Iranian nurses’ medication errors: A survey of the types, the causes, and the related factors

Study of Nurses' Malpractice Tendencies and Burnout Levels

Malpractice, which occurs when a reasonable standard of service cannot be provided, is a critical situation in nursing care and interventions. Nurses' tendency toward medical errors and burnout levels are important due to their impact on patient safety and the quality of care. This study was conducted to investigate nurses' malpractice tendencies and burnout levels and the relationship between the two. The data of this descriptive, cross-sectional, and correlational study were collected from 292 nurses working in a training and research hospital in Istanbul province between January and February 2021. A Descriptive Information Form, the Malpractice Trend Scale in Nursing (MTSN), and the Maslach Burnout Inventory (MBI) were used to collect data. In data analysis, internal consistency coefficient, descriptive, non-parametric comparisons, and correlation analyses were performed. The mean age of the nurses participating in the research was 31.13 ± 7.87 years; 79.8% were women, 50.7% were single, and 68.5% had an undergraduate degree. When nurses' opinions about malpractice were examined, it was determined that 88.7% had not committed malpractice before and 53.4% had witnessed someone who committed malpractice. Nurses' overall MTSN score was 233.48 ± 15.32. Their Maslach Burnout Inventory score was 18.20 ± 8.83 on the emotional exhaustion subscale, 8.07 ± 3.86 on the depersonalization subscale, and 21.31 ± 4.00 on the personal accomplishment subscale. The reliability coefficients of the scales and subscales ranged between 0.61 and 0.95. There was a significant difference between the MTSN scale and MBI subscales according to nurses' positions and satisfaction with the environment (p < 0.05). A negative correlation was found between the mean scores on the total MTSN and the MBI emotional exhaustion (r = -0.314) and depersonalization (r = -0.293) subscales, and a positive and statistically significant relationship (p < 0.001) existed between the MTSN total scale and the personal accomplishment (r = 0.359) subscale. The level of burnout is associated with a tendency to malpractice. Taking measures to prevent nurses from experiencing burnout may be important for reducing medical errors. These measures will be reflected in better care service and quality.

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.

Factors Influencing Medication Administration Errors as Perceived by Nurses in Pediatric Units in a Jordanian Tertiary Hospital: A Qualitative Descriptive Study

BACKGROUND

The World Health Organization declared that medication errors are the third largest global patient safety challenge. The medication administration stage is a common and susceptible stage for medical errors to occur.

OBJECTIVE

To explore the factors contributing to medication administration errors specifically in pediatric care units as perceived by nurses in a Jordanian hospital.

METHODS

A qualitative descriptive study was conducted involving face-to-face audio-recorded interviews with 9 nurses in a tertiary hospital located in the north of Jordan. A convenience sampling technique was used to select the participants of our study. Data were collected between October 2022 and November 2022. The data were analyzed using inductive thematic analysis.

RESULTS

Four themes emerged affecting medication administration errors in pediatric care units. These were environmental, staff, parents and patient, and medication-related factors.

CONCLUSION

The findings of this study raise awareness of the most frequent sources of medication errors in a Jordanian hospital. Holding training and supervision to raise awareness among nurses and the availability of equipment and supplies could improve medication safety practices.

Fatigue in nurses and medication administration errors: A scoping review

BACKGROUND

Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.

OBJECTIVE

Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.

METHOD

Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.

RESULTS

Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.

RELEVANCE TO CLINICAL PRACTICE

Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.

Medication administration errors in the domain of infusion therapy in intensive care units: a survey study among nurses

BACKGROUND

Despite extensive research carried out on medication administration errors (MAEs) in the domain of infusion therapy, there is limited knowledge on nurse's perceptions on the occurrence of MAEs during infusion therapy. Since nurses are responsible for medication preparation and administration in Dutch hospitals, it is vital to understand their perspectives on the risk factors for MAEs.

AIM

The purpose of this study is to investigate the perception of nurses, working in adult ICUs, on the occurrence of MAEs during continuous infusion therapies.

METHODS

A digital web-based survey was distributed among 373 ICU nurses working in Dutch hospitals. The survey investigated nurses' perceptions on the frequency, severity of consequences and preventability of MAEs, factors for the occurrence of MAEs, and infusion pump and smart infusion safety technology.

