ASSIGNMENT 3

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

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Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Literature Evaluation Table

Summary of Clinical Issue (200-250 words): Administering medication is one of the duties of nurses. Medication in the clinical setting is one of the major problems threatening the safety of patients and this can hugely affect morbidity and mortality rates. Medication errors occur most often than realized. They can occur at any phase of the process of medication. Medication errors occur most often than realized. Medication errors occur due to many reasons, some of which include; the prescribing, transcribing, dispensing, administering, monitoring and reporting processes. Many factors can affect the reason behind medication errors, some of which include burnout, fatigue, little work experience, being short -staffed, and an inconducive work environment. Nurses are at the forefront of medication errors because they administer medication. So, even if the physician prescribed the wrong medication or the wrong dose, the nurse is expected to catch that error and rectify it. The effects of medication errors are huge ranging from physical injuries to death. On top of this, they increase the financial burden on health care settings, cause emotional stress on the patient and family and that of health care professionals involved in the medication error. Nurses are always expected to mouthpiece or advocate of the patient by being very vigilant and reporting any medication error if they see one. One of the solutions to fixing the issue of medication errors is for the nurse to report a medication error as soon as committed or caught so that corrective measures can be put in place to prevent this type of error from happening again. But the question of how easy the workplace makes it for nurses to report medication errors is questionable. Many nurses are “put to shame” when they report medication errors rather than being applauded for doing the right thing. This definitely prevents some nurses from reporting medication errors on a timely manner or even reporting it at all.

PICOT Question: Does the workplace make it easy for nurses to report medication errors and in a timely manner?

Criteria

Article 1

Article 2

Article 3

APA-Formatted Article Citation with Permalink

Hashemi, F., Nasrabadi, A. N., & Asghari, F. (2017). Factors associated with reporting medical errors in Iran: a qualitative study. BMC nursing, 11(1), 20.

https://doi.org/10.1186/1472-6955-11-20

Elder, N. C., Brungs, S. M., Nagy, M., Kudel, I., & Render, M. L. (2016). Nurses’ perceptions of error communication and reporting in the intensive care unit. Journal of Patient Safety, 4(3), 162-168. doi: 10.1097/PTS.0b013e3181839b48

Alqubaisi, M., Tonna, A., Strath, A., & Stewart, D. (2016). Exploring behavioral determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework. European journal of clinical pharmacology, 72(7), 887-895.

https://doi.org/10.1007/s00228-016-2054-9

How Does the Article Relate to the PICOT Question?

It is related to PICOT because it tries to how to explain the barriers to reporting medication error, therefore, they have a challenge of reporting medication errors to relevant authorities

It explains how the nurses are thorn between telling each other the truth when one makes a mistake or just keep quiet and watch, or report the matter to the authorities.

It is related to PICOT since it tries to understand the behavioral patterns of nurses of how they are going to report medication errors.

Quantitative, Qualitative (How do you know?)

It is qualitative research because it assesses the reaction of the nurses towards medication errors.

It is a qualitative research because the nurses were determined to report the cases to the relevant authorities.

It is a qualitative study because it assesses the nurse’s behavior towards reporting the medication error.

Purpose statement

The reason for this study is to identify the obstacles that prevent them from reportage medication errors.

To formulate a pattern of communication in case medication errors have occurred in the intensive care unit.

The chief indication for this paper is to comprehend the nurse’s pattern behavior in reporting the incidents.

Research Question

To determine the barriers that prevents them from reporting medication errors.

To determine if reporting daily incidences in the ICU by the nurses will reduce cases of medical errors

To determine the attitude of nurses towards reporting medication errors.

Outcome

The nurses encountered barriers that hindered them from reporting the incidences.

The study shows that the nurses were able to come up with a good way of communication such that in case of challenges the nurses will know the exact thing to do in such a scenario.

The study shows that the patient’s safety and the health facility depend of behavioral determinants on reporting.

Setting (where did the study take place?)

Medical-surgical ward

Intensive Care Unit

Medical-surgical hospital

Sample

34 nurses

92 nurses of 4 different hospitals

10 nurses participated

Methods

Self- questionnaires were administered.

Administer the questionnaires.

Face-face interview, semi-structured interview

Key Findings of the Researcher

Fear and administrative barriers were on the top list that prevented them from reporting.

The nurses were reluctant to disclose their medical errors but instead, he or she had better disclosed the witnessed error to their authorities

The nurses feared to reporting medication errors since they feel like they have to protect their career and reputation.

Recommendations of the Researcher

The relevant authorities should develop a friendship with the students, thus improving the patient’s safety.

I would recommend that the relevant authorities should educate their nurses on the importance of reporting such incidences.

The negative behavioral determinants can be used to bring change in a facility thus improving patient’s safety.

Criteria

Article 4

Article 5

Article 6

APA-Formatted Article Citation with Permalink

BRADY, A. M., MALONE, A. M., & Fleming, S. (2017). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of nursing management, 17(6), 679-697.

https://doi.org/10.1111/j.1365-2834.2017.00995.x

Pronovost, P., Weast, B., Schwarz, M., Wyskiel, R. M., Prow, D., Milanovich, S. N., & Lipsett, P. (2016). Medication reconciliation: a practical tool to reduce the risk of medication errors. Journal of critical care, 18(4), 201-205.

https://doi.org/10.1016/j.jcrc.2016.10.001

Montesi, G., & Lechi, A. (2019). Prevention of medication errors: detection and audit. British journal of clinical pharmacology, 67(6), 651.

https://dx.doi.org/10.1111%2Fj.1365-2125.2019.03422.x

How Does the Article Relate to the PICOT Question

It tries to explain the nurses’ managers implement the policies that will help to reduce the causes of these errors such as reportage at international level and, thus making an audit of the nursing practice. It helps to educate the nurses on how medication errors can harm the patient and the nurse herself; therefore, one must be careful not to make such mistakes.

It describes how the nurses can use data surveys such as carrying survey on discharges and admission in that the drugs that are wrongly prescribed by the physician will be changed as soon as possible.

It explains how the nurses can reduce medication errors by use of self-reporting and voluntary reporting of self.

Quantitative, Qualitative (How do you know?)

It is quantitative research because the outcome can be measured.

Quantitative.It evaluates using numbers and the results are measurable.

It is a quantitative study because the results are recorded in numbers and measurable.

Purpose Statement

Reporting incidences of medication errors by the nurses will act as a form off training to the nurses as preventive measures of future occurrence

The purpose of this study will help reduce the incidence of medication errors by following up on drugs orders with the first 24 hours.

The medication errors will be corrected through warning, direct observation and help to promote the safe practice of medication admiration such as the use of five rights.

Research Question

To determine if nursing management nurses will be sufficient for correcting medication errors.

To determine if data survey on admission and discharges reduce cases of these errors.

Assess the effects of self –reporting and voluntarily reporting

Outcome

The nursing audit shows that most of the nurses make errors but they are afraid of perception of other nurses

The study shows cancellation of the orders on drugs on admission and discharges within the first 24 hours reduces the cases of medication errors.

Some of the nurses were afraid of reporting the incidences to the relevant authorizes while few of them admitted and were ready to share their experiences.

Setting (where did the research take place?)

The study was done to all the units in charges

Intensive care unit

Medical-surgical unit

Sample

92 unit nurses were subjected to a test.

Home medication, medical anesthesia records and allergies were reviewed.

All the medical unit nurses participated in the study.

Method

Questionnaires and interviews were used

Data analyzing of medical anesthesia, home medication and allergies report.

