Factors associated with reporting of medication errors by Israeli nurses

Impacts of Just Culture on Perioperative Nurses' Attitudes and Behaviors With Regard to Patient Safety Incident Reporting: Cross-Sectional Nationwide Survey

PURPOSE

Just culture refers to a culture that encourages members of an organization to exchange important safety information and compensates them when they perform such information exchanges. The establishment of a just culture in hospital organizations might be an important means of enhancing patient safety incident reporting. This study aimed to investigate the impact of just culture on the attitudes and behaviors toward patient safety incident reporting in perioperative nurses.

METHODS

A nationwide cross-sectional survey was performed using structured questionnaires. The participants were 208 perioperative nurses in tertiary general hospitals in South Korea. Data were collected by self-reported on-line questionnaires, from August to September 2020. Data were analyzed with descriptive statistics, independent t-test, chi-square test, Fisher's exact test, one-way ANOVA, Scheffé test, Pearson's correlation analysis, Spearman rank correlation analysis, hierarchical multiple regression, and hierarchical logistic regression using the SPSS WIN 23.0 program.

RESULTS

Hierarchical multiple regression analysis revealed that just culture explained an additional 34.5%p of the attitudes on patient safety incident reporting. Hierarchical logistic regression analysis showed that just culture was a significant predictor of behaviors regarding patient safety incident reporting (odds ratio = 2.25, p = .017). The final regression model accounted for 16.0% of the behaviors regarding patient safety incident reporting.

CONCLUSION

This study empirically shows that just culture impacted the attitudes and behaviors regarding patient safety incident reporting in perioperative nurses. This study provides an evidence about the importance of the just culture in every day nursing practice setting. Personnel and organizational efforts for improving or implementing just culture are required to ensure greater patient safety by enhancing the patient safety incident reporting of perioperative nurses in hospitals.

Estimating Proportion and Barriers of Medication Error Reporting Among Nurses in Hail City, Saudi Arabia: Implications for Improving Patient Safety

Background

Determining the proportion of nurses reporting medication errors (MEs) and identifying the barriers they perceive in ME reporting are crucial to encourage nurses to actively report MEs.

Objective

This study aimed to determine the proportion of nurses experiencing and reporting MEs, perceived barriers to reporting MEs and their association with nurses' sociodemographic and work-related characteristics.

Methods

A cross-sectional study was conducted among 350 nurses from June to November 2023. Data about sociodemographic and work-related characteristics, and ME reporting, were collected using a validated self-administered questionnaire.

Results

The study found that 34.3% of nurses reported MEs, while 11.1% reported experiencing MEs during their practice. ME reporting was higher proportion among nurses who were older than 40 years (52.1%), males (41.4%), held a master's degree (58.7%), Saudi nationals (37.8%), experienced for more than 10 years (43.1%), working in intensive care units (44.3%), working for 48 hours or more per week (39.7%), working in hospitals with a nurse-to-patient ratio of 1:3 (44.9%) and having a system for incident reporting (37.7%) and with no training on patient safety (44.6%) compared to their counterparts. The rate of experiencing MEs was higher proportion among nurses who were older than 40 years (16.7%), males (17.3%), married (14.8%), Saudi nationals (13.4%), experienced for more than 10 years (15.6%) and with no training on patient safety (15.3%) compared to their counterparts. Lack of knowledge of the person responsible for reporting MEs was the most frequent perceived barrier to ME reporting (66.6%), followed by fears of blame (65.4%).

Conclusion

In this study, nurses reported and experienced MEs during their practice. Most nurses perceive the lack of knowledge and fear of blame or disciplinary actions as barriers to reporting. Healthcare administrators should implement educational programs and workshops to increase nurses' awareness of ME reporting.

Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives

BACKGROUND

Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently.

OBJECTIVE

We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA).

METHODS

The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon.

RESULTS

A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage.

CONCLUSIONS

Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.

Nurses' experiences in voluntary error reporting: An integrative literature review

OBJECTIVE

This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER.

METHOD

This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.

RESULTS

Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management.

CONCLUSION

Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.

Understanding nurses' experiences with near-miss error reporting omissions in large hospitals

Aim

This qualitative study aimed to provide an in‐depth understanding of nurses’ experiences with near‐miss errors and report omissions known to be direct or indirect causes of medical accidents in hospitals and cited as precursors of serious medical accidents.

Design

This study collected experiences of research participants through an interview as a qualitative research method and confirmed the meaning through an inductive approach.

Methods

We selected nine nurses with various levels of experience from 27 May to 10 June 2019 for analysis. We adopted phenomenological research methods and procedures proposed by Colaizzi (Existential‐phenomenological alternative for psychology, 1978) and established the feasibility and integrity of our results based on narrative studies proposed by Lincoln and Guba (Naturalistic inquiry, 1985).

Results

This study demonstrated that near‐miss errors and report omissions experienced by professional nurses could be merged into the following themes: lack of cognitive susceptibility to near‐miss errors; confusion about the reporting system for near‐miss errors; lack of knowledge about near‐miss errors; disappointment with results of reporting near‐miss errors; and fear of reporting near‐miss errors. These results strongly suggest the need to improve recognition efforts based on a socio‐educational viewpoint involving the so‐called openness about failures.

