Nurses’ attitudes and perceived barriers to the reporting of medication administration errors

Factors influencing the reporting of medication errors and near misses among nurses: A systematic mixed methods review

AIM

This study aimed to systematically review empirical evidence on factors influencing nurses to report medication errors and near misses.

BACKGROUND

There is underreporting of medication errors among nurses, in particular among novice and beginner nurses. To improve quality of care, factors influencing the reporting of medication errors and near misses should be documented.

METHOD

A systematic mixed methods review was conducted. CINAHL, Cochrane Collaboration, Embase, Medline, PsycINFO and Web of Science databases were explored and analysed from December 1990 to December 2023. Two reviewers independently selected and extracted data using a standardized data extraction grid. Data were analysed using thematic analysis based on the adapted theory of planned behaviour.

RESULTS

Forty-two studies met the eligibility criteria. Principal factors influencing the reporting of medication errors and near misses among nurses were associated with perceived behavioural control, subjective norm and attitude. Few studies examined factors influencing reporting medication errors and near misses among novice and beginner nurses, and sociodemographic and professional factors.

CONCLUSION

To understand factors influencing reporting of medication errors and near misses, further studies should be conducted to investigate sociodemographic and professional factors.

Patient Safety Culture in the Context of Critical Care: An Observational Study

BACKGROUND

A robust safety culture is essential for ensuring high-quality healthcare delivery. From a nursing perspective, especially among critical patients, it fosters ongoing improvement by highlighting areas that need attention.

AIMS

This study aimed to evaluate the perception of patient safety culture among nurses within the critical care environment.

METHODOLOGY

An observational study was conducted at a central hospital in Portugal employing the Hospital Survey on Patient Safety Culture (HSPSC) questionnaire.

RESULTS

The study encompassed 57, nurses predominantly female (73.7%), aged 25-64. Most participants were general nurses (77.2%), with a significant proportion (61.4%) working in the emergency department and possessing an average tenure of 13 years at the facility. The perception of critical patient safety culture (CPSC) was predominantly positive (40.6%), varying by department, with intensive care nurses reporting the highest positivity rates. Teamwork was identified as a strong point, receiving 80.7% positivity, highlighting it as a well-established domain in the CPSC, whereas other domains were recognised as requiring enhancements.

CONCLUSIONS

The study pinpointed both strengths and weaknesses within the CPSC, offering a foundation for developing targeted strategies to bolster patient safety culture in critical care settings.

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.

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.

Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study

Background

Medication administration errors significantly impact patient safety, potentially leading to severe harm or fatality. Reporting such errors through active systems improves medication administration, thereby enhancing patient safety and the quality of care. However, in the context of Saudi Arabia, little is understood about the causes of medication administration errors and the obstacles hindering their reporting.

Objective

This study aimed to explore nurses' perceptions of the causes of medication administration errors and the barriers to reporting them.

Methods

The study employed a qualitative descriptive design, conducting face-to-face semi-structured interviews with 43 nurses from three hospitals in Taif Governorate, Saudi Arabia, between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis.

Results

The following themes emerged regarding the causes of medication administration errors: order deficiencies, high workloads and staff shortages, and malpractice. Regarding the barriers to reporting errors, the emerging themes were fear of punishment and lack of support, lack of knowledge and awareness about reporting, and lack of feedback.

Conclusion

This study reveals nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. Recognizing and addressing these causes and barriers are essential for patient safety and the improvement of the healthcare environment. Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions. Additionally, supportive mechanisms, such as feedback systems and resources for professional development, should be implemented to empower nurses to actively participate in error reporting and contribute to continuous improvement in medication administration practices.

Exploring the Use of Persuasive System Design Principles to Enhance Medication Incident Reporting and Learning Systems: Scoping Reviews and Persuasive Design Assessment

BACKGROUND

Medication incidents (MIs) causing harm to patients have far-reaching consequences for patients, pharmacists, public health, business practice, and governance policy. Medication Incident Reporting and Learning Systems (MIRLS) have been implemented to mitigate such incidents and promote continuous quality improvement in community pharmacies in Canada. They aim to collect and analyze MIs for the implementation of incident preventive strategies to increase safety in community pharmacy practice. However, this goal remains inhibited owing to the persistent barriers that pharmacies face when using these systems.

OBJECTIVE

This study aims to investigate the harms caused by medication incidents and technological barriers to reporting and identify opportunities to incorporate persuasive design strategies in MIRLS to motivate reporting.

METHODS

We conducted 2 scoping reviews to provide insights on the relationship between medication errors and patient harm and the information system-based barriers militating against reporting. Seven databases were searched in each scoping review, including PubMed, Public Health Database, ProQuest, Scopus, ACM Library, Global Health, and Google Scholar. Next, we analyzed one of the most widely used MIRLS in Canada using the Persuasive System Design (PSD) taxonomy-a framework for analyzing, designing, and evaluating persuasive systems. This framework applies behavioral theories from social psychology in the design of technology-based systems to motivate behavior change. Independent assessors familiar with MIRLS reported the degree of persuasion built into the system using the 4 categories of PSD strategies: primary task, dialogue, social, and credibility support.

RESULTS

Overall, 17 articles were included in the first scoping review, and 1 article was included in the second scoping review. In the first review, significant or serious harm was the most frequent harm (11/17, 65%), followed by death or fatal harm (7/17, 41%). In the second review, the authors found that iterative design could improve the usability of an MIRLS; however, data security and validation of reports remained an issue to be addressed. Regarding the MIRLS that we assessed, participants considered most of the primary task, dialogue, and credibility support strategies in the PSD taxonomy as important and useful; however, they were not comfortable with some of the social strategies such as cooperation. We found that the assessed system supported a number of persuasive strategies from the PSD taxonomy; however, we identified additional strategies such as tunneling, simulation, suggestion, praise, reward, reminder, authority, and verifiability that could further enhance the perceived persuasiveness and value of the system.

CONCLUSIONS

MIRLS, equipped with persuasive features, can become powerful motivational tools to promote safer medication practices in community pharmacies. They have the potential to highlight the value of MI reporting and increase the readiness of pharmacists to report incidents. The proposed persuasive design guidelines can help system developers and community pharmacy managers realize more effective MIRLS.

