Analytical Study of the Burden of Preventable Medication Errors in Neonatal Intensive Care Units at Teaching Hospitals in South South Nigeria

Neonates represent one of the most vulnerable populations to medication errors due to their narrow therapeutic windows, weight-based dosing requirements, and limited capacity to express adverse effects. The burden of preventable medication errors in Nigerian neonatal intensive care units is poorly quantified. This analytical study assessed the prevalence, types, and preventability of medication errors in neonatal intensive care units at teaching hospitals in South South Nigeria, covering sites in Rivers, Edo, and Delta States. A prospective, multi-site observational study was conducted over four months. Research pharmacists reviewed all medication orders, administration records, and patient charts daily. Errors were classified using the National Coordinating Council for Medication Error Reporting and Prevention taxonomy, and preventability was assessed using standard criteria. A total of 3,240 medication orders were reviewed, of which 11.6 percent contained at least one error. Dosing errors were most common at 48 percent, followed by route errors at 19 percent and drug selection errors at 16 percent. Antibiotics and electrolytes were the most frequently implicated drug classes. Preventable errors occurred in 78 percent of cases, with absent or inadequate pharmacist prescription review identified as a key contributing factor. Pharmacist review presence reduced error rates by 64 percent in units where it was available. These findings provide an evidence base for mandatory clinical pharmacist integration into neonatal intensive care unit teams in South South Nigeria. Keywords: medication errors, neonatal intensive care, preventable errors, South South Nigeria, clinical pharmacy