|Year : 2017 | Volume
| Issue : 3 | Page : 132-136
Nurses' perspectives on the reasons behind medication errors and the barriers to error reporting
Mohammad Amrollahi1, Narges Khanjani2, Mehdi Raadabadi3, Majid Bagheri Hosseinabadi4, Maryam Mostafaee5, Seyed Ehsan Samaei6
1 Social Determinants of Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Neurology Research Center, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
3 Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
4 School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
5 Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
6 Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
|Date of Web Publication||6-Nov-2017|
Seyed Ehsan Samaei
Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj
Source of Support: None, Conflict of Interest: None
Background: Medication errors may happen in any hospital setting. Medication error reporting can enhance patient safety and provide valuable information about reasons behind errors. Objectives: The present study aimed to determine nurses' perspectives on the reasons behind medication errors and the barriers to error reporting. Methods: This cross-sectional study was conducted in 2015 on 213 hospital nurses working in three hospitals in Kerman, Iran. Nurses working in different inpatient wards were selected through random sampling. Data were collected using a three-part questionnaire on nurses' demographic characteristics, reasons behind medication errors, and reasons for not reporting them. Data analysis was done through the independent sample t-test and the one-way analysis of variance. Results: The most and the least important reasons behind medication errors were nurses' insufficient attention to patients' medical records (3.63 ± 1.29) and the high number of tasks (2.01 ± 0.99), respectively. Moreover, the most and the least important reasons for not reporting medication errors included forgetting to report (2.80 ± 1.20) and fear over being blamed by doctors (2.03 ± 0.98), respectively. Conclusion: Nurse- and management-related factors were the most important reasons behind medication errors and not reporting them, respectively. Designing an efficient system for medication error reporting and a systematic approach for evaluating and managing error risk factors is recommended.
Keywords: Error reporting, Hospital, Medication errors, Nurse, Patient safety
|How to cite this article:|
Amrollahi M, Khanjani N, Raadabadi M, Hosseinabadi MB, Mostafaee M, Samaei SE. Nurses' perspectives on the reasons behind medication errors and the barriers to error reporting. Nurs Midwifery Stud 2017;6:132-6
|How to cite this URL:|
Amrollahi M, Khanjani N, Raadabadi M, Hosseinabadi MB, Mostafaee M, Samaei SE. Nurses' perspectives on the reasons behind medication errors and the barriers to error reporting. Nurs Midwifery Stud [serial online] 2017 [cited 2019 Jan 17];6:132-6. Available from: http://www.nmsjournal.com/text.asp?2017/6/3/132/217730
| Introduction|| |
Medication error is a major health concern and challenge around the world. It is an indicator of patient care quality. Despite its serious consequences, medication error is preventable. According to the Institute of Medicine reports, medical errors in the United States (US) lead to 44,000–98,000 deaths each year, from which more than 7000 are related to medication errors.,
In the recent years, the number of patient complaints about medication errors has increased in Iran. From about 55,000 medication errors occurred each year in Iran, 10,500 led to death and 23,000 caused disability. In 2007, medication error incidence rate was 8%, which is about 2.4–5.6 times more than the rate in the USA. Yet, determining the true incidence rate of medication errors is difficult because many different factors contribute to error classification and reporting. Moreover, most medication errors are usually not reported  due to different reasons. Fear over prosecution is one of the main reasons behind not reporting errors.
Reporting medical errors can minimize the complications of errors and increase patient safety. It can also shorten hospitalization stay, reduce health-care costs, and lower the incidence of errors. Identifying factors contributing to medication error can help prevent their re-occurrence.
The present study aimed to determine nurses' perspectives on the reasons behind medication errors and barriers to error reporting.
| Methods|| |
Study design and participants
This cross-sectional study was done in 2015. The study population consisted of all 1278 nurses working in three teaching hospitals affiliated to Kerman University of Medical Sciences, Kerman, Iran. The selection criteria included having direct contact with patients, having a work experience of more than two years, and holding a bachelor's degree in nursing. With a medication error incidence rate of 79% and a confidence level of 0.95, sample size calculation formula [Figure 1] revealed that at least 231 nurses were needed. Sampling was done through stratified random sampling. Initially, a list of all nurses in each hospital was created, and the number of nurses who needed to be sampled from each hospital was determined. Then, nurses were randomly recruited from each hospital.