The predictive power of electronic reporting system utilization on voluntary reporting of near-miss incidents among nurses: A PLS-SEM approach

Background

Patient safety is crucial in healthcare, with incident reporting vital for identifying and addressing errors. Near-miss incidents, common yet underreported, serve as red flags requiring attention. Nurses' underreporting, influenced by views and system usability, inhibits learning opportunities. The Electronic Reporting System (ERS) is a modern solution, but its effectiveness remains unclear.

Objective

This study aimed to investigate the role of the ERS in enhancing the voluntary reporting of near-miss (VRNM) incidents among nurses.

Methods

A cross-sectional study was conducted in the Al Dhafra region of the United Arab Emirates, involving 247 nurses from six hospitals. Data were collected using a questionnaire between April 2022 and August 2022. Structural Equation Modelling Partial Least Square (SEM-PLS) was employed for data analysis.

Results

The average variance extracted for the ERS construct was 0.754, indicating that the common factor accounted for 75.4% of the variation in the ERS scores. The mean ERS score was 4.093, with a standard deviation of 0.680. For VRNM, the mean was 4.104, and the standard deviation was 0.688. There was a positive correlation between ERS utilization and nurses' willingness to report near-miss incidents. Additionally, our research findings suggest a 66.7% relevance when applied to various hospital settings within the scope of this study.

Conclusion

The findings suggest that adopting a user-friendly reporting system and adequate training on the system's features can increase reporting and improve patient safety. Additionally, these systems should be designed to be operated by nursing staff with minimal obstacles.

Knowledge, Attitudes, and Behavior in the administration of medication in the home care setting: Cross-cultural Spanish adaptation

OBJECTIVE

The aim of the study is to validate and adapt the "Knowledge Attitute and Behaviour in the administration of medication in the home care setting questionnaire" in the home care setting in Cordoba, Spain, through a cross-validation process.

DESIGN

Cross-sectional study SAMPLE: 106 community nurses provide home care in Cordoba, and are involved in the management of the medication process in the patient's home.

MEASUREMENTS

Community nurses' knowledge, attitudes, and behaviors toward medication error prevention strategies in-home care.

RESULTS

For the evaluation of psychometric properties, Cronbach's α was calculated, which returned a value of 0.639, showing good internal consistency. Most participants agreed that the home care setting increases the risk of medication errors.

CONCLUSION

The study, underscores the importance of analyzing the phenomenon of medication errors in the home care setting. The characteristics and peculiarities of a home care setting are different from a hospital setting, which means that factors such as the environment, the figures involved in the care process (caregivers and/or family members), and the way in which they communicate with the rest of the multi-professional team can influence both the type of errors and the likelihood of their occurrence.

Relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing

PURPOSE

The purpose of this study was to explore relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing. Patient safety events are underreported and costly. To promote reporting, many healthcare organizations have adopted the high reliability framework with strategies to foster team psychological safety.

DESIGN

A web-based survey was distributed through the Society of Pediatric Nurses and the National Pediatric Nurse Scientist Collaborative. Data were collected from 244 pediatric nurses using a demographic form, Safety Organizing Scale, Team Psychological Safety Scale, and Intention to Report Safety Events Scale. Data were analyzed using logistic and linear regression.

RESULTS

Psychological safety and perception of working in a high reliability organization (HRO) showed positive statistically significant relationships with reporting intentions (p = 0.034). Odds of nurses achieving highest reporting intention scores increased by a factor of 0.3 with each practice year.

CONCLUSIONS

Psychological safety was found to be a predictor for intention to report safety events among pediatric nurses. Findings also demonstrated that nurses' perceptions of whether they worked in a high reliability setting also profoundly affect their attitude towards reporting.

PRACTICE IMPLICATIONS

Focusing organizational efforts on cultivating psychological safety and embedding the high reliability framework into professional practice may significantly affect attitudes towards safety event reporting.

The effect of electronic error-reporting forms on nurse's stress and the rate of error-reporting

OBJECTIVES

The patient safety culture includes a systematic approach that promotes safe care for patients and the leadership that supports it. Medical errors threaten patient safety. A significant portion of medical errors is committed by nurses. Although error-reporting provides valuable information to prevent errors, most nurses do not report their errors due to their high level of stress. This study was to investigate the effect of electronic error-reporting forms on nurses' stress and the rate of error-reporting.

METHODS

The nurses' level of stress was compared when using paper error-reporting and 6 months after using electronic forms. A revised version of the Coudron questionnaire was completed by 186 nurses. Data were analyzed by SPSS 23 using Wilcoxon test. The number of reported errors in paper and electronic media was compared over the same period.

RESULTS

Implementation of the electronic error-reporting form reduced the job stress of nurses by 22.22 points (p=.00) and increased the error-reporting rate by 12.86% (p<.05).

CONCLUSIONS

Although nurse's stress significantly decreases after implementing electronic error-reporting forms, their level of stress is still high and they are still at risk for physical and mental problems. Using methods like modifying the error-reporting form will increase the error-reporting rate.

A study of error reporting by nurses: the significant impact of nursing team dynamics

Background

Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported.

Aims

The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors.

Methods

The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis.

Results

Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting.

Conclusion

The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.

Knowledge and Attitudes Regarding Medication Errors among Nurses: A Cross-Sectional Study in Major Jeddah Hospitals

Medication error is a multifactorial problem that mainly involves missing or bypassing the administration, which may have life-threatening impacts on the patient. Nevertheless, there is a dearth of information on medication errors among nurses in Saudi Arabia. This study investigates the knowledge and attitudes toward medication errors and their associated factors among nurses in Saudi Arabia. A cross-sectional study was conducted in four major public hospitals by recruiting a total of 408 nurses using cluster random sampling and proportional stratified sampling techniques. Data were gathered using an online self-administered questionnaire from January to March 2022. Descriptive statistics, Chi-square tests, and binary logistic regression models were performed to analyze the data. The prevalence of medication error among the nurses was 72.1%, only 41.2% were reported, while wrong doses (46.9%) were the most common type of medication error. Approximately 55% and 50% of the respondents demonstrated good knowledge and a positive attitude toward medication errors, respectively. The prevalence of medication error was associated with age groups of less than 25, and 25-35 years old, King Fahad and King Abdulaziz hospitals, no history of attending an MER training course, poor knowledge, and negative attitude. These findings reflect a high prevalence of medication error among nurses in Saudi Arabia, and the factors identified could be considered in mitigating this important health problem.