Report systems, direct observation

The key finding of the researcher

The nurses were overworked, fear of losing their job in case they report such incidences and lack of motivation among the staff

The medication errors which were found in drug orders were corrected before the end of 24 hours.

Some of the nurses were afraid of reporting the incidences to the relevant authorizes while few of them admitted and were ready to share their experiences. Recommendations of the Researcher

I would recommend that each nurse who advocates of the patients by taking in the prevention of medication errors through reporting of such cases.

I would recommend that should continue with the same spirit of championing in the eradication of such errors.

The nurses should always practice nursing audit on medication and practice the reporting of medication errors.

References

Hashemi, F., Nasrabadi, A. N., & Asghari, F. (2017). Factors associated with reporting medical errors in Iran: a qualitative study. BMC nursing, 11(1), 20. https://doi.org/10.1186/1472-6955-11-20

Montesi, G., & Lechi, A. (2019). Prevention of medication errors: detection and audit. British journal of clinical pharmacology, 67(6), 651. https://dx.doi.org/10.1111%2Fj.1365-2125.2019.03422.x

Tang, F. I., Sheu, S. J., Yu, S., Wei, I. L., & Chen, C. H. (2017). Nurses relate the contributing factors involved in medication errors. Journal of clinical nursing, 16(3), 447-457

Running head: FACTORS AFFECTING THE REPORTING OF MEDICATION ERRORS BY NURSES

FACTORS RELATED TO THE REPORTING OF MEDICATION ERRORS BY NURSES

Factors Affecting the Reporting of Medication Errors by Nurses

One fundamental aspect in the delivery of healthcare is the safety of the patients. The safety of the patients is a priority for every healthcare system and it involves providing quality and safe care. However, the quality of healthcare is greatly affected by medication errors nurses make and even worse by the poor system surrounding the reporting of those medication errors. The process of delivering safe care must be free of medication errors, and ensure an effective system of reporting medication errors which will not only prevent further harm to patients but also to help in designing measures to prevent such errors in the future. Due to the poor or lack of reporting system in healthcare facilities, the maintenance and improvement of quality healthcare and safety of the patients is affected . The poor reporting practices are associated with fear, administrative barriers, and the lack of commitments from the hospital management. Therefore, the poor reporting practices by nurses are associated with several factors which act as barriers. This paper will discuss some factors related to reporting of medication errors by nurses backed-up by the articles below.

Article I

: Hashemi, F., Nasrabadi, A. N., & Asghari, F. (2017). Factors associated with reporting medical errors in Iran: a qualitative study. BMC Nursing, 11 (1), 20. https://doi.org/10.1186/1472-6955-11-20

Article II

: Alqubasi, M., Tonna, A., Strath, A., & Stewart, D. (2016). Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework. European journal of clinical pharmacology, 72 (7), 887-895. https://www.ncbi.nlm.nih.gov/pubmed/27066954

Background of Study

Article I

The study was aimed at clarifying the factors linked to the reporting of the nursing errors through the experience of the clinical nurses and the nursing managers. This research work was guided by the research question aimed at determining the barriers preventing nurses from giving reports on the medication errors. The problem that the authors of this study dealt with was related to the reporting of the professionals’ errors. The safety of the patient in healthcare is affected by the increasing number of avoidable medication errors which then tends to be common in most healthcare facilities (Hashemi, Nasrabadi, & Asghari, 2017). The major area of focus of healthcare facilities and healthcare providers needs to be on the safety of the patients. The safety of the patients is achieved through a reduction of medication errors once they are identified. The successful process of dealing with medication errors need proper reporting to determine the type of errors and the best solution that can be used to deal with them. However, due to the poor process of giving reports on medication errors by healthcare professionals, it becomes hard to improve on the safety of the patients. This study is important to nursing since it informs about the importance of identifying the barriers to the process of providing reports on the medication errors to help in the improvement of patient safety. This study also informs about some of the factors that are acting as barriers towards reporting of nursing errors (Hashemi, Nasrabadi, & Asghari, 2017).

Article II

Successful medical error reporting processes are important in the promotion of the patients’ safety. According to the authors of this article, there is inadequate research that has explored the reporting of medication errors by the proffesionals in the medical field. Therefore, this study was aimed at describing as well as providing knowledge about the behavioral determinants of the healthcare providers’ reporting of medication errors. The research question in this article was aimed at determining the attitude of the nurses towards givig reports of the medication errors. This study is important in the nursing practice since the determinants in this study can be used to help in mapping the behavioral change strategies that healthcare facilities can develop as interventions, improving the organizational reporting and safety culture, and improving the effectiveness of the medication error reporting (Alqubasi, Tonna, Strath, & Stewart, 2016).

How the Study Support the Nurse Practice Issue Chosen

Article I

The article is supports the chosen issue since it attempts to explain some of the barriers to the process of giving reports on medication errors by the nurses. The chosen issue was focuses on whether the work environment encourages nurses to give reports on medication errors promptly. This article confirms that nurses are faced with several challenges that prevent the process of reporting medication errors by the nurses. This implies that within these facilities, nurses are facing challenges when it comes to reporting the medication errors thus making it hard to improve on the safety of the patients (Hashemi, Nasrabadi, & Asghari, 2017).

Article II

The article attempts to gain an understanding of the behavioral patterns of the nurses when it comes to the reporting of medical erros. This research work shows that there are behaviors among nurses which makes it hard for the facility to get medication errors reported to design the best solutions to the issue. The behaviors of the nurses might be based on the individuals’ attitudes or might be due to the underlying factors within the facilities (Alqubasi, Tonna, Strath, & Stewart, 2016).

Methods of Study

Article I

The authors of this article utilized qualitative study techniques and adopted the focus group methodology to help in investigating the nurses’ perceptions as well as their feelings concerning some of the factors linked to the process of giving reports of the nursing errors. Before meeting the participants, written informed consent were acquired from the participants. About 115 nurses employed in the healthcare facilities working in the clinics affiliated to Tehran and Shiraz were targeted. Semi-structured group discussion was used to gather data in a 17 sessions. The data wes analyzed using a content analysis approach. Even though the focused-group discussion study method employed by the researchers help in the measurement of the reaction of the participants, it however not effective in covering maximum depth on this issue. It is also possible for the members not to express their honest and personal thoughts (Hashemi, Nasrabadi, & Asghari, 2017).

Article II

When compared to the previous study which involved the focused group discussion, this study utilized qualitative face-to-face design and the semistructured interviews. The study was performed in three major medical-surgical healthcare facilities with 412, 451, and 461 beds In Abu Dhabi United Arab Emirates. The method employed by the authors helped in covering the maximum depth of the issue, however, it cannot guarantee the honesty of the study subjects and sometimes hard to compare the responses (Alqubasi, Tonna, Strath, & Stewart, 2016).

Results of Study

Article I

The outcome of the study shows that nurses faced barriers that prevented them from reporting the medication error incidences. The fear and administrative barriers were the key barriers to the factors that are preventing nurses from giving reports on the medication errors. The results of this study have implications in the nursing practice since it shows that training the nurses and the nursing managers about the goals of error reporting and methods of utilizing the information is important in making improvements to the safety of the patients and the quality of the healthcare (Hashemi, Nasrabadi, & Asghari, 2017).

Article II

The safety of the patients and the organization is determined by the behavioral determinants of reporting of the medication errors. Nurses fear giving reports medication errors since they believe that their career is important and are not ready to be responsible for those errors thus prefer to ignore the reporting of the medication errors. Nurses are also discouraged from reporting since they do not receive feedback after reporting. They also fear that they might affect their professional reputation. This study implies that the determinants in the study can be used to map the behavioral changes strategies that help in the promotion of the development of the interventions, promoting the safety and a culture of reporting, and improvement of the medication error reporting (Alqubasi, Tonna, Strath, & Stewart, 2016).

