| Folli50 USA 1987 | Errant medication order: ordering physician and pharmacist agreed on the need to change the order | Not described | Paediatric wards including NICU | Pharmacist reviews all medication orders and reports all errant orders | Type of medication order Patient age Severity Unit in which patient received the order | Member of the paediatric faculty or attending physician Two paediatric clinical pharmacist practitioners | – | >3 |
| Vincer47 Canada 1989 | Medication incidents Incident has reached the patient (except for errors of omission). | Non-punitive Voluntary | NICU | Either self reported or reported by another person who identified incident | Type of incident Patient information and severity Cause of incident Time | Committee of three: Neonatologist Nursing unit coordinator Clinical neonatal pharmacist | +/− | <1 |
| Raju39 USA 1989 | Medication errors Medication dose must reach the patient, except for errors of omission (criteria by American Society of Hospital Pharmacists, 1988) | Non-punitive Anonymous Voluntary | NICU/PICU | ICU staff, person who noticed the error | Type Severity Error attribution Time | Manager from the pharmacy department Department of quality assurance | ? | <1 |
| Frey23 Switzerland 2000 | Overall critical incident monitoring Critical incident: any event which might have reduced, or did reduce, the safety margin for the patient | Non-punitive Anonymous Voluntary | NICU/PICU | ICU staff fills out form immediately on becoming aware of a critical incident | Narrative, including contributing factors Patient information and severity Incident attributionTime and location | Critical incident group: Two nurses One consultant | + | 1–3 |
| Ross51 UK 2000 | Medication error: wrong medicine, wrong dose, wrong route, wrong preparation, wrong time, unauthorised drug or omission, wrong dispensing, or to someone known to be allergic | Gradual change from punitive to non-punitive Mandatory | Paediatric wards, including NICU | Hospital-wide reporting, all staff | Standardised form in all departments Not further specified | Head of department | + | 1–3 |
| Kaushal15 USA 2001 | Medication errors and (potential)(intercepted) ADEs. An ADE is an injury that results from a drug. A preventable ADE is an ADE associated with a medication error | Non-punitive Non-anonymous Voluntary | Paediatric wards including NICU | House officers, nurses and pharmacists report verbally to trained data collectors | Type of error Name, dose, route and category of drug Point in system where error occurred | Two physicians (severity, preventability and attribution were recorded) | + | <1 |
| Frey24 Switzerland 2002 | Drug related critical incidents A critical incident is a harmful and potentially harmful event | Non-punitive Anonymous Voluntary | NICU/PICU | ICU staff fill out form immediately on becoming aware of a critical incident | Narrative, including contributing factors Patient information and severity Time and location Was patient harm prevented by check? Proposals for prevention Were patient/parents informed? | Quality assurance group: One consultant Three senior nurses One teaching nurse One junior nurse One person responsible for ICU equipment | + | 1–3 |
| Simpson41 UK 2004 | Medication errors identified through critical incident reports | Non-punitive | NICU | Nursing or medical staff involved in the error, or the clinical pharmacist | Not specified | Risk management group: Clinical pharmacist Consultant neonatologist Neonatal specialist registrar Senior nurse (severity was recorded) | + | <1 |
| Suresh43 USA 2004 | Errors that resulted in harm to the patient as well as near misses | Non-punitive Anonymous Voluntary | NICU | 739 Healthcare providers (physicians, nurses, pharmacists and others) from a total of 54 NICUs were authorised to report to hypertext mark-up language forms | External, internet based Phase 1: 4 free text boxes (title, description, key words, references) Phase 2: structured scroll-down form:severity, time and location, type, contributing and mitigating factors, changes to prevent recurrence | Members of Center for Patient Safety in neonatal intensive care | + | <1 |
| Kanter14 USA 2004 | Medical error: International Classification of Diseases (ICD)-9 diagnosis codes 996–999 (complications of medical or surgical care) | Not specified | Hospital discharge data of neonates | Not specified | Discharge records with diagnostic, utilisation and patient information | Healthcare Cost and Utilisation Project of the Agency for Healthcare Research and Quality | – | Not specified |