***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE . The goal was to determine whether implementation of a computerized physician order entry system was associated with a decrease in medication administration variances in a NICU . METHODS . A prospect i ve observational study was conducted . Research nurses recorded details of medication administrations for patients in a NICU during st and ardized observation periods . Details of each administration were compared with the medication order ; a variance was defined as a discrepancy between the order and the medication administration . Rates of variances before and after implementation of computerized physician order entry in the NICU were compared . Specific types of and reasons for variances were also compared . RESULTS . Data on 526 medication administrations , including 254 during the pre-computerized physician order entry period and 272 after implementation of computerized physician order entry , were collected .  Medication variances were detected for 19.8 % of administrations during the pre-computerized physician order entry period , compared with 11.6 % with computerized physician order entry ( rate ratio : 0.53 ) . Overall , administration mistakes , prescribing problems , and pharmacy problems accounted for 74 % of medication variances ; there were no statistically significant differences in rates for any of these specific reasons before versus after introduction of computerized physician order entry .  Administration of a medication at the wrong time accounted for 53.1 % of all variances . Variance rates related to giving a drug at the wrong time were significantly lower in the computerized physician order entry period than in the pre-computerized physician order entry period ( rates : 6.7 % and 9.9 % , respectively ; rate ratio : 0.53 ) . CONCLUSIONS . Implementation of computerized physician order entry in a NICU was associated with a significant decrease in the rate of medication administration variances . However , even with the use of computerized physician order entry , variances were noted for > 11 % of all medication administrations , which suggests that additional methods may be needed to improve neonatal patient safety Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable OBJECTIVE To evaluate the incidence of adverse events in Brazilian hospitals . DESIGN Retrospective cohort study based on patient record review . SETTING Three teaching hospitals in the State of Rio de Janeiro , Brazil . PARTICIPANTS R and om sample ( 1103 ) of 27 350 adult patients admitted in 2003 . Patients under 18 years old , psychiatric patients and patients whose length of stay was less than 24 hr were excluded , and obstetric cases were included . MAIN OUTCOME MEASURE(S ) Incidence of patients with adverse events ; proportion of preventable adverse events ; number of adverse events per 100 patients and incidence density of adverse events per 100 patient-days . RESULTS The incidence of patients with adverse events was 7.6 % ( 84 of 1103 patients ) . The overall proportion of preventable adverse events was 66.7 % ( 56 of 84 patients ) . The incidence density was 0.8 adverse events per 100 patient-days ( 103 of 13,563 patient-days ) . The patient 's ward was the most frequent location of adverse events ( 48.5 % ) . In regard to classification , surgical adverse events were the most frequent ones ( 35.2 % ) . CONCLUSIONS The incidence of patients with adverse events at the three hospitals was similar to that in international studies . However , the proportion of preventable adverse events was much higher in the Brazilian hospitals Abstract . Medication-related critical incidents ( CIs ) comprise harmful and potentially harmful events . The aim of CI monitoring is quality improvement through system changes . In a prospect i ve survey , we analysed our drug-related CIs of the year 2001 with an emphasis on how they contributed to system changes . A voluntary , anonymous , non-punitive CI reporting was used . The study was performed in a multidisciplinary , 23-bed , neonatal-paediatric intensive care unit ( ICU ) .  CI severity was grade d : minor ( no interventions required ) , moderate ( requiring routine therapy , available outside the ICU ) , major ( need for therapeutic interventions specific to the ICU ) . There were 284 drug-related CIs , 76 % ( 95 % confidence interval 71%–81 % ) of minor , 19 % of moderate and 5 % of major severity . A total of 24 CIs were potentially life threatening ( if not detected ) . Some 27 % of CIs were intercepted , 17 % before preparation and 10 % before administration of the drug to the patient . There was a negative correlation between median delay ( from CI to detection ) and mean severity of the different drug classes involved ( P=0.027 ) . As to the impact on quality , 46 CIs were followed by system changes and 63 % ( 95 % confidence interval 49%–77 % ) of these CIs were of minor severity . Examples of system changes are : double checking for potentially harmful drugs , st and ardised prescription form and contact to the national drug control agency regarding misleading drug labels . Conclusion : most of the system changes were based on minor critical incidents which were often detected only after a longer period of time . This shows the value of our " low-threshold " critical incident monitoring . Repeated checks along the drug delivery process ( prescription , preparation , administration ) are an important means to reduce adverse drug events The relationship between the level of illumination and the  prescription-dispensing  error rate in a high-volume Army outpatient pharmacy was investigated . The prescription error rate was determined by direct , undisguised observation and retrospective prescription review under three levels of illumination ( 45 , 102 , and 146 foot-c and les ) during 21 consecutive weekdays . Illumination was controlled in the prescription-checking area of the pharmacy by using additional fluorescent lamps and filters . The three levels of illumination were r and omly assigned to the 21 days to provide a total of 7 days of observations per level . The final sample consisted of 10,888 prescriptions dispensed by five pharmacists . The overall prescription error rate ( including both content and labeling errors ) was 3.39 % ( 369 prescriptions ) . An illumination level of 146 foot-c and les