Ethical Consideration

Article I

The ethical consideration of the study was achieved through giving a description of the research purpose, seeking written informed consent forms for participants participating in the group discussion, taking records of the participants’ voice, willingness to share the study results, maintenance of the anonymity, and allowing the participants the choice of withdrawing from the study at any stage (Hashemi, Nasrabadi, & Asghari, 2017).

Article II

The authors followed the ethical procedures required before the performance of this research work. This is because the authors obtained ethical approval from the ethical review panel of the university in the United Kingdom and the ethics committee of each hospital from the United Arab Emirates that participated in the study (Alqubasi, Tonna, Strath, & Stewart, 2016).

Conclusion

Patient safety is considered to be an important aspect in the quality of healthcare. The issue of healthcare quality is affected by the poor reporting practices by the nurses. The poor reporting practices are associated with the fears and the barriers from the administration. These barriers are affecting the efforts and willingness of the nurses to report on the medication errors. Nurses also fear a bad reputation and losing their jobs when they give reports on the medication errors especially if those errors are caused by the nurses themselves. The poor reporting approaches is also increased by the lack of commitment from the hospital management to provide the feedback on some of the strategies that are being planned to help in dealing with those issues. So, there needs to be a better system in place that encourages nurses in the work environment to report medication errors to ensure the safety of patients which is the number one priority in health care.

References

Alqubasi, M., Tonna, A., Strath, A., & Stewart, D. (2016). Exploring behavioral determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework. European journal of clinical pharmacology, 72 (7), 887-895. https://www.ncbi.nlm.nih.gov/pubmed/27066954
Bahadori, M., Ravangard, R., Aghili, A., Sdeghifar, J., Manshadi, M. G., & Smaeilnejad, J. (2013). The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses’ Viewpoints: A Case Study in a Hospital in Iran. ISRN Nursing.
Hashemi, F., Nasrabadi, A. N., & Asghari, F. (2017). Factors associated with reporting medical errors in Iran: a qualitative study. BMC Nursing, 11 (1), 20.

ResearchCritique Guidelines – Part II

Use this document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the studies in your responses.

Quantitative Studies

Background

1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

1. Discuss how these two articles will be used to answer your PICOT question.

. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

1. State the methods of the two articles you are comparing and describe how they are different.

2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

1. Summarize the key findings of each study in one or two comprehensive paragraphs.

What are the implications of the two studies you chose in nursing practice?

Outcomes Comparison

1. What are the anticipated outcomes for your PICOT question?

2. How do the outcomes of your chosen articles compare to your anticipated outcomes?

Reportingof medication administration errors by nurses in South Korean hospitals

Eunjoo Lee

International Journal for Quality in Health Care, Volume 29, Issue 5, October 2017, Pages 728–734,

https://doi.org/10.1093/intqhc/mzx096

Published:

28 July 2017

Article history

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Abstract

Objective

To identify differences in what nurses consider as medication administration errors, to examine their willingness to report these errors and to identify barriers to reporting medication errors by hospital type.

Design

Cross-sectional, descriptive design. The questionnaire comprised six medication administration error scenarios and items related to the reasons for not reporting medication errors.

Setting

Two tertiary and three general hospitals in a metropolitan area, and five general hospitals in K province, in South Korea.

Participants

Registered nurses working at tertiary and general hospitals in South Korea (n = 467).

Main outcome measures

Consideration of medication administration errors, intention to report medication errors and reasoning for not file an incident report.

Results

There were no significant differences in what nurses considered as medication administration errors between nurses working different in hospital types. The rate of incident reporting was very low; it ranged from 6.3% to 29.9%, regardless of hospital type. Korean nurses were more likely to report an error to a physician than file an incident report. The primary reason for not reporting medication errors was fear of the negative consequences of reporting the error and subsequent legal action.

Conclusions

The rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. These results may have significant implications for improving medication safety in hospitals, and more efforts are needed at the organizational level to improve incident reporting by nurses.

medication errors

Korea

patient safety

incident reporting

Topic:

·
medication errors

nurses

drug administration error

·
incident reporting

south korea

Issue Section:

Research article

Introduction

Globally, patient safety is a central issue in the current healthcare system. Medication errors, the most common type of medical error [1–5], result in negative consequences, including long hospital stays, increased economic burden [6] and threat to patients’ lives [1, 7, 8]. In view of this, medication errors have been used as a barometer of patient safety [9].

Healthcare organizations in South Korea are not immune to medication errors. In a previous study, 98.7% of Korean nurses reported that they had committed medication errors within the previous 3 months, with an average of 13.57 medication errors reported [10]. However, approximately 88% of medication errors are intercepted by nurses [11]. These findings suggest that nurses are the healthcare professionals who could contribute the most toward the reduction of medication errors by performing checks at the final stage of medication administration. Furthermore, the number and severity of medication errors could primarily depend on the ability of nurses to manage the medication administration process. Thus, assessing nurses’ knowledge and behavior with regard to medication administration is critical for enhancing patient safety in healthcare systems.

While most nurses perceive themselves as knowledgeable about medication errors, previous studies have indicated disagreement among nurses concerning the definition of a medication error [12–16]. A medication administration error is defined as a ‘deviation from the prescriber’s medication order as written on a patient’s record, manufacturers’ preparation, administration instructions or institutional policies/procedures’ on medication administration’ [17]. Identifying what nurses consider as medication administration errors would be an important first step towards enhancing medication administration safety [1]. Without a coherent understanding of medication administration errors, differing decisions as to whether to file an incident report will likely persist among nurses.

Medication error reporting provides an opportunity to identify and correct errors that threaten patient safety by communicating and sharing knowledge stored in an incident reporting system. Nurses must be able to learn from their own and others’ errors. However, the rate of medication error reporting described over the past decade has been very low internationally [2–4, 8, 12, 18–20]. In Korea, the rate may be even lower, as only 50.8% of hospitals have adopted an electronic incident reporting system [21].

Little research has been conducted to directly examine what nurses consider as medication administration errors, their behavior with regard to medication error reporting, and any differences that exist among nurses working at different types of hospitals. Most studies on medication administration errors have focused on safety culture or climate, factors that contribute to the errors, work environment and incident reporting [3–5, 7, 8, 10]. Additionally, previous research has been mainly implemented in tertiary hospitals [3, 4, 10, 18], with a dearth of studies in mid-sized, or less acute hospitals, especially in South Korea.

Therefore, this study aimed to identify differences by hospital type in what nurses in South Korea consider as medication administration errors, and in their intention towards reporting these errors. Based on these data, educational programs to improve safety on medication administration error could be developed. In addition, these data can help to inform strategies that could be implemented in an effort to eliminate or remove barriers to reporting errors.

Methods

Design

This study employed a descriptive, cross-sectional design using a questionnaire measure.

Settings and population

The healthcare system in South Korea is predominantly private [22], with private clinics and hospitals representing more than 95% of all healthcare facilities [23]. Currently, the numbers of tertiary and general hospitals in Korea are 44 and 281, respectively [23]. In addition, the majority of healthcare facilities are located in urban and metropolitan areas, which results in a disproportionate amount of acute care hospitals in South Korea [22, 23].