Evaluation of Medication Incidents in a Long-term Care Facility Using Electronic Medication Administration Records and Barcode Technology

Objective To describe the frequency, type, and severity of reported medication incidents that occurred at a long-term care facility (LTCF) despite electronic medication administration record and barcode-assisted medication administration (eMAR-BCMA) use. The study also contains analysis for the contribution of staff workarounds to reported medication administration errors (MAEs) using an established typology for BCMA workarounds, characterize if the eMAR-BCMA technology contributed to MAEs, and explore characteristics influencing incident severity. Design Retrospective incident report review. Setting A 239-bed LTCF in Alberta, Canada, that implemented eMAR-BCMA in 2013. Participants 270 paper-based, medication incident reports submitted voluntarily between June 2015 and October 2017. Interventions None. Results Most of the 264 resident-specific medication incidents occurred during the administration (71.9%, 190/264) or dispensing (28.4%, 75/264) phases, and 2.3% (6/264) resulted in temporary harm. Medication omission (43.7%, 83/190) and incorrect time (22.6%, 43/190) were the most common type of MAE. Workarounds occurred in 41.1% (78/190) of MAEs, most commonly documenting administration before the medication was administered (44.9%, 35/78). Of the non-workaround MAEs, 52.7% (59/112) were notassociated with the eMAR-BCMA technology, while 26.8% (30/112) involved system design shortcomings, most notably lack of a requirement to scan each medication pouch during administration. MAEs involving workarounds were less likely to reach the resident (74.4 vs 88.8%; relative risk = 0.84, 95% CI 0.72-0.97). Conclusion Administration and dispensing errors were the most reported medication incidents. eMAR-BCMA workarounds, and design shortcomings were involved in a large proportion of reported MAEs. Attention to optimal eMAR-BCMA use and design are required to facilitate medication safety in LTCFs.

Registered nurses' approach to pressure injury prevention: A descriptive qualitative study

AIMS

To explore Registered Nurses' approaches to pressure injury prevention, including how they perceive their roles, how they prioritize pressure injury prevention and factors influencing prevention in the Chinese context.

DESIGN

A qualitative descriptive study.

METHODS

Audio-recorded, face-to-face, semi-structured individual interviews were conducted with Registered Nurses in a large tertiary hospital in China from August to December 2020. Using the System Engineering Initiative for Patient Safety Model, the interview guide was developed to describe the work system, processes and outcomes (three domains) associated with nurses' pressure injury prevention practices. Deductive and inductive content analyses were used.

FINDINGS

Twenty-seven nurses participated in the interviews. Four themes related to two domains of the model emerged: Work system: (i) Nurses lead and coordinate pressure injury prevention; Work processes: (ii) Individualized pressure injury prevention is founded on comprehensive patient assessment; (iii) Collaborating ensures patients receive appropriate pressure injury prevention; and (iv) Competing factors influence the delivery of appropriate pressure injury prevention. One category emerged about work outcome: Nurses strive to do their best in pressure injury prevention but hold major concerns when pressure injuries occur.

CONCLUSIONS

Nurses play a leading role in pressure injury prevention delivery but require appropriate resources and assistance and support from other healthcare personnel, patients and carers. Understaffing, lack of resources, complex reporting and poor patient compliance challenge nurses in their delivery of pressure injury prevention.

IMPACT

Pressure injury prevention is primarily a nursing responsibility therefore nurses' approaches to prevention were explored. Nurses rely on collaboration with others and access to various resources to provide pressure injury prevention. They recognize the patients' and carers' roles and acknowledge the importance of accessing guidance and support from nursing leaders and wound experts. Acknowledging nurses leading role in prevention and ensuring they have adequate resources are important for quality care.

Organizational Factors That Promote Error Reporting in Healthcare: A Scoping Review

GOAL

The overarching aim of this systematic review was to offer guidelines for organizations and healthcare providers to create psychological safety in error reporting. The authors wanted to identify organizational factors that promote psychological safety for error reporting and identify gaps in the literature to explore innovative avenues for future research.

METHODS

The authors conducted an online search of peer-reviewed articles that contain organizational processes promoting or preventing error reporting. The search yielded 420 articles published from 2015 to 2021. From this set, 52 full-text articles were assessed for eligibility. Data from 29 articles were evaluated for quality using Joanna Briggs Institute critical appraisal tools.

PRINCIPAL FINDINGS

We present a narrative review of the 29 studies that reported factors either promoting error reporting or serving as barriers. We also present our findings in tables to highlight the most frequently reported themes. Our findings reveal that many healthcare organizations work at opposite ends of the process continuum to achieve the same goals. Finally, our results highlight the need to explore cultural differences and personal biases among both healthcare leaders and clinicians.

APPLICATIONS TO PRACTICE

The findings underscore the need for a deeper dive into understanding error reporting from the perspective of individual characteristics and organizational interests toward increasing psychological safety in healthcare teams and the workplace to strengthen patient safety.

Nurses' knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine

BACKGROUND

Medication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors.

AIMS

This study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated.

METHODS

A cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME.

RESULTS

A total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%).

CONCLUSIONS

Nurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.

Implementing an Intervention to Improve Physicians’ Incident Reporting in the Hospital Setting: A Pilot Study

Objectives: To improve patient safety, information regarding errors must be collected. This practice constitutes one of the strategies that hospital managers use to understand the types of errors that occur at their hospitals. This pilot study aimed to evaluate an intervention designed to improve error reporting percentage among physicians. Methods: The study was conducted at University Hospital A, where data were collected from April 2017 to March 2019. The intervention began in April 2018 and involved the following steps: receiving support and appropriate feedback from the hospital administrator, defining reporting standards, improving the incident reporting system, and having the hospital administrators set clear goals and begin a visualized feedback process. Physicians were the main target for these steps in this study. Results: The percentage of reports submitted by physicians relative to nonphysicians increased from fiscal year (FY) 2017 to FY 2018, with the largest monthly increase within 2018 occurring in November. Physician reporting was higher in FY 2018 than in FY 2017, with the greatest difference observed for December of the respective FYs (p < 0.001, analyzed using Fisher’s exact test). The percentage of reports submitted by physicians increased by 2.6% (95% confidence interval [CI]: 1.7, 3.5) from FY 2017 to FY 2018, raising the percentage to 9%. Conclusions: Based on these results, it can be said that the intervention effectively increased incident reporting among not only physicians but also nonphysician staff members. In this regard, reporting barriers were broken when hospital administrators encouraged staff to submit incident reports. Active feedback by hospital administrators—the executive class of the hospital—may encourage not only physicians, but also staff members to submit incident reports, thus effectively removing reporting barriers.

