Effectiveness of a Barcode Medication Administration System in Reducing Preventable Adverse Drug Events in a Neonatal Intensive Care Unit: A Prospective Cohort Study
Received 22 April 2008; received in revised form 29 July 2008; accepted 13 August 2008. published online 29 September 2008.
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.
Study design
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 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.
Conclusion
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.
Reprint requests: Frank H. Morriss, Jr., MD, MPH, Department of Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242
Funded by grants from the American Society of Health-System Pharmacists Research and Education Foundation and the University of Iowa Pharmaceutical Enterprise. The American Society of Health-System Pharmacists Research and Education Foundation had no role in study design, collection, analysis or interpretation of the data, the writing of the report, nor the decision to submit the manuscript for publication. Paul Abramowitz is currently an officer of the American Society of Health-System Pharmacists Research and Education Foundation. The other authors have no actual or perceived conflicts of interest.
ABSTRACT