Medication errors: a focus on nursing practice

Objectives

Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.

Methods

A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.

Key findings

This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.

Conclusions

Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.

A meta-synthesis of how registered nurses make sense of their lived experiences of medication errors

BACKGROUND

Medication errors are a frequent phenomenon in nursing, as the nurses are primarily responsible for preparation and administration of medications to patients. Little is known about how nurses make sense of their experiences of medication errors as a lived phenomenon.

OBJECTIVE

To aggregate, synthesise and interpret the qualitative evidence of studies which explored nurses' lived experiences of medication errors.

METHOD

A meta-synthesis is presented with thematic analysis by Thomas & Harden (BMC Medical Research Methodology, 8, 2008, 45). Qualitative studies (January 1980-June 2018) retrieved from PubMed, BNI, CINAHL, EMBASE, AMED, PsycINFO, ProQuest, ScienceDirect and Wiley Online Library. The PRISMA flow chart, CASP tool and COREQ checklist are integrated in the meta-synthesis.

FINDINGS

Eight primary research studies were included with the follow themes: "moral impact," "emotional impact," "constructive learning," "impact on professional registration and employment," "nurses' coping strategies with the experience," "patient and family," "identification of contributing factors to medication errors" and "preventive measures for medication errors."

CONCLUSION

The moral and emotional impact of medication errors to nurses was devastating for themselves. Yet, they detected strategies to cope with their error and its consequences and even more translated their experience into a constructive lesson and identified ways to prevent future errors.

RELEVANCE FOR CLINICAL PRACTICE

The meta-synthesis provides a holistic perspective about how registered nurses made sense of their lived experiences of medication errors. Its findings reveal that the experience has both positive impact and negative impact to the nurses. Its findings should inform mainly the clinical nursing practice, clinical nurses, nurse educators, nurse leaders and policymakers of medication administration.

The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic

Despite efforts to increase patient safety, medical incidents and near misses occur daily. Much is still unknown about this phenomenon, especially due to underreporting. This study examined why nursing students and clinical instructors underreport medical events, and whether they believe that changes within their institutions could increase reporting. 103 third- and fourth-year nursing students and 55 clinical instructors completed a validated questionnaire. The results showed that about one-third of the instructors and one-half of the nursing students believed that circumstances and lack of awareness, and fear of consequences, lead to underreporting. Both nursing students and clinical instructors ranked "fear of consequences" as the main reason for not reporting, yet students ranked this higher than their instructors. Moreover, both groups believed that incident reporting could be increased following changes in the clinical field, mainly by increasing awareness and knowledge. A large percentage of participants also wrote that they do not report errors that are the result of circumstances and lack of awareness, mainly fear of consequences. Therefore, hospitals and academic institutions may need to create a more accepting organizational climate. Moreover, institutions that allow incident reports to be submitted anonymously and that take educational (not disciplinary) action, may increase incident reporting.

Proportion of medication error reporting and associated factors among nurses: a cross sectional study

BACKGROUND

A medication error (ME) is any preventable event that may cause or lead to inappropriate medication use or patient harm. Voluntary reporting has a principal role in appreciating the extent and impact of medication errors. Thus, exploration of the proportion of medication error reporting and associated factors among nurses is important to inform service providers and program implementers so as to improve the quality of the healthcare services.

METHODS

Institution based quantitative cross-sectional study was conducted among 397 nurses from March 6 to May 10, 2015. Stratified sampling followed by simple random sampling technique was used to select the study participants. The data were collected using structured self-administered questionnaire which was adopted from studies conducted in Australia and Jordan. A pilot study was carried out to validate the questionnaire before data collection for this study. Bivariate and multivariate logistic regression models were fitted to identify factors associated with the proportion of medication error reporting among nurses. An adjusted odds ratio with 95% confidence interval was computed to determine the level of significance.

RESULT

The proportion of medication error reporting among nurses was found to be 57.4%. Regression analysis showed that sex, marital status, having made a medication error and medication error experience were significantly associated with medication error reporting.

CONCLUSION

The proportion of medication error reporting among nurses in this study was found to be higher than other studies.

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature

OBJECTIVES

The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.

DESIGN

To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.

RESULTS

The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).

CONCLUSION

A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.

Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea

OBJECTIVE

This study compared registered nurses' perceptions of safety climate and attitude toward medication error reporting before and after completing a hospital accreditation program. Medication errors are the most prevalent adverse events threatening patient safety; reducing underreporting of medication errors significantly improves patient safety. Safety climate in hospitals may affect medication error reporting.

DESIGN

This study employed a longitudinal, descriptive design. Data were collected using questionnaires.

SETTING

A tertiary acute hospital in South Korea undergoing a hospital accreditation program.

PARTICIPANTS

Nurses, pre- and post-accreditation (217 and 373); response rate: 58% and 87%, respectively.

INTERVENTIONS

Hospital accreditation program.