RESULTS

A total of 300 nurses started to fill out the survey but only 91 of them (30.3%) fully completed it and were included in analyses. Medication-related factors and Care professional-related factors were perceived as the two most important risk categories for the occurrence of MAEs. Important risk factors contributing to the occurrence of MAEs included high patient-nurse ratio, problems in communication between caregivers, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on labels. Drug library was reported as the most important infusion pump feature and both Bar Code Medication Administration (BCMA) and medical device connectivity as the two most important smart infusion safety technologies. Nurses perceived the majority of MAEs as preventable.

CONCLUSIONS

Based on ICU nurses' perceptions, the present study suggests that strategies to reduce MAEs in these units should focus on, among other factors, the high patient-to-nurse ratio, problems in communication between nurses, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on drug labels.

Investigation of factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht city, Iran

BACKGROUND

Report of medical error is one of the effective components in the quality of healthcare services. A significant part of medical errors can be prevented by acting appropriately. The theory of planned behavior offers a framework in which the nurse intention to perform the behavior of error reporting is investigated. This study was conducted to determine the factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht based on the theory of planned behavior in 2020.

METHODS

In this descriptive-analytical study, 326 nurses in all medical centers in Rasht were selected by the multi-stage random sampling method. Data collection tool was a valid and reliable questionnaire based on the theory of planned behavior. Data analysis was conducted using the SPSS software, analysis of variance, correlation, and linear regression.

RESULTS

39% of nurses reported that they had reported a medical error, and the average number of error reports per nurse during the last 3 months was 1.42 errors. The predictive power of the theory of behavioral intention was 47%, and predictive constructs were attitude (B = .43), perceived behavioral control (B = .33), and subjective norm (B = .04) using linear regression. The predictive power of the theory for nurses' behavior was 3.1%. None of the demographic variables played a role in predicting the behavior of nurses' reporting clinical error, and no behavioral intention predicted the behavior of nurses' reporting clinical errors.

CONCLUSION

The theory of planned behavior expresses the factors affecting the behavior intention of nurses' reporting clinical errors satisfactorily. However, it was an inappropriate theory in behavior prediction. It appears that factors, such as fear of consequences of error reporting, social pressures by colleagues and officials, and lack of knowledge and skills required to identify medical errors, are the barriers to conversion of intention to the behavior of reporting clinical errors. It is necessary to provide the ground to increase nurses' report of clinical errors by acting appropriately.

Evaluation of COVID-19 Patient Safety Compared to Non-COVID-19 Patients and Predisposing Factors of Nursing Errors

Objectives: The present study aims to determine Patient Safety in hospitalized patients with COVID-19 compared to non-COVID-19 ones and find predisposing factors of nursing errors according to nurses’ perceptions. Methods: This descriptive-comparative research employed data from 800 nurses in eight Iranian hospitals in 2021 using three researcher-made questionnaires of sociodemographic, patient safety indicators, and predisposing factors of nursing errors, with high reliability and validity. The collected data were analyzed using ANOVA, independent t-test, and the SPSS22 software. Results: The mean patient safety scores in patients with and without COVID-19 were 3.42 ± 0.17 and 3.74 ± 0.06, respectively. The highest differences in patient safety were attributed to infection control (0.66) and patient fall (0.56) dimensions. The most common causes of nursing errors were related to management (2.67 ± 1.39), and the most common predisposing factors of nursing errors were high workload, low ratio of nurses to patients, and fatigue. Conclusions: COVID-19 patients have lower safety than non-COVID ones. Also, improper management and high workload lead to nursing errors. Therefore, the authorities must devise appropriate strategies to reduce the nurses’ workload and improve patient safety, especially in COVID-19 patients.

