This study analyzed risk factors for medication/near-miss errors in the neonatal intensive care unit by using Grey Relational Analysis based on self-incident reports from staff nurses. The ASSESS-ERR Medication System Worksheet was used. A total of 156 medication/near-miss errors were found across 5 stages of the medication use process. The order prescribing stage had the most errors. The highest systemic risk factors were critical drug information missing; environmental, staffing, and workflow problems; and lack of staff education.
School of Nursing, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China (Drs Zhang and Liu, and Ms Chen); School of Nursing, University of Texas at Tyler (Dr Lee); and WHO Collaborating Centre for Nursing Policy-Making and Quality Management, Beijing, China (Dr Liu).
Correspondence: Huaping Liu, PhD, RN, FAAN, School of Nursing, DonDan 3 Tiao, No. 9, PUMC, Beijing 100730, China (huapingliu@vip.126.com).
The authors acknowledge Professor Dong Du, School of Business, Hehai University, for his assistance in developing the statistical analysis strategy.
The authors declare no conflict of interest.
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Accepted for publication: August 13, 2016.
Published ahead of print: November 8, 2016