Participants were registered nurses (RNs) working in two tertiary and three general hospitals in a metropolitan area, and in five general hospitals in the K province of South Korea. These 10 hospitals were located in geographically diverse regions of Korea. Hospital size varied, with bed capacities ranging from 100 to 900. The number of nurses working in each hospital also varied from approximately 70 to 600 nurses per hospital. Only two tertiary hospitals had an electronic incident reporting system, and the others had a paper-based incident reporting system. All RNs engaged in direct patient care were invited to participate. Sample size was calculated using the G*Power 3.1 program [24]. In total, 470 participants were required for an effect size of 0.03, with a power (1 – β) of 0.90, and a two-tailed alpha of 0.05 [24, 25], with an allocation ratio of 3:1 in an independent t-test analysis.

Questionnaire development

A questionnaire was used to identify what Korean nurses consider as medication administration errors, and to examine their intention to file an incident report and to report the error to the physician. The questionnaire comprised three parts. The nurses were presented six scenarios and were first asked whether each scenario could be categorized as a medication administration error. Subsequently, using the same scenarios, nurses were asked if they would report the error to the physician, and, finally, they were asked if they would file a report in the incident reporting system. For each question, the nurses were asked to answer ‘Yes,’ ‘No’ or ‘Do not Know.’ Finally, nurses were asked to cite the reasons for not reporting medication administration errors in the incident reporting system.

Translation and validation of medication administration scenarios into Korean language

Six medication administration scenarios, developed by Mayo and Duncan [12] based on theoretical or hypothetical medication administration errors, were adopted in this study. First, the six scenarios were translated into Korean by a bilingual researcher, and then they were back-translated into English by another bilingual professor who had majored in English. These two versions were reviewed by a Korean American professor in a college of nursing in the USA, and minor revisions were made to minimize confusion and improve clarity. Then, the revised scenarios were reviewed by five RNs in Korea to ensure face validity. All the RNs had Master’s degrees in nursing, with 5–18 years of experience in direct patient care. As these RNs reported that the Korean version of the scenarios was clear to understand, they were adopted in the study without any further changes.

After the questionnaire was designed, pilot testing was conducted with six RNs with more than 5 years of work experience in the medical intensive care unit (MICU) in order to identify any misunderstandings or confusion by the participants regarding the questionnaire. These nurses approved use of the questionnaire without changes.

Reasons for not reporting medication errors using an incident reporting system

On the basis of the Modified Gladstone Survey [16], a literature search, and input from five experts, each with more than 10 years of clinical nursing experience in tertiary hospitals, 14 items were developed to determine the reasons for frequent failure by Korean nurses to report medication errors.

Each item was rated on a 6-point Likert-type scale ranging from 1 (Very Strongly Disagree) to 6 (Very Strongly Agree), to enable comparisons with previous studies [26, 27]. A pilot test was then conducted with six RNs, each with more than 5 years of work experience in the MICU, to ensure face validity. Several items were revised to increase clarity.

Data collection procedures

A convenience sampling method was employed to select participants. The researcher visited three of the hospitals and explained the study purposes and data collection procedures to the directors of the nursing departments. Owing to geographical barriers, the other seven hospitals were contacted by telephone. After obtaining permission, the questionnaires were delivered to the respective nursing departments by express mail. The total number of questionnaires distributed to each hospital was primarily based on the number of nurses working and input from the nursing director at each hospital. A total of 650 questionnaires were distributed, and 480 were returned, resulting in a response rate of 73.8%. Thirteen questionnaires were excluded from analyses because of insufficient information. The response rate of the participating units ranged from 69% to 90%.

Each potential participant received a letter containing information explaining the purposes of the study along with the questionnaire. The consent form clearly stated that participants were free to decide to participate in the study and were not compelled to do so in any way or by anyone. The participants were informed of their right to withdraw from the study at any time. The final sample reflected those who agreed to participate in the study by completing the questionnaires.

In order to increase the response rate, three reminder calls were made to the directors of the nursing departments of the participating hospitals. A locked box for the completed questionnaires was placed in the nursing lounge of each unit for 2 weeks. The participants were asked to return the completed questionnaires within 2 weeks. A research assistant visited three of the hospitals to retrieve the questionnaires, while the other hospitals returned the questionnaires by express mail. All of the data collected were stored to ensure confidentiality and anonymity.

Analysis

The data were analyzed using SPSS 19.0 (SPSS Inc., IL, USA). A chi-square test was used to examine differences between hospital types in terms of the demographic variables of nurses, what they considered as medication administration errors, and their willingness to report these errors. Independent t-tests were used to compare nurses’ reasons for not reporting medication errors in the incident reporting system between hospital types. Results were considered to be statistically significant when P < 0.05

Results

Demographic characteristics of the participants

A total of 467 RNs participated in this study. The numbers of nurses working in tertiary and general hospitals were 349 and 118, respectively. In both types of hospitals, most participants were female, less than 30 years of age, and only about 17% were older than 36 years. Almost 40.5% of nurses had above a Bachelor of Science in Nursing (BSN) degree in tertiary hospitals, whereas almost 85% of nurses in the general hospitals had a diploma. There were no differences in gender, age or years of experience between hospital types, but education level was higher among nurses working in tertiary hospitals (

Table 1

Demographic characteristics of participants

Tertiary hospital

General hospital

n = 349

n = 118

Gender

Female

342 (98.0%)

115 (97.5%)

0.73

Male

7 (2.0%)

3 (2.5%)

Age (years)

≤25

111 (32.2%)

37 (31.4%)

0.98

26–30

132 (38.3%)

44 (37.3%)

31–35

45 (13.0%)

17 (14.4%)

≥36

57 (16.5%)

20 (16.9%)

Educational degree

Diploma

210 (60.5%)

100 (84.7%)

0.001

Above BSN

137 (39.5%)

18 (15.3%)

Years working as an RN

<1 year

28 (8.1%)

8 (6.9%)

0.49

≥1 and <4 years

108 (31.3%)

39 (33.6%)

4–7 years

85 (24.6%)

33 (28.4%)

7–10 years

45 (13.0%)

18 (15.5%)

Over 10 years

79 (22.9%)

18 (15.5%)

What Korean nurses consider as medication administration errors by hospital type

The data on what nurses considered as medication administration errors by hospital type are presented in

Table 2

. There were no significant differences in what nurses considered as medication administration errors between tertiary and general hospitals.

Table 2

What nurses consider a medication administration error: difference between hospital types

Yes

Don’t know

7 (5.9%)

Yes

Don’t know

Yes

Don’t know

Yes

69 (58.5%)

Don’t know

Yes

Don’t know

19 (5.6%)