Evaluation of medication errors in the hospital environment

INTRODUCTION

Healthcare is inherently associated with a risk to patient health. One risk is associated with medication-related errors, which are commonly reported adverse events. By analyzing the root causes of medication errors, effective preventive measures can be proposed to reduce their likelihood. This study aimed to identify the reasons of medication administration errors, determine the number of medication administration errors reported, and describe the barriers hindering reporting.

METHODOLOGY

The study used a standardized Questionnaire Medication Administration Error Survey (MAE survey) that was quantitatively analyzed. The study involved 112 nurses from four hospitals in the South Bohemian Region.

RESULTS

Risk factors that increase the likelihood of medication administration errors include similarity of drug names (3.7 ± 1.3) and packaging (3.9 ± 1.5), frequent prescription changes for patients (3.2 ± 1.5), illegibility of written prescriptions (3.1 ± 1.6), a lack of clarity of medical records (2.6 ± 1.5). Only a proportion of medication administration errors are reported by nurses (16% to 21%). The reluctance of nurses to report medication administration errors is linked to fear of being blamed for the deterioration of the patients health (3.3 ± 1.7), fear of the doctors reaction to a medication administration error (2.6 ± 1.4), and repressive responses from hospital management to reported misconduct (2.9 ± 1.5).

CONCLUSION

Measures to reduce the likelihood of medication administration errors include building a non-punitive system for reporting adverse events and medication errors, introducing electronic prescription systems, promoting open communication within the team, involving clinical pharmacists in the pharmacotherapy process, and regular comprehensive training of nursing staff.

Medication Errors in Secondary Care Hospitals in Kuwait: The Perspectives of Healthcare Professionals

Objectives: Medication errors (MEs) are the most common cause of adverse drug events (ADEs) and one of the most encountered patient safety issues in clinical settings. This study aimed to determine the types of MEs in secondary care hospitals in Kuwait and identify their causes. Also, it sought to determine the existing system of error reporting in Kuwait and identify reporting barriers from the perspectives of healthcare professionals (HCPs).

Material and Methods: A descriptive cross-sectional study was conducted using a pre-tested self-administered questionnaire. Full-time physicians, pharmacists, and nurses (aged 21 years and older) working in secondary care governmental hospitals in Kuwait were considered eligible to participate in the study. Descriptive statistics and the Statistical Package for Social Science Software (SPSS), version 27 were used to analyze the data.

Results: A total of 215 HCPs were approached and asked to take part in the study, of which 208 agreed, giving a response rate of 96.7%. Most HCPs (n = 129, 62.0%) reported that the most common type of ME is “prescribing error,” followed by “compliance error” (n = 83; 39.9%). Most HCPs thought that a high workload and lack of enough breaks (n = 128; 61.5%) were the most common causes of MEs, followed by miscommunication, either among medical staff or between staff and patients, which scored (n = 89; 42.8%) and (n = 82; 39.4%), respectively. In the past 12 months, 77.4% (n = 161) of HCPs reported that they did not fill out any ME incident reports. The lack of feedback (n = 65; 31.3%), as well as the length and complexity of the existing incident reporting forms (n = 63; 30.3%), were the major barriers against reporting any identified MEs.

Conclusions: MEs are common in secondary care hospitals in Kuwait and can be found at many stages of practice. HCPs suggested many strategies to help reduce MEs, including proper communication between HCPs; double-checking every step of the process before administering medications to patients; providing training to keep HCPs up to date on any new treatment guidelines, and computerizing the health system.

Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study

BACKGROUND

Despite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries.

OBJECTIVES

To assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario.

DESIGN

A cross-sectional observational study.

SETTINGS

One university four-year nursing program each in Indonesia, Taiwan, and Thailand.

PARTICIPANTS

A total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand.

METHODS

The medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used.

RESULTS

Overall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors.

CONCLUSIONS

Medication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.

Knowledge and Attitude toward Medication Error among Pharmacists

Objective: This study aimed to evaluate knowledge and attitude toward medication error (ME) among pharmacists working in public health care institutions. Methods: A cross-sectional study was conducted among pharmacists working in public health care institutions. Respondents were randomly recruited from 5 hospitals and 25 primary healthcare clinics in the state of Pahang, Malaysia. A set of self-administered questionnaires was used to assess their knowledge and attitude, distributed as a web-based survey. Knowledge and attitude toward ME reporting were assessed using five-point Likert-scale. This study was conducted between May and July 2019. Results: A total of 186 respondents participated in the study. A majority of respondents were female (n = 144). About 90% of the respondents had good score on knowledge on ME. Only 25.4% of the respondents had favorable attitude toward ME reporting. Female pharmacists (P = .001), more experienced pharmacists (P = .012) and those working in primary health clinics (P = .014) were associated with more favorable attitude. Knowledge did not correlate well with attitude toward ME reporting (r = 0.08, P = .29). Conclusion: Despite having good knowledge on ME, the attitude toward ME reporting was still very poor among the pharmacists.

Improving patient safety through identifying barriers to reporting medication administration errors among nurses: an integrative review

BACKGROUND

The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative.

OBJECTIVE

This review systematically identified and examined the barriers hindering nurses from reporting medication administration errors in the hospital setting.

DESIGN

An integrative review.

REVIEW METHODS

PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication administration error reporting from January 2016 to December 2020. Two reviewers (AA, and KDK) independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.

RESULTS

Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes and subthemes identified as barriers to reporting medication administration errors after the integration of results from qualitative and quantitative studies were: organisational barriers (inadequate reporting systems, management behaviour, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons, and inadequate knowledge of errors).

CONCLUSION

Providing an enabling environment void of punitive measures and blame culture is imperious for nurses to report medication administration errors. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses' ability to report medication administration errors.

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.

Factors causing medication errors in an electronic reporting system

Aim

To analyse medication error data from a hospital's electronic reporting system and identify the factors affecting error types and harmfulness.

Design

A retrospective study.

Methods

The 805 near misses and adverse events reported to the hospital's electronic reporting system between January 2014 and December 2018 were analysed using descriptive statistics, chi‐square tests and logistic regression analyses.

