; the References section for one new source of information; the Results section for updated information about consultations, guidelines, and website activity; and the Resources section for updated staffing information.

Innovation Patient Safety Focus

Increasing access to specialized obstetric services for patients in rural communities via telehealth reduced patient safety events associated with high-risk pregnancies.

Evidence Rating

Moderate: The evidence consists of before-and-after comparisons of key outcomes, including access to consultation and tertiary services, along with post-implementation satisfaction rates and cost savings estimates.

Resources Used and Skills Needed

  • Staffing: Total staffing for the program is approximately 120 paid personnel, including five maternal–fetal medicine physicians; one maternal–fetal medicine fellow; advanced practice nurses; call center RNs; and other physicians, nurses, nurse practitioners, technologists, and support personnel. The program adds to its staffing needs by paying a percentage of specialists' salaries so that they may contribute to care as needed.
  • Training: Participation in the program required staff training and familiarity with the software and other technology that allowed for remote consultation with patients. This may have also included guidance regarding patient engagement and interaction via electronic platforms.
  • Costs: Data on program costs are unavailable. Renewing annually, the program contract dedicates the majority of funding toward the telemedicine infrastructure, equipment, and personnel required to deliver this service to rural Arkansas.

Use By Other Organizations

The High Risk Pregnancy Program has been replicated by organizations in Tennessee and Louisiana.

Developing Organizations

Date First Implemented

Web Resource
Government Resource
Better Safer Care Victoria.
Safer Care Victoria and Victorian Agency for Health Information. Better Safer Care Victoria.
Subscribe to Neonatology and Intensive Care