MAIN OUTCOME MEASURES

Perceived safety climate and attitude toward medication error reporting.

RESULTS

The level of safety climate and attitude toward medication error reporting increased significantly following accreditation; however, measures of institutional leadership and management did not improve significantly. Participants' perception of safety climate was positively correlated with their attitude toward medication error reporting; this correlation strengthened following completion of the program.

CONCLUSIONS

Improving hospitals' safety climate increased nurses' medication error reporting; interventions that help hospital administration and managers to provide more supportive leadership may facilitate safety climate improvement. Hospitals and their units should develop more friendly and intimate working environments that remove nurses' fear of penalties. Administration and managers should support nurses who report their own errors.

Exploration of the barriers of reporting nursing errors in intensive care units: A qualitative study

AIM

The aim of this study was to explore the barriers to reporting nursing errors in intensive care units in Iranian hospitals.

METHODS

A descriptive qualitative analysis design was used. The data were collected through in-depth semi-structured interviews with a purposive sample of 16 nurses working in four general intensive care units in Kurdistan province, Iran. Interviews were transcribed and finally analysed through conventional content analysis.

RESULTS

There are four major barriers to the reporting of errors by nurses working in Iranian critical care units: (a) saving professional reputation and preventing stigma; (b) fear of consequences - punishment, legal problems and organisational misconduct; (c) feelings of insecurity - pointing a finger at nurses and lack of managerial support and (d) not investigating the root cause of error.

CONCLUSIONS

The findings revealed the need to support and provide security to nurses and to consider and find the cause of error occurrence. Managers must provide the required personal, professional and legal support for nurses to encourage them to effectively report errors, discover the root cause of errors and take measures to prevent them.

Aged-care nurses in rural Tasmanian clinical settings more likely to think hypothetical medication error would be reported and disclosed compared to hospital and community nurses

Objective

This study aims to determine the likelihood that rural nurses perceive a hypothetical medication error would be reported in their workplace.

Design

This employs cross-sectional survey using hypothetical error scenario with varying levels of harm.

Setting

Clinical settings in rural Tasmania.

Participants

Participants were 116 eligible surveys received from registered and enrolled nurses.

Main outcome measures

Frequency of responses indicating the likelihood that severe, moderate and near miss (no harm) scenario would ‘always’ be reported or disclosed.

Results

Eighty per cent of nurses viewed a severe error would ‘always’ be reported, 64.8% a moderate error and 45.7% a near-miss error. In regards to disclosure, 54.7% felt this was ‘always’ likely to occur for a severe error, 44.8% for a moderate error and 26.4% for a near miss. Across all levels of severity, aged-care nurses were more likely than nurses in other settings to view error to ‘always’ be reported (ranging from 72–96%, P = 0.010 to 0.042,) and disclosed (68–88%, P = 0.000). Those in a management role were more likely to view error to ‘always’ be disclosed compared to those in a clinical role (50–77.3%, P = 0.008–0.024).

Conclusion

Further research in rural clinical settings is needed to improve the understanding of error management and disclosure.

Organizational safety culture and medical error reporting by Israeli nurses

PURPOSE

To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses.

DESIGN

Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%).

METHODS

The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data.

FINDINGS

Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance.

CONCLUSIONS

This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level.

CLINICAL RELEVANCE

A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety.

The courage of one's conviction: when do nurse practitioners report unsafe practices?

When and why do nurses report unsafe patient practices when they see them? This paper adds to our understanding of the characteristics of health care practitioners who report errors and their environment by introducing role identity as an important concept for understanding this communication behavior. We analyzed the results of a national survey of 330 nurses to address three questions: (1) What factors are associated with nurses stating that they have observed tolerance for unsafe practices; (2) what fosters reporting of unsafe practices; and (3) what is the impact on nurses' commitment to the organization and the profession as a result of observing unsafe practices? Results suggest that the probability of reporting unsafe practices increases as the frequency of unsafe practices increases; this relationship is moderated by nurse role identity and supervisory support for reporting. The probability of reporting of unsafe practices also increases when nurses have a strong role identity and strong organizational role identity. Surprisingly, the highest probability for reporting occurs when both organization and nurse role identities are low. Finally, we examine how risk propensity influences reporting and discuss potential strategies for improving reporting of unsafe practices.

On the ball: leadership for patient safety and learning in critical care

OBJECTIVE

To explore nursing leadership for patient safety in critical care and identify opportunities to improve leadership that promotes patient safety.

BACKGROUND

There is limited systematic evidence about how nurses lead the microsystem of critical care and to the creation of a culture of patient safety.

METHODS

Focus groups of multidisciplinary frontline providers and managers were used to gain insight into leadership that promotes patient safety and learning.

RESULTS

Gains in critical care patient safety require a skilled nursing leader who is mindful of bedside situations and has real-time decision-making authority. Patient safety is seen as management of the moment, rather than a function of organizational systems and processes.

CONCLUSION

Leadership for improved patient safety resides primarily with nurses who provide direct patient care. These nurse leaders play 3 critical roles: they are the "go-to," they are "on the ball," and they "keep the ball rolling."