Results

A total of 632 near misses and 173 adverse events were reported. Near misses and adverse events were the most common error type during the dispensing stage and medication administration, respectively. The odds of medication errors reported by nurses with 1–9 years of clinical experience were relatively low. After adjusting for confounders, the odds of medication errors directly observed by nurses were 65% lower than the odds of medication errors not directly detected. In clinical practice, nurses must be educated about errors in reporting depending on their degree of clinical experience.

Academic evaluation, management and satisfaction of clinical practicums among undergraduate students: software CliPrAS@UB

AIM/OBJECTIVE

To determine the development of competency acquisition, the satisfaction of the agents involved and recording incidents with a digital platform CliPrAS @UB on the Clinical Placements I and II courses in the second and third years of the Bachelor's Degree in Nursing.

BACKGROUND

The teaching of clinical practice subjects requires an analysis of the competence evolution, a management structure and an analysis of the satisfaction of the agents involved in the subject.

DESIGN

Prospective, analytical, observational cohort study.

METHODS

The study was carried out in a public university center in Barcelona with 387 students distributed in nine centers of the network of Health Institutions.

RESULTS

An increase of 2.32 points was observed in the competence dimensions of Professional Practice and with a reduction in the average score in the skills of care provision, therapeutic communication and professional development of more than 0.08 points. Regarding the seminars, a reduction of the average global score of 0.58 points was observed.

CONCLUSIONS

The use of the CliPrAS @ UB computer platform has improved the implementation of the mandatory documents, the recording of incidents and the overall satisfaction of the students.

Common Barriers to Reporting Medical Errors

BACKGROUND

Medical errors are the third leading cause of death in the United States. Reporting of all medical errors is important to better understand the problem and to implement solutions based on root causes. Underreporting of medical errors is a common and a challenging obstacle in the fight for patient safety. The goal of this study is to review common barriers to reporting medical errors.

METHODS

We systematically reviewed the literature by searching the MEDLINE and SCOPUS databases for studies on barriers to reporting medical errors. The preferred reporting items for systematic reviews and meta-analyses guideline was followed in selecting eligible studies.

RESULTS

Thirty studies were included in the final review, 8 of which were from the United States. The majority of the studies used self-administered questionnaires (75%) to collect data. Nurses were the most studied providers (87%), followed by physicians (27%). Fear of consequences is the most reported barrier (63%), followed by lack of feedback (27%) and work climate/culture (27%). Barriers to reporting were highly variable between different centers.

Medication Error Concept and Reporting Practices in Saudi Arabia: A Multiregional Study Among Healthcare Professionals

Background

Medication errors pose a risk for individual patients and for public health, with the misuse and overuse of medications being linked to severe patient safety problems. Therefore, the objective of this study was to investigate healthcare professionals’ (HCPs’) knowledge about medication errors, their knowledge about medication error reporting systems, and predictors for HCPs to report medication errors in Saudi Arabia.

Methods

An observational cross-sectional study was conducted among HCPs (physicians, pharmacists, and nurses) between January and March 2020. The study included 6 distinct locations in the Saudi Arabian regions of Hail, Al-Qassim, Al-Jouf, Al-Madinah, the eastern region, and the western region. Descriptive statistical and inferential analyses were computed using Statistical Package for the Social Sciences (SPSS) v.22.

Results

In total, 980 questionnaires for 348 (35.5%) physicians, 144 (14.7%) pharmacists, and 488 (49.8%) nurses were distributed with a response rate of 100%. Interestingly, only 277 (28.3%) of the HCPs had a good understanding of the stages of medication errors. With regard to reporting practices, a high number of the HCPs, 576 (58.8%), had not reported medication errors in their workplaces, and nearly 369 (37.7%) of respondents said they believe that legal implications are a major barrier to the reporting of medication errors. More than half, 524 (53.5%), of HCPs revealed that no clear electronic system is available for the reporting of medication errors in most hospitals. In addition, 537 (54.8%), of the HCPs had not attended any training programs regarding medication error reporting systems within the past year, which is alarming.

Conclusion

Our study identified a huge lack of the reporting of medication errors, knowledge about medication error stages, and training on medication errors. Therefore, an urgent need to address these weaknesses exists.

Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors

BACKGROUND

Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses' overall health affects the occurrence of medical errors.

OBJECTIVE

To examine the associations among critical care nurses' physical and mental health, perception of workplace wellness support, and self-reported medical errors.

METHODS

This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors.

RESULTS

A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%).

CONCLUSION

Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

Willingness to Report Medical Incidents in Healthcare: a Psychological Model Based on Organizational Trust and Benefit/Risk Perceptions

Many healthcare organizations have incident reporting systems to reduce and prevent medical errors. However, many systems have failed or not been implemented due to medical professionals' reluctance to report errors made by themselves or others. This study investigated the factors influencing their willingness to report incidents voluntarily. A psychological model based on the trust heuristic was proposed, hypothesizing that organizational trust could affect willingness to report based on the perceived benefits and risks of incident reporting or directly influence willingness to report. Three hundred twenty participants were recruited from 19 provinces in China to participate in an online survey conducted between June and July 2018. Participants included doctors, nurses, medical technicians, medical service staff, and administrative staff from different hospitals. All had access to incident reporting systems. Partial least squares structural equation modeling (PLS-SEM) was applied to examine the proposed psychological model. Participants had a modest willingness of reporting. Organizational trust was found to, directly and indirectly, affect participants' willingness to report their own incidents. Compared with perceived risk, perceived benefit was a more important predictor for willingness of reporting and a more important mediator in the effect of organizational trust on willingness of reporting. Our results highlight the importance of increasing the perceived benefit from incident reporting and building a "trust culture" for improving incident reporting.

Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

Incident reporting in health care prevents error recurrence, ultimately improving patient safety. A qualitative systematic review was conducted, aiming to identify barriers to incident reporting among nurses. Joanna Briggs Institute methodology for qualitative systematic reviews was followed, with data extracted using JBI QARI tools, and selected studies assessed for methodological quality using Critical Appraisal Skills Program (CASP). A meta-aggregation synthesis was carried out, and confidence in findings was assessed using GRADE ConQual. A total of 921 records were identified, but only five studies were included. The overall methodological quality of these studies was good and GRADE ConQual assessment score was "moderate." Fear of negative consequences was the most cited barrier to nursing incident reporting. Barriers also included inadequate incident reporting systems and lack of interdisciplinary and interdepartmental cooperation. Lack of nurses' necessary training made it more difficult to understand the importance of incident reporting and the definition of error. Lack of effective feedback and motivation and a pervasive blame culture were also identified.

