Assumed but unverified: Healthcare professionals' experiences of medication delivery reliability in neonatal care – A qualitative focus group study

Background Accurate medication delivery is fundamental to safe neonatal infusion therapy, yet clinicians rarely have direct confirmation that medications are delivered as intended. Consequently, infusion monitoring relies on indirect indicators such as pump-alarms and patient condition, creating uncertainty in routine neonatal practice. Aim To explore the experiences and perceptions of neonatal nurses and related healthcare professionals regarding infusion monitoring and medication delivery reliability in neonatal care. Methods An exploratory qualitative focus group study was conducted using a single focus group involving six Dutch neonatal healthcare professionals experienced in infusion therapy. Data were collected using a semi-structured topic guide and analysed using reflexive thematic analysis. Results Four interrelated themes described how medication delivery was largely assumed rather than verified in routine neonatal care: (1) reactive monitoring as the dominant system pattern, (2) knowledge limitations and educational gaps in infusion practice, (3) organisational and system-level constraints, and (4) consequences for patients and healthcare professionals. Participants described relying on indirect indicators such as pump alarms, visual inspection, and changes in the infant's clinical condition to judge whether therapy was being delivered as intended. Educational and organisational factors, together with limited visibility of medication delivery, reinforced reactive monitoring, contributing to clinical uncertainty, increased workload, and concerns regarding patient safety. Conclusion Neonatal infusion monitoring operates within systems where medication delivery is largely assumed rather than directly verified. Reactive monitoring represents an adaptive response to limited system visibility rather than a deficiency in clinical practice. Improving infusion safety requires a coordinated systems approach that combines education, organisational improvement, and appropriately evaluated technologies that enhance the visibility of medication delivery, supporting a transition from reactive to proactive monitoring.