Views and experiences of decision-makers on organisational safety culture and medication errors

An Exploration of Nurses' Attitudes and Beliefs on Reporting Medication Errors

BACKGROUND

Medication errors in health care are prevalent. Nurses play an important role in reporting; however errors remain underreported in incident reporting systems. Understanding the perspective of nurses will inform strategies to improve reporting and build systems to reduce errors.

PURPOSE

The purpose of this study was to explore nurses' perceptions and attitudes of medication error reporting practices.

METHODS

This qualitative study used direct content analysis to analyze interview sessions with 21 total nurses.

RESULTS

Participant's description of medication error reporting practices fell into 2 themes. Internal factors described circumstances within nurses themselves that affect reporting. External factors described outside influences from processes or places.

CONCLUSIONS

Medication error reporting is a multidimensional phenomenon with internal and external factors impacting nurses' attitudes and willingness to report errors. Nurses need support from leadership to understand that reporting medication errors can improve practice and impact patient outcomes.

Barriers and facilitators to improving patient safety learning systems: a systematic review of qualitative studies and meta-synthesis

BACKGROUND

The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.

METHODS

We performed a systematic review and meta-synthesis by searching MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Scopus and Web of Science. We included English-language manuscripts of qualitative studies evaluating effectiveness of the PSLS and excluded studies evaluating specific individual adverse events, such as systems for tracking only medication side effects, for example. We followed the Joanna Briggs Institute methodology for qualitative systematic reviews.

RESULTS

We extracted data from 22 studies, after screening 2475 for inclusion/exclusion criteria. The included studies focused on reporting aspects of the PSLS, however, there were important barriers and facilitators across the analysis, learning and feedback phases. We identified the following barriers for effective use of PSLS: inadequate organisational support with shortage of resources, lack of training, weak safety culture, lack of accountability, defective policies, blame and a punitive environment, complex system, lack of experience and lack of feedback. We identified the following enabling factors: continuous training, a balance between accountability and responsibility, leaders as role models, anonymous reporting, user-friendly systems, well-structured analysis teams, tangible improvement.

CONCLUSION

Multiple barriers and facilitators to uptake of PSLS exist. These factors should be considered by decision makers seeking to enhance the impact of PSLS.

ETHICS AND DISSEMINATION

No formal ethical approval or consent were required as no primary data were collected.

Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study

A focus group study was conducted to explore nurses’ perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses’ perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety.

Communication related to medication incidents-A concept analysis and literature review

AIMS

(1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts.

DESIGN

Concept analysis.

DATA SOURCES

Twenty-three articles from seven scientific databases covering the years 2010-2020 and two official documents.

METHODS

Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive-inductively; conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting.

RESULTS

A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' individual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept.

CONCLUSION

The 128-item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues.

IMPACT ON MEDICATION SAFETY

The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.