Scenarios: drug error				Hospital type
		Tertiary			General
		A patient misses the midday dose of oral Ampicillin because the patient was in X-ray for 3 h.
						Yes	158 (46.6%)	50 (42.4%)
						No	156 (46.0%)	61 (51.7%)		0.55
						Don’t know	25 (7.4%)		7 (5.9%)
Four patients in a busy surgical unit receive their 6 PM dose of IV antibiotics 4 h late.
235 (68.7%)	79 (66.9%)
94 (27.5%)	32 (27.1%)	0.62
13 (3.8%)
A patient receiving TPN feeding via an infusion pump is given 200 ml/h instead of the correct rate of 125 ml/h for the first 3 h of the 24-h infusion. The pump was reset to the correct rate after the change of shift at 7 AM, when the incoming nurse realized that the pump was set at the incorrect rate.
312 (91.5%)	108 (92.3%)
20 (5.9%)	5 (4.3%)	0.74
9 (2.6%)			4 (3.4%)
		A patient admitted with status asthmaticus on 08/13 at 2 AM is prescribed albuterol (Ventolin) nebulizers every 4 h. The nurse omits the 6 AM dose on 08/13 as the patient is asleep.
198 (58.2%)		69 (58.5%)
123 (36.2%)	40 (33.9%)	0.70
	19 (5.6%)		9 (7.6%)
A physician orders oxycodone hydrochloride and acetaminophen (Percocet) 1–2 tablets to manage postoperative pain every 4 h. At 4 PM the patient complains of pain, requests 1 pill, and is medicated. At 6:30 PM the patient requests a second pain pill. The nurse administers the pill.
107 (31.6%)	39 (33.1%)
204 (60.2%)	0.95
28 (8.3%)	10 (8.5%)
A patient is receiving a routine 9 AM dose of digoxin every day. Yesterday’s digoxin level was 1.8 (the high side of normal). Another sample was drawn at 6 AM today, to test the digoxin level. At 9 AM the nurse withholds the digoxin administration because the lab value is not available yet.
79 (23.2%)	15 (12.7%)
242 (71.2%)	95 (80.5%)	0.05
	8 (6.8%)

TPN, total parenteral nutrition.

Intent to report medication administration errors to the physician by hospital type

There were no significant differences in physician reporting between nurses in tertiary and general hospitals in all six medication administration error scenarios. Thus, regardless of whether nurses classified an incident as a medication error, more than 50% of the nurses responded that they would notify a physician (

Table 3

Willingness of nurses to notify medication administration errors to physicians: difference between hospital types

Hospital type

Tertiary

General

A patient misses the midday dose of oral Ampicillin because the patient was in X-ray for 3 h.

Yes

Don’t know

Yes

Don’t know

4 (3.4%)

Yes

Don’t know

A patient admitted with status asthmaticus on 08/13 at 2 AM is prescribed albuterol (Ventolin) nebulizers every 4 h. The nurse omits the 6 AM dose on 08/13 as the patient is asleep.

Yes

Don’t know

10 (3.0%)

7 (6.0%)

Yes

Don’t know

3 (2.5%)

Yes

18 (15.3%)

0.46

Don’t know

10 (3.0%)

4 (3.4%)

Scenarios: notify the physician
215 (64.4%)	80 (67.8%)
109 (32.6%)	33 (28.0%)		0.56
		10 (3.0%)	5 (4.2%)
	Four patients on a busy surgical unit receive their 6 PM dose of IV antibiotics 4 h late.
167 (50.5%)	67 (56.8%)
145 (43.8%)	47 (39.8%)	0.38
19 (5.7%)
	A patient receiving TPN feeding via an infusion pump is given 200 ml/h instead of the correct rate of 125 ml/h for the first 3 h of the 24-h infusion. The pump was reset to the correct rate after the change of shift at 7 AM when the incoming nurse realized that the pump was set at the incorrect rate.
235 (70.6%)	77 (65.8%)
87 (26.1%)	33 (28.2%)	0.37
11 (3.3%)		7 (6.0%)
181 (54.7%)	73 (62.4%)
140 (42.3%)	37 (31.6%)		0.07
A physician orders oxycodone hydrochloride and acetaminophen (Percocet) 1–2 tabs for post-operation pain every 4 h. At 4 PM the patient complains of pain, requests 1 pill, and is medicated. At 6:30 PM the patient requests a second pain pill. The nurse administers the pill.
233 (69.8%)	88 (74.6%)
85 (25.4%)	27 (22.9%)		0.46
16 (4.8%)
	A patient is receiving a routine 9 AM dose of digoxin every day. Yesterday’s digoxin level was 1.8 (the high side of normal). A digoxin level was drawn at 6 AM today. At 9 AM the nurse withholds the digoxin because the lab value is not available yet.
288 (86.0%)		96 (81.4%)
37 (11.0%)

Intent to report medication administration errors in the incident reporting system by hospital type

There were no significant differences in filing a report in the incident reporting system between nurses in tertiary and general hospitals in all six medication administration error scenarios (

Table 4

). In five of the scenarios, with the exception of the infusion pump issue, more than 70% of nurses indicated that they would not file an incident report. Furthermore, in three of the six scenarios, fewer than 10% reported that they would file an incident report.

Table 4

Willingness of nurses to report medication administration errors in the incidence reporting system: difference between hospital types

Hospital type

Tertiary

General

A patient misses the midday dose of oral Ampicillin because the patient was in X-ray for 3 h.

Yes

Don’t know

18 (15.5%)

Four patients on a busy surgical unit receive their 6 PM dose of IV antibiotics 4 h late.

Yes

Don’t know

A patient receiving TPN feeding via an infusion pump is given 200 ml/h instead of the correct rate of 125 ml/h for the first 3 h of the 24-h infusion. The pump was reset to the correct rate after the change of shift at 7 AM when the incoming nurse realized that the pump was set at the incorrect rate.

Yes

Don’t know

A patient admitted with status asthmaticus on 08/13 at 2 AM is prescribed albuterol (Ventolin) nebulizers every 4 h. The nurse omits the 6 AM dose on 08/13 as the patient is asleep.

Yes

Don’t know

Yes

8 (6.8%)

96 (81.4%)

Don’t know

14 (11.9%)

A patient is receiving a routine 9 AM dose of digoxin every day. Yesterday’s digoxin level was 1.8 (the high side of normal). A digoxin level was drawn at 6 AM today. At 9 AM the nurse withholds the digoxin because the lab value is not available yet.

Yes

9 (7.6%)

259 (78.2%)

Don’t know

37 (11.2%)

Scenarios: filing an incident report
21 (6.3%)	14 (12.1%)
	259 (78.2%)	84 (72.4%)	0.14
51 (15.4%)
31 (9.3%)	22 (18.6%)
249 (75.0%)	82 (69.5%)		0.02
52 (15.7%)		14 (11.9%)
99 (29.7%)	35 (29.9%)
187 (56.2%)	63 (53.8%)	0.84
47 (14.1%)	19 (16.2%)
41 (12.4%)	20 (17.1%)
253 (76.7%)	81 (69.2%)	0.27
36 (10.9%)	16 (13.7%)
A physician orders oxycodone hydrochloride and acetaminophen (Percocet) 1–2 tabs for postoperation pain every 4 h. At 4 PM the patient complains of pain, requests 1 pill, and is medicated. At 6:30 PM the patient requests a second pain pill. The nurse administers the pill.
27 (8.2%)
267 (80.7%)	0.88
	37 (11.2%)
35 (10.6%)
90 (76.3%)	0.29
19 (16.1%)

Reasons for not reporting medication errors by hospital type

Korean nurses’ reasons for not reporting medication errors are presented in

Table 5.

Only three items significantly differed between nurses in tertiary and general hospitals. These items were related to criticism and responses from peers or other professionals, and fear of managers. The nurses in general hospitals were typically less afraid of criticism and of their nurse manager than the nurses in tertiary hospitals. Fear of the negative consequences of error reporting and legal action were the main reasons for not reporting errors across both hospital types.

Table 5.