was associated with a significantly lower error rate ( 2.6 % ) than the baseline level of 45 foot-c and les ( 3.8 % ) . There was a linear relationship between each pharmacist 's error rate and that pharmacist 's corresponding daily prescription workload for all three illumination levels . The effect of the observer was minimal . The rate of prescription-dispensing errors was associated with the level of illumination . Ergonomics can affect the performance of professional tasks OBJECTIVES . Currently there are few practical methods to identify and measure harm to hospitalized children . Patients in NICUs are at high risk and warrant a detailed assessment of harm to guide patient safety efforts . The purpose of this work was to develop a NICU-focused tool for adverse event detection and to describe the incidence of adverse events in NICUs identified by this tool . METHODS . A NICU-focused trigger tool for adverse event detection was developed and tested . Fifty patients from each site with a minimum 2-day NICU stay were r and omly selected . All adverse events identified using the trigger tool were evaluated for severity , preventability , ability to mitigate , ability to identify the event earlier , and presence of associated occurrence report . Each trigger , and the entire tool , was evaluated for positive predictive value . Study chart review ers , in aggregate , identified 88.0 % of all potential triggers and 92.4 % of all potential adverse events . RESULTS . Review of 749 r and omly selected charts from 15 NICUs revealed 2218 triggers or 2.96 per patient , and 554 unique adverse events or 0.74 per patient . The positive predictive value of the trigger tool was 0.38 . Adverse event rates were higher for patients < 28 weeks ' gestation and < 1500 g birth weight . Fifty-six percent of all adverse events were deemed preventable ; 16 % could have been identified earlier , and 6 % could have been mitigated more effectively . Only 8 % of adverse events were identified in existing hospital-based occurrence reports . The most common adverse events identified were nosocomial infections , catheter infiltrates , and abnormal cranial imaging . CONCLUSIONS . Adverse event rates in the NICU setting are substantially higher than previously described . Many adverse events result ed in permanent harm and the majority were classified as preventable . Only 8 % were identified using traditional voluntary reporting methods . Our NICU-focused trigger tool appears efficient and effective at identifying adverse events Objectives : To examine the characteristics of incidents reported after introduction of a voluntary , non-punitive incident reporting system for neonatal intensive care units ( NICUs ) in the Netherl and s ; and to investigate which types of reported incident pose the highest risk to patients in the NICU . Design : Prospect i ve multicentre survey . Methods : Voluntary , non-punitive incident reporting was introduced in eight level III NICUs and one paediatric surgical ICU . An incident was defined as any unintended event which ( could have ) reduced the safety margin for the patient . Multidisciplinary , unit-based patient safety committees systematic ally collected and analysed incident reports , and assigned risk scores to each reported incident . Data were central ly collected for specialty-based analysis . This paper describes the characteristics of incidents reported during the first year . Bivariate logistic regression analysis was conducted to identify high-risk incident categories . Results : There were 5225 incident reports on 3859 admissions , of which 4846 were eligible for analysis .  Incidents with medication were most frequently reported ( 27 % ) , followed by laboratory ( 10 % ) and enteral nutrition ( 8 % ) . Severe harm was described in seven incident reports , and moderate harm in 63 incident reports . Incidents involving mechanical ventilation and blood products were most likely to be assigned high-risk scores , followed by those involving parenteral nutrition , intravascular lines and medication dosing errors . Conclusions : Incidents occur much more frequently in Dutch NICUs than has been previously observed , and their impact on patient morbidity is considerable . Reported incidents concerning mechanical ventilation , blood products , intravascular lines , parenteral nutrition and medication dosing errors pose the highest risk to patients in the NICU Objectives To systematic ally investigate the causes and severity of incidents with mechanical ventilation and intravascular catheters in neonatal intensive care units ( NICUs ) in the Netherl and s , in order to develop effective strategies to prevent such incidents in the future . Design Prospect i ve multicentre survey . Methods Inclusion criteria were : incidents with mechanical ventilation and intravascular catheters reported to a voluntary , non-punitive , incident-reporting system which had been systematic ally analysed using the Prevention Recovery Information System for Monitoring and Analysis ( PRISMA ) -Medical method . The type , severity and causes of incidents reported from 1 July 2005 to 31 March 2007 are described . Local interventions performed as a result of systematic analysis of incidents are also described . Results 533 of 1306 ( 41 % ) reported incidents with mechanical ventilation and intravascular catheters ( n=339/856 and n=194/450 , respectively ) had been PRISMA analysed and were included in the study . Four incidents result ed in severe harm , 18 in moderate harm and 222 in minor harm . Tube-related incidents accounted for the greatest proportion of harm . 1233 root causes were identified , with most being classified as human error ( 55 % ) . Of the remaining failures , 20 % were organisational , 16 % technical , 6 % patient-related and 4 % unclassifiable . The majority of failures were rule-based errors . Conclusion Incidents with mechanical ventilation and intravascular catheters 
    Output:
    
This study reveals that the types of incidents that occur in NICUs , with or without injury to the patient , are related to errors or failures in medication use , healthcare-associated infections ( HAIs ) , skin injuries , mechanical ventilation and intravascular catheters .
The cause of incidents and adverse events in NICUs are associated with human factors and the outcomes that are most damaging are due to HAIs .