A Prospective Observational Study of Factors Influencing Medication Error in Nicu

Medication errors are a significant challenge in Neonatal Intensive Care Units (NICUs) because neonates are highly vulnerable due to physiological immaturity, rapid changes in body weight, and the need for precise weight-based drug dosing. This prospective observational study was conducted in India from August 2025 to February 2026 to evaluate the factors influencing medication errors in the NICU and to identify their incidence and types. A total of 150 prescriptions were analyzed, among which 55 medication errors were identified, resulting in an overall error rate of 36.7%. Prescribing errors were the most frequently reported errors, accounting for 50.9% of all medication errors, followed by medication preparation errors (27.3%), dispensing errors (16.4%), and administration errors (5.5%). Within prescribing errors, wrong dose calculation was the most common type, while incorrect dilution was the leading medication preparation error. The study identified several factors contributing to medication errors, including complex dose calculations, polypharmacy, prolonged hospital stay, unclear prescriptions, inadequate communication among healthcare professionals, heavy workload, staff fatigue, and lack of technological support systems. Multivariate analysis demonstrated that prolonged hospital stay (>7 days) and polypharmacy (>5 drugs per prescription) were significant predictors of medication errors. The findings emphasize that medication errors remain highly prevalent in NICUs and highlight the importance of strengthening clinical pharmacy services, improving staff training, promoting effective communication, and implementing standardized medication safety protocols. A multidisciplinary and system-focused approach is essential to reduce medication errors and improve neonatal patient outcomes.