Three questionnaires were used for data gathering. The first was a demographic questionnaire including items on nurses' demographic and organizational characteristics. The second questionnaire was about the reasons behind medication errors. This questionnaire had 28 items in four dimensions, namely, nurse-related (8 items), workplace-related (5 items), management-related (10 items), and medication-related reasons (5 items). A 5-point Likert-type scale (from 1 = very low to 5 = very high) was used for scoring. Higher scores showed greater item importance. The validity and reliability of this questionnaire had been confirmed in another study.
The third questionnaire was about the reasons behind not reporting medication errors. This questionnaire included 19 questions in the following three dimensions: fear over the consequences of reporting (11 items), management-related factors (5 items), and reporting-related factors (3 items). A 5-point Likert-type scale (from 1 = strongly disagree to 5 = strongly agree) was used for scoring. The validity and reliability of this questionnaire had also been confirmed in an earlier study.
The first author referred to the hospitals in the morning, evening, and night shifts, recruited eligible nurses, and asked them to complete the questionnaires.
The present study was approved by the Ethics Committee of Kerman University of Medical Sciences, Kerman, Iran (with the code of KA.92.601). All nurses were made aware of the purpose of the study and verbally consented to participate. The data were managed confidentially and participants had the right to voluntarily withdraw from the study.
Data analysis was done using the SPSS software, version 13.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistic measures were reported for all variables. The Kolmogorov–Smirnov test was used to examine the normality of the data. The independent sample t-test was run to examine the differences in the reasons behind medication errors among the nurses of different genders, work shifts, educational degrees, and marital status. Moreover, the one-way analysis of variance was performed to determine the differences in the reasons behind medication errors among nurses with different age and work experience groups. The significance level for all tests was set as <0.05.
| Results|| |
More than 80% of nurses were female. [Table 1] summarizes nurses' demographic characteristics.
The highest-scored nurse-, workplace-, and management-related reasons behind medication errors were, respectively, insufficient attention to patients' medical records (3.63 ± 1.29), inappropriate drug protocols (2.94 ± 1.05), and wrong drug administration route (3.27 ± 1.14) [Table 2].
|Table 2: Frequency, mean, and standard deviation of the reasons behind medication errors and reasons for not reporting them|
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On the other hand, the most important reasons for not reporting medication errors were fear over the negative effects of error reporting on salaries (2.55 ± 1.20), unfair supervisory reactions which are disproportionate to error seriousness (2.41 ± 0.96), and forgetting to report medication errors (2.80 ± 1.20) [Table 2].
There were no significant differences among nurses of different ages, genders, work shifts, educational degrees, and marital status with respect to the reasons behind medication errors and the reasons for not reporting medication errors.
| Discussion|| |
In this study, the most important reasons behind medication errors were nurse-related factors such as nurses' insufficient attention to patients' medical records, their job dissatisfaction, and errors in calculating drug dosage. Therefore, implementing in-service training programs for enhancing nurses' awareness of the importance of preadministration adequate assessment of patients and their drug history can help reduce the rate of medication errors.
Nurses' job dissatisfaction was another reason behind medication errors. The causes of job dissatisfaction are multifactorial. Previous studies reported that insufficient number of nurses, severe fatigue due to extra working hours, heavy workload, and job specifications not only affect nurses' job satisfaction, but also increase the possibility of errors in drug dose calculation.
The results of this study also showed that management-related factors were the main reason for not reporting medication errors by nurses. This finding is consistent with the findings of earlier studies conducted in Iran , and Saudi Arabia. Inadequate managerial feedback is a main reason for not reporting. This problem can be managed through improving nurse–manager relationships and creating more efficient reporting systems. Nurse managers should also clearly define the concept of medication error and train nurses about the benefits of error reporting. Such strategies can facilitate error self-reporting and enhance patient safety.
This study was solely conducted in teaching hospitals. Futures studies are recommended to replicate this study in private hospitals.
| Conclusion|| |
Nurse-related factors are the main reasons behind medication errors while management-related factors are the main reasons for not reporting medication errors. Error rate can be reduced through establishing efficient reporting and feedback systems. Nurses need to be able to self-report medication errors without any fear over reporting-related consequences.
The authors would like to express their appreciation to the nurses working in the hospitals affiliated to Kerman University of Medical Sciences who participated in the study.
Financial support and sponsorship
This study was supported by the deputy of research at Kerman University of Medical Sciences, Kerman, Iran.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]