Application of the HEART method to enhance patient safety in the intensive care unit

BACKGROUND: The intensive care unit (ICU) is a complex, dynamic, high stress and time-sensitive place. While a variety of rules and regulations provided to reduce medication errors in recent years, many studies have emphasized that medication errors still happen. OBJECTIVE: The purpose of this investigation is to predict, reveal and assess medication errors among surgical intensive care unit (SICU) nurses. METHODS: This study was performed in one of the public hospitals in Shiraz, namely Shahid Faghihi hospital. The human error assessment and reduction technique (HEART) method was adopted to measure and assess medication errors in the ICU. RESULTS: Findings indicate that ICU nurses perform 27 main tasks and 125 sub-tasks. The results also showed that setting and using DC shock task has the highest human error probability value, and assessment of patients by a nutritionist has the lowest human error probability value. CONCLUSION: Medical errors are key challenges in the ICU. Therefore, alternative solutions to mitigate medication errors and enhance patient safety in the ICU are necessary. Although the technique can be used in healthcare; there is a need to localize the coefficients and definitions to achieve more accurate results and take appropriate controls. Employing experienced people and providing conditions that reduce the possibility of errors in nurses, increasing the number of staff, and developing specialized and simulated training were identified as the most important control strategies to reduce errors in nurses.

Patient Safety Competencies among Senior Students of Health Professions: An Iranian Evaluation Study

Introduction:

Patient safety refers to preventing and reducing adverse events that might harm the patient while providing care. Enhancing patient safety competence upon entering the clinical environment requires introducing and integrating it in health professions' education.

Aim:

This study aimed to investigate patient safety competence among senior health professions students.

Methods:

This study was conducted in 2020 using a cross-sectional study. In total, 390 senior health professions students of Isfahan University of Medical Sciences, Isfahan, Iran, including medicine, nursing, pharmacy, midwifery, surgical technologist (operating room technician), and anesthesia were selected through a stratified convenience method. Data were collected using the Health Professional Education in Patient Safety Survey – H-PEPSS from August to September 2020 and analyzed using descriptive and analytical statistics. All statistical computations were carried out using SPSS version 16. A significant level of 5% was considered (P <0.05).

Results:

The mean scores of patient safety in health professions education in the classroom and clinical setting were 0.51 and 0.47, respectively. Among Health Professional Education in Patient Safety Survey – H-PEPSS domains, the highest mean score was obtained in the effective communication domain (0.61 in the classroom and 0.57 in the clinical setting). In contrast, domains of working in teams with other health professions showed the lowest mean score (0.39 in the classroom and 0.38 in the clinical setting).

Conclusion:

Patient safety in health profession education, particularly working in teams with other health professions, is at a moderate level in the classroom and a weak level in the clinical setting. Regarding the importance of interprofessional collaboration in promoting patient safety, it is recommended that the health sciences curriculum in Iran be reviewed to motivate students for interprofessional collaboration and the perception of its significance in reducing health profession's errors.

The Effect of Personal Protective Equipment Use on Nurses' Tendencies to Make Medical Errors and Types of Their Medical Errors: A Cross-Sectional Study

This study was conducted to determine the effect of nurses' use of Personal Protective Equipment (PPE) during their care practices on their tendency to make medical errors and types of medical errors. The study was conducted with 505 nurses in Turkey between May 2021 and June 2021. Descriptive statistics, Kruskal-Wallis H test, Spearman's correlation test, and Mann-Whitney U test were used to analyze the data. During the COVID-19 pandemic, nurses often used PPE on different levels. A significant relationship was determined between the type of PPE used by the nurses and falls, hospital infections and patient monitoring/material safety (p < 0.05). The conclusions in this study reveal the necessity of increasing the usability, safety and effectiveness of PPE used by nurses in health institutions.

Workload as the most Important Influencing Factor of Medication Errors by Nurses

Background:

This research is motivated by the fact that medication errors are serious threats to the safety of patients in hospitals. Nurses are one of the health workers who play a significant role in preventing these errors.

Objective:

The aim of this quantitative research is to determine the factors that influence the incidence of medication errors by nurses.

Methods:

The adopted method had a correlative descriptive design and used samples obtained from 164 nurses through a purposive sampling technique. The sample inclusion criteria were the nurses who worked in patient’s rooms, those who were healthy and not sick, not currently in school, and were willing to be respondents. Furthermore, the research instruments were questionnaires, which were developed through the Cronbach's alpha validity and reliability test results of 0.681 and 0.873, respectively. Analysis was conducted using the independent t test, X2 (chi-square) and multiple logistic regressions.