The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review

Aim

To synthesize the available evidence on the relationship between the nursing practice environment in acute care hospitals and five selected nursing‐sensitive patient outcomes (mortality, medication error, pressure injury, hospital‐acquired infection and patient fall).

Design

A quantitative systematic review of literature was conducted using the PRISMA reporting guidelines (PROSPERO: CRD42020143104).

Methods

A systematic review was undertaken up to October 2020 using: CINAHL, MEDLINE and Scopus. The review included studies exploring the relationship between the nursing practice environment in adult acute care settings and one of five selected patient outcomes using administrative data sources. Studies were published in English since 2000.

Results

Ten studies were included. Seven studies reported that a favourable nursing practice environment reduced the likelihood of mortality in acute care hospitals, but estimates of the effect size varied. Evidence on the association between the nursing practice environment and medication administration error, pressure injury and hospital‐acquired infection was mixed.

Medical error reporting among doctors and nurses in a Nigerian hospital: A cross-sectional survey

AIM

To compare doctors' and nurses' perceptions of factors influencing medical error reporting.

BACKGROUND

In Nigeria, there is limited information on determinants of error reporting and systems.

METHODS

From the total workforce (N = 600), 140 nurses and 90 doctors were selected by random sampling and completed the questionnaire February to March 2017.

RESULTS

All 140 nurses and 90 doctors approached responded. Inter-professional differences in response to sentinel events showed that 55/140, 39.3% nurses and 48/90, 53.3% doctors would never report wrong medicines administered and 49/138, 35.5% nurses and 35/90, 38.9% doctors would never report a haemolytic transfusion error. Some respondents (72/140, 51.4% nurses vs. 29/90, 32.2% doctors) were unaware of reporting systems. Most (77/140, 55% nurses vs. 48/90, 53.3% doctors) considered these to be ineffective and confounded by a 'blame culture'. Perceived barriers included lack of confidentiality; facilitators included clear guidelines about protection from litigation.

CONCLUSIONS

Error reporting is suboptimal. Nurses and doctors have a minimal common understanding of barriers to error reporting and demonstrate inconsistent practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Suboptimal reporting of serious adverse events has implications for patient safety. Managers need to prioritize education in adverse events, clarify reporting procedures and divest the organisation of a 'blame culture'.

Nature of adverse events with opioids in hospitalised patients: a post-hoc analysis of three patient record review studies

OBJECTIVE

Opioids are increasingly prescribed and frequently involved in adverse drug events (ADEs). The underlying nature of opioid-related ADEs (ORADEs) is however understudied. This hampers our understanding of risks related to opioid use during hospitalisation and when designing interventions. Therefore, we provided a description of the nature of ORADEs.

DESIGN

A post-hoc analysis of data collected during three retrospective patient record review studies (in 2008, 2011/2012 and 2015/2016).

SETTING

The three record review studies were conducted in 32 Dutch hospitals.

PARTICIPANTS

A total of 10 917 patient records were assessed by trained nurses and physicians.

OUTCOME MEASURES

Per identified ORADE, we described preventability, type of medication error, attributable factors and type of opioids involved. Moreover, the characteristics of preventable and non-preventable ORADEs were compared to identify risk factors.

RESULTS

Out of 10 917 patient records, 357 ADEs were identified, of which 28 (8%) involved opioids. Eleven ORADEs were assessed as preventable. Of these, 10 were caused by dosing errors and 4 probably contributed to patients' death. Attributable factors identified were mainly on patient and organisational levels. Morphine and oxycodone were the most frequently involved opioids. The risk for ORADEs was higher in elderly patients.

CONCLUSIONS

Only 8% of ADEs identified in our sample were related to opioids. Although the frequency is low, the risk of serious consequences is high. We recommend to use our findings to increase awareness among physicians and nurses. Future interventions should focus on safe dosing of opioids when prescribing and administering, especially in elderly patients.

Factors Affecting the Failure to Report Medical Errors by Nurses Using the Analytical Hierarchy Process (AHP)

This cross-sectional study aimed to determine factors affecting the failure to report medical errors in teaching hospitals affiliated to Iran. The required data were collected during stages of systematic review and develop of researcher-made questionnaire. A total of 131 nurses were selected using Cochran's sample size formula. The collected data were analyzed by Analytic Hierarchy Process (AHP) using Expert Choice software. Results showed that the most important factors affecting the failure to report medical errors by nurses were, respectively, management-related factors (W = 0.595), nurse-related factors (W = 0.276), and factors related to the error reporting process (W = 0.128).

Knowledge, perceived barriers and facilitators of medication error reporting: a quantitative survey in Malaysian primary care clinics

Background Medication errors are the most common types of medical errors that occur in health care organisations; however, these errors are largely underreported. Objective This study assessed knowledge on medication error reporting, perceived barriers to reporting medication errors, motivations for reporting medication errors and medication error reporting practices among various health care practitioners working at primary care clinics. Setting This study was conducted in 27 primary care clinics in Malaysia. Methods A self-administered survey was distributed to family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. Main outcome measures Health care practitioners' knowledge, perceived barriers and motivations for reporting medication errors. Results Of all respondents (N = 376), nurses represented 31.9% (n = 120), followed by doctors (n = 87, 23.1%), pharmacists (n = 63, 16.8%), assistant medical officers (n = 53, 14.1%), pharmacist assistants (n = 46, 12.2%) and family medicine specialists (n = 7, 1.9%). Of the survey respondents who had experience reporting medication errors, 56% (n = 62) had submitted medication error reports in the preceding 12 months. Results showed that 41.2% (n = 155) of respondents were classified as having good knowledge on medication error and medication error reporting. The mean score of knowledge was significantly higher among prescribers and pharmacists than nurses, pharmacist assistants and assistant medical officers (p < 0.05). A heavy workload was the key barrier for both nurses and assistant medical officers, while time constraints prevented pharmacists from reporting medication errors. Family medicine specialists were mainly unsure about the reporting process. On the other hand, doctors and pharmacist assistants did not report primarily because they were unaware medication errors had occurred. Both family medicine specialists and pharmacist assistants identified patient harm as a motivation to report an error. Doctors and nurses indicated that they would report if they thought reporting could improve the current practices. Assistant medical officers reported that anonymous reporting would encourage them to submit a report. Pharmacists would report if they have enough time to do so. Conclusion Policy makers should consider using the information on identified barriers and facilitators to reporting medication errors in this study to improve the reporting system to reduce under-reported medication errors in primary care.