Nurses’ reasons for not reporting medication errors in the incident reporting system (n = 467)

Hospital type

0.55

0.02

0.07

2.75 (0.98)

0.56

0.64

Items
Tertiary mean (SD)	General mean (SD)
1. Nurse managers tend to focus on the individual, rather than system factors, as a potential cause of error.	2.34 (0.88)	2.25 (0.92)	0.33
2. The error was not serious enough to be reported.	2.60 (1.03)	2.55 (0.98)		0.64
3. There was no clear definition or standard for medication error reporting.	3.00 (1.04)	3.12 (0.87)	0.25
4. Fear of legal action by patients or families.	3.08 (0.98)	3.02 (0.88)
5. Criticism from peers or other professionals.	2.34 (1.03)	1.97 (1.03)	0.001
6. Responses to medication errors do not match the severity of the medication errors.	2.27 (1.00)	2.03 (1.05)	0.03
7. Fear of reprisal or penalties from manager.	2.54 (1.04)	2.27 (1.17)
8. Medication error is overemphasized as an example of low quality nursing care.	2.90 (1.04)		2.75 (0.98)	0.15
9. Nurses do not recognize or identify medication errors that occur.	2.72 (1.01)	2.53 (1.04)
10. No feedback is given for error reporting.	2.26 (1.10)	2.11 (1.18)	0.22
11. Other nurses will consider me incompetent.	2.82 (1.05)
12. I do not agree with the medication error as defined.	2.57 (1.02)	2.52 (1.10)
13. It would take too much time to report the error.	2.62 (0.94)	2.59 (0.94)	0.76
14. I would be afraid of the negative consequence of reporting	3.16 (1.01)	3.09 (0.87)	0.50

Means were calculated using a 6-point Likert scale: 1 (Very Strongly Disagree) to 6 (Very Strongly Agree).

Discussion

This study identified that the majority of participants would not report an error using an incident reporting system, no matter how they classified the scenario. The rate of filing an incident report was lower for Korean nurses than for US nurses [12] in all of the scenarios presented. In a recent study on medication errors in Korea, 22% of the nurses responded that they would inform only the physician, and not the nurse manager, and 19% indicated that they would not report medication errors committed by anyone else [3]. Thus, in general, Korean nurses were less likely to report an error to a nurse manager than they would to a physician, and an even lower number of these nurses indicated that they would file an incident report.

In studies performed by Ulanimo et al. [20] and Mayo and Duncan [12], US nurses believed that only 28.9% and 25% of medication errors, respectively, were being reported to the nurse manager through filing of an incident report. In a study by Güneş et al. [13], 66.7% of nurses stated that they had made medication errors in the past 6 months and had not reported the errors, and 29.6% said that they did not know how to file a report. Potylycki et al. [19] also reported that 50–96% of errors go unreported because nurses are afraid of the negative consequences of reporting an error and distrust their employer’s ability to be constructive and to provide support.

However, the rate of reporting using an incident reporting system in this study was even lower than that revealed in previous studies [12, 13, 19, 20], as only approximately 10% of Korean nurses in this study responded that they would file an incident report. This finding raises questions as to why Korean nurses are more reluctant to report medication errors through an incident report than nurses in the USA. A possible reason for this lower tendency to report errors to the nurse manager than to the physician may be a result of the hierarchical relationship between the nurse and the nurse manager in Asian cultures. In a study conducted in Taiwan by Chiang and Pepper [26], it was reported that fear was the main barrier to reporting and that this fear was related to the organizational power hierarchy. Nurse managers directly supervise and evaluate the performance of nurses in their wards, but they do not have clinical treatment authority like physicians do, such as prescribing treatments or necessary procedures to affected patients. Thus, nurses may feel that physicians could resolve or decrease any adverse patient reactions, and they feel more comfortable reporting medication errors without worrying about penalty and performance evaluation by nurse managers.

In general, there were few significant differences in the reasons for not reporting medication errors between hospital types. The primary reason for not reporting errors in this study was fear. Similarly, Ulanimo et al. [20] reported that US nurses do not report certain medication errors because they fear the reactions of their nurse managers (60%) and peers (65%). In a study that Petrova [28] conducted in Malta, nurses perceived that the focus on the individual, rather than the system, was a barrier to reporting medication errors. In other studies, the reasons for not reporting medication errors included lack of positive feedback, as well as the concern that patients and families or the physician might develop a negative attitude toward the nurses [1, 3, 26, 29, 30].

Using focus groups and in-depth interviews with risk managers, Hartnell et al. [1] categorized barriers to reporting medication errors according to the following five themes: reporter burden, professional identity, information gaps, organizational factors, and fear. In previous studies performed across Korea, nurses have consistently reported that fear is the primary reason for not reporting medication errors [4, 31, 32]. Therefore, the development of a supportive organizational environment to encourage the reporting of medication errors and a nonblaming organizational culture are prerequisites for promoting patient safety.

There were no differences in what Korean nurses considered as medication administration errors or their intent to report medication administration errors in terms of educational degree, years of work experience, hospital type, or electronic incident reporting system in this study. A strength of this study is the relatively large sample size collected from geographically diverse regions. Most previous studies on medication errors performed in South Korea have utilized data from only a few hospitals, which were mainly tertiary, and from limited regions.

Limitations

The study had several limitations. First, the use of convenience sampling limits the generalizability of the results. Second, educational level was higher among nurses working in tertiary hospitals compared to those in general hospitals. Third, the data collection method differed across hospitals due to geographical barriers, which may have influenced the results of the study. Finally, the response rate in this study was 78.3%, which although relatively high, cannot guarantee nonresponse bias. This factor needs to be taken into consideration when interpreting the present results.

Conclusions

There were no significant differences based on hospital type in terms of what nurses considered as medication administration errors. Additionally, the rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. However, nurses felt more comfortable reporting issues directly to the physician rather than filing an incident report. The primary reason cited for not reporting medication errors was fear. Therefore, in order to remove barriers to error reporting, greater efforts should be made at the administrative and organizational levels to create a positive environment that removes fear of penalties and eliminates blame from others.

© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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Published: 18 July 2016

Medication administration error reporting and associated factors among nurses working at the University of Gondar referral hospital, Northwest Ethiopia, 2015

Berhanu Boru Bifftu

Berihun Assefa Dachew

Bewket Tadesse Tiruneh

Debrework Tesgera Beshah

BMC Nursing

volume 15, Article number: 43 (2016)

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Abstract

Background

Medication administration is the final step/phase of medication process in which its error directly affects the patient health. Due to the central role of nurses in medication administration, whether they are the source of an error, a contributor, or an observer they have the professional, legal and ethical responsibility to recognize and report. The aim of this study was to assess the prevalence of medication administration error reporting and associated factors among nurses working at The University of Gondar Referral Hospital, Northwest Ethiopia.

Methods

Institution based quantitative cross – sectional study was conducted among 282 Nurses. Data were collected using semi-structured, self-administered questionnaire of the Medication Administration Errors Reporting (MAERs). Binary logistic regression with 95 % confidence interval was used to identify factors associated with medication administration errors reporting.

Results

The estimated medication administration error reporting was found to be 29.1 %. The perceived rates of medication administration errors reporting for non-intravenous related medications were ranged from 16.8 to 28.6 % and for intravenous-related from 20.6 to 33.4 %. Education status (AOR =1.38, 95 % CI: 4.009, 11.128), disagreement over time – error definition (AOR = 0.44, 95 % CI: 0.468, 0.990), administrative reason (AOR = 0.35, 95 % CI: 0.168, 0.710) and fear (AOR = 0.39, 95 % CI: 0.257, 0.838) were factors statistically significant for the refusal of reporting medication administration errors at p-value <0.05.

Conclusion

In this study, less than one third of the study participants reported medication administration errors. Educational status, disagreement over time – error definition, administrative reason and fear were factors statistically significant for the refusal of errors reporting at p-value <0.05. Therefore, the results of this study suggest strategies that enhance the cultures of error reporting such as providing a clear definition of reportable errors and strengthen the educational status of nurses by the health care organization.

