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 Vol. 9 No. 1, January 2008
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NeoReviews Vol.9 No.1 2008 e8
© 2008 American Academy of Pediatrics

Adverse Medical Events in the NICU

Epidemiology and Prevention

Frank H. Morriss, Jr, MD, MPH*

* Professor of Pediatrics, Division of Neonatology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa and University of Iowa Children's Hospital, Iowa City, Ia

Adverse medical events and adverse drug events are not uncommon in NICUs, and research has been directed at determining the causes of such events as well as potential methods of reducing their occurrence. Both human fallibility and the complex adaptive system that comprises the NICU present opportunities for errors. Human factors engineering and systems can improve reliability, as can computer systems for ordering, dispensing, administering, and monitoring drugs. Barcode scanning medication dispensing and administration systems and smart pumps also have been investigated. Human factors that have contributed to errors include fatigue, communication failure, poor handoffs, problems with cross-coverage, workload, and staffing patterns. Addressing these factors can aid in reducing medical errors.

Abbreviations: AAP: American Academy of Pediatrics • ADE: adverse drug event • AE: adverse (medical) event • AHRQ: Agency for Healthcare Research and Quality • BSMA: barcode-scanning medication administration • CI: confidence interval • CPOE: computer provider/physician/prescriber order entry • eMAR: electronic medication administration record • ICU: intensive care unit • IT: information technology • ME: medication error • NICU: neonatal intensive care unit • OR: odds ratio • PDSA: Plan-Do-Study-Act • PICU: pediatric intensive care unit • RR: relative risk • VA: Veterans Affairs • VLBW: very low birthweight • VON: Vermont Oxford Network






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