The mediating role of power distance and face-saving on nurses' fear of medication error reporting: A cross-sectional survey

BACKGROUND

The fear of social and professional consequences is a significant barrier to medication error reporting among nurses. Although some studies have identified cultural factors as playing a significant role in medication error reporting, little is known about the mechanisms by which these cultural characteristics influence the relationship between patient safety emphasis and the fear of medication error reporting.

OBJECTIVES

(1) Identify nurses' perceptions of patient safety emphasis, face-saving, power distance, and fear of medication error reporting; and (2) explore face-saving and power distance as the underlying mechanisms for cultural factors in the relationship between nurses' perceptions of safety emphasis and the fear of medication error reporting.

DESIGN

A cross-sectional, descriptive, and correlational design.

SETTINGS

Three tertiary teaching hospitals located in China, including one children's hospital and two adult hospitals.

PARTICIPANTS

We recruited a total of 569 female registered nurses with at least one year of work experience. Most of the participants (73.8%) were junior nurses with mid-associate or associate degrees (55.4%).

METHODS

Participants completed four questionnaires, including Safety Emphasis subscales from the Safety Climate Scale, Face-Saving Scale, the Index of Hierarchy of Authority, and the Nurses' Fear of Medication Error Reporting.

RESULTS

The average scores of safety emphasis, face-saving, power distance, and the fear of medication error reporting were 20.27 (SD=2.36), 14.63 (SD=3.57), 17.36 (SD=3.49), and 18.92 (SD=4.20), respectively. There were no demographic characteristics associated with these variables, except education (B=-0.16, p = 0.013) and work experience (B=-0.14, p = 0.019), which were related to power distance. Face-saving and power distance were significant mediators that explained the effect of safety emphasis on nurses' fear of medication error reporting. The overall indirect effect for both mediators was statistically significant (β=-0.27, p<0.05). When we compared the specific mediators' indirect effects, face-saving was a more powerful mediator than power distance (β=-0.24 vs. β=-0.04). These mediation effects remained after we adjusted for the effects of education and work experience on power distance.

CONCLUSIONS

When nurses have a common cultural background, they tend to perceive similar barriers to medication error reporting. For this study, face-saving and power distance are the two most important cultural factors because they significantly influence the relationship between safety emphasis and the fear of medication error reporting among Chinese nurses. It may not be possible to develop a work culture that minimizes fears of medication error reporting without first addressing face-saving needs and power differences.

Analysis of Medication Errors and near Misses Made by Nursing Students

Despite extensive research and technological advancements, errors related to medication administration continue to rise annually. The body of evidence surrounding medication errors has focused largely on licensed practicing nurses. Nursing students can offer a unique perspective regarding medication administration as their foundation for professional psychomotor skills and cognitive abilities are developed. The purpose of this study was to explore the variables related to medication errors made by pre-licensure nursing students. Data were collected from 2013–2015 in a pre-licensure program. Students completed a post-error survey available in Google Forms. One hundred thirteen responses to the error report were completed. By exploring the factors related to medication errors among nursing students, teaching and learning strategies forming the foundations of medication administration can improve professional nursing practice and improve safety and quality of care.

Ethical leadership, nursing error and error reporting from the nurses’ perspective

Background:

Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership.

Aim:

This study determined the level of ethical leadership from the nurses’ perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Research design:

This was a cross-sectional descriptive study.

Participants and research context:

A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using “ethical leadership in nursing, nursing errors and error reporting” questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics.

Ethical considerations:

This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study.

Findings:

The results showed that the level of nursing managers’ ethical leadership was moderate from the nurses’ point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers’ level of ethical leadership with error rates and error reporting.

Conclusion:

The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.

Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study

Background

Individual and organizational factors correlate with perceived barriers to error reporting. Understanding medication administration errors (MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and allows healthcare providers to report perceived and identified errors more frequently. Therefore, an emphasis must be placed on medication competence, including medication administration knowledge and decision-making. It can be helpful to utilize an organizational approach, such as collaboration between nurses and physicians, but this type of approach is difficult to establish and maintain because patient-safety culture starts at the highest levels of the healthcare organization. This study aimed to examine the canonical correlations of an individual self-efficacy/bottom-up organizational approach variable set with perceived barriers to reporting MAEs among nurses.

Methods

We surveyed 218 staff nurses in Korea. The measurement tools included a questionnaire on knowledge of high-alert medication, nursing decision-making, nurse-physician collaboration satisfaction, and barriers to reporting MAEs. Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson’s correlation coefficient, and canonical correlations were used to analyze results.

Results

Two canonical variables were significant. The first variate indicated that less knowledge about medication administration (− 0.83) and a higher perception of nurse-physician collaboration (0.42) were related to higher disagreement over medication error (0.64). The second variate showed that intuitive clinical decision-making (− 0.57) and a higher perception of nurse-physician collaboration (0.84) were related to lower perceived barriers to reporting MAEs.

Conclusions

Enhancing positive collaboration among healthcare professionals and promoting analytic decision-making supported by sufficient knowledge could facilitate MAE reporting by nurses. In the clinical phase, providing medication administration education and improving collaboration may reduce disagreement about the occurrence of errors and facilitate MAE reporting. In the policy phase, developing an evidence-based reporting system that informs analytic decision-making may reduce the perceived barriers to MAE reporting.

Knowledge, attitude and practice on medication error reporting among health practitioners in a tertiary care setting in Saudi Arabia

OBJECTIVES

To assess knowledge, attitudes and practices towards the reporting of medication errors among health practitioners at King Abdulaziz Medical city in Riyadh, Kingdom of Saudi Arabia. Methods: A cross-sectional study using a self-administered questionnaire was conducted in a convenient sample of 62 physicians and 303 nurses, between June and September 2017 at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Results: The sample consisted of 365 subjects, with a response rate of 73%. Approximately 97% had sufficient  knowledge and a favorable attitude (90%) towards medication error reporting. With regard to reporting practices, some participants (21.6%) preferred to educate those who made a medication error, rather than reporting it. Approximately 44.8% had not reported medication errors during their work experience. Conclusion: Study participants demonstrated a sufficient knowledge base with regard to medication error reporting. Despite sufficient knowledge and favorable attitudes towards medication error reporting, there is still an under-reporting of medication errors when it comes to practice. We recommend the establishment of frequent medication safety courses as a prerequisite for all health care providers. We also advocate the application of error detecting alarms such as digital programs to minimize medication errors.