Peer Review reports

Background

Patient safety is the freedom from accidental or preventable injuries produced by medical care [

]. It is a central concern and an indicator of health care quality services [

]. That is why, concerns about patient safety have prompted the formation of a World Health Organization (WHO) patient safety program in response to a World Health Assembly in 2002 with the vision of ‘every patient receives safe health care, every time, everywhere [

Patient safety can be affected as a result of a constellation of different factors and circumstances [
2
]. In all health care systems, medical errors are the main factors endangering the patient safety [

]. Medication errors are one of the most common types of medical errors. Medication errors are an error in the medication process: ordering, transcription, dispensing, and administration [

]. Medication errors listed in the top ten causes of mortality worldwide [

]. A systematic review of 45 studies revealed that the prevalence of medication errors ranges from 2 to 75 % [

Medication administration error is one of the most common errors in the medication error process and occur when a discrepancy occurs between the drugs received by the patient and the drug intended by the prescriber [

]. For example, study from United Kingdom’s National Patient Safety Agency revealed that of different types of medication errors, almost 50 % account to administration error compared to 18 % for dispensing, and 16 % for prescribing [

]. A systematic literature review in Iran on medication error also indicated that reported prevalence of medication administration errors holds the highest ranges that is from 14.3 to 70 % compared to 29.8–47.8 % for prescribing error, 3–33.6 % for dispensing error and from 10 to 51.8 % for transcribing errors [

]. In Ethiopia, where there is lack of educated health care professionals and high patient flow, evidences indicate that medication error is a common problem that ranges from 4.35 to 89.9 % [

]. For example according to a recently published study, [

] the incidence of medication administration error was 56.4 % of this, majority (87.5 %) indicated documentation error, followed by technique error 73.1 % and time error 193 (53.6 %) respectively. Ages, work experience, nurse to patient ratio, medication administration at night shift were associated with errors [
13
].

In health care delivery system, the outcome of any errors result in serious patient outcomes [

] in terms of morbidity, mortality, adverse drug events, re-admissions to hospital, and increased length of hospital stay [
13
,

]. Therefore, prompt detection and report of an error can reduce the risk of such serious patient outcomes [

]. Voluntary medication error reporting systems rely on the ability and willingness of individual physicians, pharmacists, and nurses to detect and report errors as part of routine practice [

]. Nurses are intimately involved in and ultimately responsible for the delivery of medication [

]. The medication administration process is a daily component of nursing practice and is often viewed as a routine and basic nursing task that account for around 40 % of their work time [
15
].

As part of the health care team, whether the nurses are the source of an error, a contributor, or an observer, they have a professional responsibility to recognize and report medication administration errors that could harm patient safety by clarifying ambiguous orders; and questioning orders that are inappropriate [
14
]. Error reporting through established systems provides opportunities to prevent future similar and perhaps even more serious errors, [
9
] nevertheless nurses are reluctant to report medication errors because of several reasons. Including: fear of disciplinary actions [

], lack of protection for reported errors, culture of blame and punishment, variations in how errors are defined and because of its potential damage to the hospitals’ reputation [
4
,
7
,
9
,
18
,
20
–

]. Regarding the association of medication administration error reporting and nurses characteristics, most of the finding indicated there is no relationship between medication administration error reporting and nurses’ characteristics. For example a survey of nurses revealed nurses did not vary in their concerns medication administration error reporting based on their socio demography such as age of the nurse, type of education and length of experiences [

], married nurses and nurses on permanent contract [

]. Few study reveal inconsistent relation between medication administration error reporting and nurses’ characteristics such as: experience, education, sex, working position, working unit [

]. Therefore, the main aim of this study was to assess medication administration error reported and associated factors among nurses working at the University of Gondar Hospital.

Methods

Study design, periods and study area

Institution based cross sectional quantitative study design was employed from May, 1 to 30, 2015 at The University of Gondar Hospital. The University of Gondar hospital is located at 748 km away from the capital city of Ethiopia, Addis Ababa. It is a tertiary level referral hospital, which acts as the referral centre for four district hospitals in the area and has 500 inpatient beds, and 559 health professionals to provide health service to the community of which the majority of them are nurses (n = 302). The hospital provides health referral services for over 5 million inhabitants in the North West region of Ethiopia.

Participants

The participants of this study were all nurses working in The University of Gondar Hospital. The inclusion criteria were those nurses who directly involved in patient care and had been employed for more than six months. Head nurses and those in higher administrative positions were excluded.

Instruments

For the assessment of medication administration errors reporting, we used medication administration errors reporting questionnaire. It contained 65 questions with three sections; the first section included 29 items regarding reasons why medication errors occur, second section included 16 items regarding reasons why medication errors not reported. Respondents were asked to indicate their level of agreement using a five point Likert type scale with fix values ranging from 5 = strongly agree to 1 = strongly disagree. The third section included 20 items regarding what percentage of each type of medication error actually reported in their units; 9 items for non intravenous (Non-IV) medication errors and 11 items for intravenous (IV) medication errors. More specifically, participants were asked to use a 10-point ordinal scale to indicate the range of MAEs which they perceived to be reported on their patient care units. This scale has been developed by Wakefield, et al., 2005. The items in the original instrument underwent rigorous validation and tested for its psychometric property factors analysis. The construct and criterion-related validity test and subscale reliability with Cronbach’s alpha were ranging from .69 to .76 [
24
,

]. This scale has been widely used across the world including Africa [
22
,
24
]. In this study, the reliability of the questionnaire was measured by Cronbach’s alpha and it had 0.81 for the 20 item MAER and 0.83 for the 16 item barrier to MAER.

For the purpose of this study, we used the estimated percentage of medication errors actually reported with 20 item and reasons why medication errors are not reported with16 items. The estimate of medication error reporting was defined by the estimated mean percentage of errors reported on the 20 items of medication errors that has actually been reported. This scale has been widely used across the world.

Data collection methods

Data were collected using a semi-structured self administered questionnaire consists of socio-demographic characteristics and medication administration errors reporting questionnaire. The questionnaires were distributed in the nursing office by two MSc nurses working in the academic area. The questionnaires need 10–20 min to complete.

Data processing and analysis

Data cleanup and cross-checking were made before the analysis. EPI info version 3.5.3 statistical software and Statistical Package for Social Science (SPSS) windows version 20 programs were used for data entry and analysis respectively. Bivariate and multivariate logistic regression and odds ratio with 95 % confidence interval were used to identify the associated factors with medication administration errors reporting. Variables with p-value (p < 0.05) were used as the cutoff point.

Results

Total of 282 participants participated in this study with a 96.9 % response rate.

Socio-demographic characteristics of the respondents

The majority of the participants were men 160 (56.7 %). The mean (± standard deviation) age of the participants was 28.89 (±9.70) years, 203 (72 %) of the participants were BSc in Nursing. Regarding their work experience, the majority of the participants 158 (56 %) served from 6 months to 4 years (Table
1
).

Table 1 Socio-demographic characteristics of the respondents, Gondar University Referral Hospital (GURH), Northwest Ethiopia, 2015 (n = 282)

Full size table

Perceived prevalence of medication administration error reporting

The estimated medication administration error reported was found to be 29.1 %. The perceived rates of medication administration error reported for non intravenous medications were ranged from 18.1 to 28.4 % and from 20.6 to 33.7 % for intravenous related medication (Table
2
).

