title: Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 log(10)doses 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA. frankmorriss@uiowa.edu
authors.forename: Frank H
authors.initials: FH
authors.lastname: Morriss
authors.forename: Paul W
authors.initials: PW
authors.lastname: Abramowitz
authors.forename: Steven P
authors.initials: SP
authors.lastname: Nelson
authors.forename: Gary
authors.initials: G
authors.lastname: Milavetz
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Michael
authors.forename: Sara N
authors.initials: SN
authors.lastname: Gordon
authors.forename: Jane F
authors.initials: JF
authors.lastname: Pendergast
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control*; D001330:Electronic Data Processing / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D012308:Risk Management / Q000379:methods / Q000458:organization & administration