Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study

J Pediatr. 2009 Mar;154(3):363-8, 368.e1. doi: 10.1016/j.jpeds.2008.08.025. Epub 2008 Sep 27.


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 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.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Drug-Related Side Effects and Adverse Reactions / etiology
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Electronic Data Processing / methods
  • Electronic Data Processing / organization & administration*
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal / organization & administration*
  • Medication Errors / adverse effects
  • Medication Errors / prevention & control*
  • Medication Systems, Hospital*
  • Outcome Assessment, Health Care
  • Program Evaluation
  • Prospective Studies
  • Risk Management / methods
  • Risk Management / organization & administration