Table 2 Proportion of perceived medication administration error reported for each item at GURH, Northwest Ethiopia, 2015 (n = 282)

Full size table

Reasons for Not reporting medication administration errors

The overall mean and standard deviations of the subtotal scores were: 19 ± 8.14 for disagreement over time and error definition reasons, 12.03 ± 5.37 for fear reasons and 11.93 ± 5.19 for administrative reasons.

Factors associated with medication administration error reporting

From the bivariate analysis: sex, age, educational statuses, work experience, disagreement over time and error definition, administrative and fear reason were factors associated with the refusal of MAEs at p-value <0.2 and entered into multivariate analysis. From the multivariate analysis; Education status (AOR =1.38, 95 % CI: 4.009, 11.128), disagreement over time - error definition (AOR = 0.44, 95 % CI: 0.468, 0.990), administrative reason (AOR = 0.35, 95 % CI: 0.168, 0.710) and fear (AOR = 0.39, 95 % CI: 0.257, 0.838) were factors statistically significant for the refusal of reporting medication administration errors at p-value <0.05 (Table 3 ).

Table 3 Bivariate and multivariate logistic regression analysis of factors associated with MAER at GURH, Northwest Ethiopia, 2015 (n = 282)

Full size table

Discussion

The main purpose of this study was to assess medication administration error reporting and associated factors. Finding from this study revealed that the estimated MAER was found to be 29.1 %. This finding support the study carried out in Korea and Taiwan that revealed the prevalence of 28.3 % [

] and 24.5 % [

] respectively. But the result of this study (29.1 %) is slightly higher than the study carried out in Saudi Arabia 22 % [
24
]. On the other hand compared to other study carried out in Jordan, 86 % [

] and 35 % [

] and 48 to 70 % in Taiwan [
23
], the result of this finding (29.1 %) is lower. The possible reason for the difference may be accounted for fear of legal issues, blame for the reported errors in the working environment and lack of personal confidence to withstand any punishments following the reporting of errors. Study from United State revealed that the main reasons for nurses do not report medication administration errors were: fear, disagreement over whether or not an error had occurred, administrative responses to medication errors, and the effort involved in the reporting process [

]. Another study also revealed that around 25 % of the study participants did not reported error because of fear of their supervisors punish [

Regarding factor or barrier for MAER using MAER questionnaires, disagreement over time – error definition is considered as the most perceived barrier followed by fear reasons and administrative reasons for MAER. This finding is supported by several other studies using similar instrument as disagreement over time – error definition, fear reasons and administrative reasons are barrier for MAER with different ranking order [
22
,
23
,
30
,
31
]. As to the statistical association, those participants who disagreed for the presence of disagreement over time – error definition as a barrier for MAER were about forty four times more likely reported MAE (AOR = 0.44, 95 % CI:0.468, 0.990) than those participants who agreed for the presence of disagreement over time – error definition as a barrier for MAER. This finding is similar to other studies [

]. This could be due to the fact that those participants who do not clearly recognized the actual definition of medication administration error do not report the error because reportable errors need their own knowledge like the knowledge of error, who it could be reported, to whom it reported and the like. Studies support this explanation as a knowledge deficit is seen in lack of knowledge of process (not knowing how to report an error) and uncertainty about definitions (e.g., what is an error? What is a near miss?) for the refusal to report errors [
22
,

]. Another cross-sectional study from Korea revealed that although 95 % of participants were not afraid to report mistakes, but about half of the respondents reported that they were not clear about the types of errors should be reported [

Those participants who disagreed administrative reason as a barrier for MAER were thirty five times more likely reported MAE (AOR = 0.35, 95 % CI: 0.168, 0.710) than those participants who agreed administrative reason as barrier for MAER. In this study more than half (50 %) of the study participant did not reported MAE because of Administrative Reason. This is similar with other studies [
22
,
23
,
37
].

Those participants who disagreed fear reason as a barrier for MAER were about thirty nine times (AOR = 0.39, 95 % CI: 0.257, 0.838) more likely reported MAE than those participants who agreed fear reason as barrier for MAER. This may be due to the fact that fear of the consequence of the errors on their future career. This result is consistent with other studies [
16
,
22
,
23
,
30
,
31
].

Those participants who had educational status of BSc and above were more than one times (AOR =1.38, 95 % CI: 4.009, 11.128) more likely reported MAE than those participants who had educational status of diploma. These result is consistent with the previous study. This is due to the fact that those participants who had higher educational status may have higher knowledge, attitude and practice toward the drug adverse effect or they may develop confidence to defend the consequence of MAER through their educational journey.

Limitation of the study

This study has some important limitations that should be kept in mind when interpreting the results. The cross-sectional nature of the study design does not confirm definitive cause and effect relationship and since, the study was based on self-reported information that may be prone for reporting bias because of the respondent’s interpretation of the questionnaire or desire to report their feeling. Some nurses characteristics such as working area (unit), working position and other were not collected that may affect MAE reporting.

Conclusion

Overall, more than two third of the participants did not reported medication administration errors. Educational status, disagreement over time – error definition, administrative and fear reason were factors statistically significant for the refusal of reporting medication administration errors at p-value <0.05. Therefore, the results of this study suggest strategies that enhance the cultures of error reporting such as providing a clear definition of reportable errors, establishing a good relationship with the healthcare administrators that make the workers free to report any mistakes without fear and strengthen the educational status of nurses by the health care organization.

Abbreviations

AOR, adjusted odd ratio; CI, confidence interval; COR, crude odd ratio; MAER, Medication Administration Error Reporting; Non-IV, non intravenous; SPSS, statistical package for social science; WHO, World Health Organization

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Acknowledgment

The authors would like to thank The University of Gondar for the financial support to conduct this research. Funder had no role in study design, data collection, analysis and decision to publish. The corresponding author had full access to all the data in this study and had final responsibility for the decision to prepare the manuscript and submit for publication. We would also like to thank the study subjects for their willingness to participate in the study to share their experience.

Funding

The fund of this paper was covered by University of Gondar College of Medicine and Health Science. Funder had no role in study design, data collection, analysis and decision to publish. The corresponding author had full access to all the data in the study and had final responsibility for the decision to prepare the manuscript and submit for publication.

Availability of data and materials

Data can be provided on request from the corresponding author on reasonable request.

Authors’ contribution

BB carried out the manuscript from its outset, analysis and interpretation of data and drafted the manuscript. BA, BT and DT participated in data analysis, interpretation and review of the manuscript. All authors read and approved the final version of manuscript.

Authors’ information

BB, BT and DT are from The University of Gondar College of Medicine and Health Science, Department of Nursing, Gondar, Ethiopia. BA from The University of Gondar College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, Gondar, Ethiopia.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The study proposal was approved by the ethical review board of The University of Gondar and a formal letter of permission was obtained. Verbal and then written informed consent was sought from each participant who agreed to participate in the study.

Author information

Affiliations

1. Department of Nursing, University of Gondar College of Medicine and Health Science, P. O. Box: 196, Gondar, Ethiopia

· Berhanu Boru Bifftu

· , Bewket Tadesse Tiruneh

· & Debrework Tesgera Beshah

2. Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar College of Medicine and Health Science, P. O. Box: 196, Gondar, Ethiopia

· Berihun Assefa Dachew

Corresponding author

Correspondence to
Berhanu Boru Bifftu
.

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Bifftu, B.B., Dachew, B.A., Tiruneh, B.T. et al. Medication administration error reporting and associated factors among nurses working at the University of Gondar referral hospital, Northwest Ethiopia, 2015. BMC Nurs 15, 43 (2016). https://doi.org/10.1186/s12912-016-0165-3

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· Received18 December 2015

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· Published18 July 2016

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