An Observational Study on Medication Errors with Special Reference to High-alert Medication Drugs in Intensive Care Unit Patients in a Tertiary Care Hospital in Eastern India

Background: Medication errors (MEs) remain a major threat to patient safety, especially in intensive care units (ICUs) where the medication-use process is complex and high-alert medications (HAMs) carry an elevated risk of harm.This study aimed to estimate the incidence of MEs in an adult ICU in Eastern India, elucidate their root causes, determine the involvement of HAMs, and assess patient outcomes using the National Coordinating Council for ME Reporting and Prevention (NCCMERP) index.Methods: In this prospective observational descriptive study, adult patients admitted to the ICU of a tertiary care teaching hospital in Eastern India over 12 months (July 2024-June 2025) were enrolled (n = 1,486).Medication charts were audited daily, and MEs at any stage of the medication-use process (prescription, transcription, dispensing, administration, and monitoring) were identified and categorized by type and root cause.HAM involvement was recorded and its incidence calculated per 100 HAM prescriptions.Severity was graded using the NCCMERP index (Categories A-I).Data were entered in MS Excel and analyzed using Statistical Package for the Social Sciences (SPSS) v18.0; results are presented as frequencies and percentages.Results: Of the 1,486 screened prescriptions, 217 MEs were identified (incidence ~14.6%).The largest proportions occurred at the prescription stage (41.9%) and transcription stage (36.4%).The commonest root causes were prescription errors (illegible handwriting, non-standard abbreviations) and dose/frequency errors.High-alert medications were implicated in 67 of 217 errors (30.9% of MEs; equivalent to 4.5 errors per 100 HAM prescriptions, 95% CI: 3.6-5.8).Among HAM-related errors, the leading drug classes were oral hypoglycemics (5.99%), insulin (5.06%), and sedative agents (5.06%).In terms of severity, over 50% of errors were NCCMERP category A (no harm, near-miss), ~46% were category B-C, with very few category D and none in higher harm categories.Conclusion: Medication errors were frequent in this ICU setting, especially during the prescription and transcription stages.A substantial proportion involved HAMs.Although most errors were intercepted before patient harm, the high incidence of near-misses indicates a significant latent risk in the system.Interventions such as computerized provider order entry (CPOE), standardized documentation, and enhanced clinical pharmacy oversight are warranted. Clinical significance:The findings highlight the urgent need for safety measures such as computerized prescriptions and better documentation.