Barriers to nurses reporting errors and adverse events

AIM

this study aimed to assess nurses' views about major barriers to reporting errors and adverse events in intensive care units.

METHOD

a descriptive analytical study was used to examine barriers to reporting such events. A questionnaire was completed by 251 nurses across seven hospitals in Iran to elicit information about their views on reporting errors and adverse events.

RESULTS

the study identified three main areas that prevented the reporting of incidents-fear of the consequences after reporting an error, procedural barriers and management barriers.

CONCLUSION

the most important approach to overcoming barriers that prevent nurses reporting adverse events would be to develop an atmosphere within which all nurses can report errors and the reasons that led to their occurrence honestly and without fear.

Exploration of Nurses' Knowledge, Attitudes, and Perceived Barriers towards Medication Error Reporting in a Tertiary Health Care Facility: A Qualitative Approach

Medication error reporting (MER) is an effective way used to identify the causes of Medication Errors (MEs) and to prevent repeating them in future. The underreporting of MEs is a challenge generally in all MER systems. The current research aimed to explore nurses' knowledge on MER by determining their attitudes towards reporting and studying the implicated barriers and facilitators. A total of 23 nurses were interviewed using a semi-structured interview guide. The saturation point was attained after 21 interviews. All the interviews were tape-recorded and transcribed verbatim, and analysed using inductive thematic analysis. Four major themes and 17 sub-themes were identified. Almost all the interviewees were aware about the existence of the MER system. They showed a positive attitude towards MER. The main barriers for MER were the impacts of time and workload, fear of investigation, impacts on the job, and negative reactions from the person in charge. The nurses were knowledgeable about MER but there was uncertainty towards reporting harmless MEs, thus indicating the need for an educational program to highlight the benefits of near-miss reporting. To improve participation strategies, a blameless reporting culture, reporting anonymously, and a simplified MER process should be considered.

Student perceptions of faculty feedback following medication errors - A descriptive study

Nursing students make medication errors as they progress through educational programs. It is important that faculty feedback is such that students feel comfortable reporting subsequent medication errors. The objectives of this study are to determine factors which increase the likelihood of nursing students reporting medication errors; to elicit nursing student perception of faculty feedback following a medication error, and determine how this faculty feedback impacts reporting of subsequent medication errors; and to develop recommendations regarding the most effective faculty approaches when providing feedback to nursing students following medication errors. This quantitative study uses a non-experimental, descriptive design. A convenience sample of 106 nursing students in one Canadian province completed a self-report questionnaire. The factors identified as increasing the likelihood of reporting medication errors for students who made a medication error were the same as for those who did not make an error. Group sizes were too small to determine if characteristics of faculty feedback had a significant impact on likelihood of reporting future errors. Students in both groups indicated intention to report errors based upon professional attitudes, behaviors and/or values. The researchers concluded that professional socialization, in combination with supportive learning environments, may increase student comfort in reporting medication errors.

Barriers to reporting of patient safety incidents in tertiary hospitals: A qualitative study of nurses and resident physicians in South Korea

We explored the barriers to reporting patient safety incidents experienced by nurses and resident physicians while working in tertiary hospitals in South Korea. Sixteen in-depth interviews with 10 nurses and 6 resident physicians, all of whom had experienced patient safety incidents, were conducted. The interviews were analyzed using directed content analysis in accordance with a coding scheme developed in this study, which contains 4 categories (incidents and reporters, reporting procedures and systems, feedbacks, and reporting culture) and 9 subcategories. The barriers to reporting near-misses included the following: characteristics of the incident (eg, nonhazardous and high frequency), reporters' lack of knowledge, uncertainty, fear of blame, lack of role model, and inappropriate responses. Reporting adverse/sentinel events was also prevented by feelings of pressure or guilt, the fact that reporting was nonmandatory, and a belief that reporting was not part of the job. Some other barriers included lack of education, review process after reporting, lack of confidentiality when reporting, absence of feedback for reporting, unfair reporting based on work experience, perception of potential blame, and stigmatization resulting from it. In South Korea, a national system for reporting and learning of patient safety accidents has been operating since July 2016. To fully implement this system, it is necessary to encourage reporting at the institutional level. Our results might help reduce the barriers to patient safety incident reporting among nurses and resident physicians in tertiary hospitals in Korea through informing the development of improvement plans.

Barriers to medication error reporting among hospital nurses

AIMS AND OBJECTIVES

The study purpose was to report medication error reporting barriers among hospital nurses, and to determine validity and reliability of an existing medication error reporting barriers questionnaire.

BACKGROUND

Hospital medication errors typically occur between ordering of a medication to its receipt by the patient with subsequent staff monitoring. To decrease medication errors, factors surrounding medication errors must be understood; this requires reporting by employees. Under-reporting can compromise patient safety by disabling improvement efforts.

DESIGN

This 2017 descriptive study was part of a larger workforce engagement study at a faith-based Magnet^® -accredited community hospital in California (United States).

METHODS

Registered nurses (~1,000) were invited to participate in the online survey via email. Reported here are sample demographics (n = 357) and responses to the 20-item medication error reporting barriers questionnaire. Using factor analysis, four factors that accounted for 67.5% of the variance were extracted. These factors (subscales) were labelled Fear, Cultural Barriers, Lack of Knowledge/Feedback and Practical/Utility Barriers; each demonstrated excellent internal consistency.

RESULTS

The medication error reporting barriers questionnaire, originally developed in long-term care, demonstrated good validity and excellent reliability among hospital nurses. Substantial proportions of American hospital nurses (11%-48%) considered specific factors as likely reporting barriers. Average scores on most barrier items were categorised "somewhat unlikely." The highest six included two barriers concerning the time-consuming nature of medication error reporting and four related to nurses' fear of repercussions.

CONCLUSIONS

Hospitals need to determine the presence of perceived barriers among nurses using questionnaires such as the medication error reporting barriers and work to encourage better reporting.

RELEVANCE TO CLINICAL PRACTICE

Barriers to medication error reporting make it less likely that nurses will report medication errors, especially errors where patient harm is not apparent or where an error might be hidden. Such under-reporting impedes collection of accurate medication error data and prevents hospitals from changing harmful practices.