Medical error in neonatal units: an Italian survey on national frequency and types of error

Background Neonatal Units (NUs) are high-risk environments for medication errors (MEs), mainly due to complex weight/gestational age-based dosing and frequent off-label drug use. Although the incidence of serious harm is low, medication errors remain a major safety concern. The aim of this study was to have a snapshot of MEs errors within Italian NUs. Methods The Neonatal Pharmacotherapy Study Group and the Risk Management and Simulation Study Group of the Italian Society of Neonatology (SIN) conducted a national cross-sectional web-based survey between 2022 and 2023. Responding NUs were stratified into two groups: those reporting fewer than five MEs per year (< 5 MEs/y )and those with five or more (≥ 5 MEs/y). Descriptive and inferential statistics were applied. Results Prescription (33%) and drug preparation (29%) were the most frequently reported error types. The use of digital prescribing tools was higher in centers reporting fewer errors. Double-checking procedures limited to high-alert drugs was associated with higher error rates. 80% of NUs did not have a structured annual error report, and 55% failed to re-evaluate or implement corrective actions after identifying errors. Only 21% of NUs systematically informed families of therapeutic errors; as reasons for non-disclosure many centers citing the absence of harm or fear of legal/professional consequences. Conclusions While some centers adopt proactive safety strategies, others use incomplete protocols or outdated tools. The lack of systematic error reporting underscores the need for a cultural shift toward a constant analysis of this problem and a more continuous surveillance and evaluation of implemented safety strategies. A unified, anonymous digital reporting system could support error monitoring and targeted interventions at the local and national levels.