Effectiveness of a Barcode Medication Administration System in Reducing Preventable Adverse Drug Events in a Neonatal Intensive Care Unit: A Prospective Cohort Study

• Published in: The Journal of pediatrics Vol. 154; no. 3; pp. 363 - 368.e1
• Main Authors: Morriss, Frank H., Abramowitz, Paul W., Nelson, Steven P., Milavetz, Gary, Michael, Stacy L., Gordon, Sara N., Pendergast, Jane F., Cook, E. Francis
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.03.2009; Elsevier
• Subjects: Automatic Data Processing - methods; Automatic Data Processing - organization & administration; Biological and medical sciences; Drug-Related Side Effects and Adverse Reactions - etiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; General aspects; Humans; Infant, Newborn; Intensive Care Units, Neonatal - organization & administration; Medical sciences; Medication Errors - adverse effects; Medication Errors - prevention & control; Medication Systems, Hospital; Miscellaneous; Outcome Assessment (Health Care); Pediatrics; Prevention and actions; Program Evaluation; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Management - methods; Risk Management - organization & administration; SD; ADE; GEE; UIHC; NICU; BCMA; CPOE; MAR; Barcode medication administration; Generalized estimating equation; Computer prescriber order entry; Medication administration record; Neonatal intensive care unit; University of Iowa Hospitals and Clinics; Standard deviation; Adverse drug event; Drug; Pediatrics; Intensive care; Toxicity; Neonatology; Pharmacovigilance; System; Intensive care unit; Prevention; Chemotherapy; Treatment; Efficiency; Follow up study; Cohort study; Secondary effect; Public health
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2008.08.025

Patients are at risk of harm from medication errors. Barcode medication administration (BCMA) systems are recommended to mitigate preventable adverse drug events (ADEs). Our hypothesis was that a BCMA system would reduce preventable ADEs by 45% in a neonatal intensive care unit. We conducted a prospective, observational, cohort study of a BCMA system intervention in a neonatal intensive care unit. Participants were admitted neonates during 50 weeks. Medication errors and potential or preventable ADEs were detected by a daily structured audit of each subject's medical record, with assignment of an event as a preventable ADE made by blinded assessors. The generalized estimating equation method was used in modeling the targeted, preventable ADE rate with covariates. A total of 92 398 medication doses were administered to 958 subjects. The generalized estimating equation method yielded a relative risk of preventable ADE when the system was implemented of 0.53 (95% confidence limits 0.29 to 0.91, P = .04), adjusted for log10doses of medication/subject/day, a significant predictive covariate (P < .001), as well as for birth weight, sex, Caucasian race, birth cohort number, and nursing hours/subject/day. The BCMA system reduced the risk of targeted, preventable ADEs by 47%, controlling for the number of medication doses/subject/day, an important risk exposure.