Results:

The results showed that the factors which influenced the incidence of medication errors were work experience, motivation, workload, managerial and environmental elements. Moreover, the variable which contributed the most, with a p-value of 0.004 and OR of 5.387 was workload.

Conclusion:

Finally, the following factors, including nurse's workload, motivation, work experience, good managerial management and environmental elements, should be considered when preventing medication errors.

Assessment and analysis of outpatient medication errors related to pediatric prescriptions

BACKGROUND

Medication errors are the errors that impact the efficacy and safety of the therapy. The impact of medication errors is higher for certain subjects, such as pediatrics, who require more attention. Hence, the current study aimed to investigate the types and frequency of outpatient medication errors of pediatric subjects related to different prescription types.

METHODS

A cross-sectional study was carried in several community pharmacies to record the medication errors found in outpatient pediatric prescriptions by gathering data from the outpatient prescriptions besides direct counseling with the subjects and their parents. Many medical resources (disease and drug-related) were used for checking the different aspects of medication errors. The data collection process included a preprepared sheet containing several items representing the medication errors in addition to a counseling session. Data were expressed as percentages and compared through the Chi-square test for results of handwritten and computerized prescriptions.

RESULTS

752 outpatient pediatric prescriptions were recruited in the study as they involve medication errors. Among the highest percentage of medication errors was the absence of essential data in the prescription, such as diagnosis, age, and weight. The duration of the therapy and contraindication for some of the prescribed medications were among the highest recorded errors. Among the critical errors were the drug interaction and drug duplication that directly affect the drug's efficacy and safety. There was a significant difference between computerized and handwritten prescriptions regarding the number of medication errors related to each type.

CONCLUSION

Medication errors related to outpatient pediatric prescriptions vary from one to another prescription with predominant errors that influence the therapy's safety or efficacy. The role of patient counseling and prescription checking is critical for improving patient therapy.

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.

Nurses' perceptions toward factors that cause medication errors in Jordan: A qualitative study

AIMS

The aim of this study was to investigate nurses' experiences related to medication errors (MEs) from the perspective of Jordanian nurses. This article reports the findings concerning the factors that cause MEs from the perspectives of Jordanian nurses.

BACKGROUND

MEs are critical issues facing healthcare providers and health institutions. Most of the studies on MEs were conducted in Western countries. However, there is little research that seeks to understand this issue in the developing countries and Jordan is one of these countries.

DESIGN

A qualitative descriptive approach was used in three hospitals in different clinical settings in Jordan.

METHODS

Individual semi-structured face-to-face interviews were conducted with 24 nurses.

RESULTS

The data that emerged from the interviews was arranged and contextualized in two major themes, individual and systemic factors, that explained the main causes of MEs. From the individual side, lack of knowledge and experience ranked as the highest concerns, and from the systematic side workload was the most important factor.

CONCLUSION

This study provides an opportunity for stakeholders and Jordanian managers to increase their awareness of these factors and address them in the future, thereby increasing the level of care provided in their health organizations.

The Influence of Nurses' Characteristics on Medication Administration Errors: An Integrative Review

Background

Medication administration errors (MAEs) are a frequent cause of morbidity and mortality in acute care settings and can result in a prolonged hospital stay. The WHO estimated that medication errors cost up to $42 billion globally per a year. Therefore, MAEs was among the most common medical errors to occur in acute care settings. Studies of medication error usually focus on system factors, thus creating a gap between what researchers know about the causes of MAEs, and what frontline nurses actually do in the clinical setting. The purpose of this review is to fill a gap in the existing literature by focusing on the relationship between nurses' characteristics and MAEs.

Methods

Online databases were accessed, including CINAHL, PsycINFO, PubMed, Scopus, and Google Scholar from 2007-2020 period. This review was guided by the methods described by Whittemore and Knafl. Studies that addressed the occurrence of medication errors based on RN demographics were included in this review. The included studies were reviewed and analyzed by the two authors.

Results

Of the 1141 publications retrieved, 19 studies met inclusion criteria. The result provided strong evidence that nurses' level of education, length of experience, and attendance at training courses, are directly associated with the occurrence of MAEs. There is weak evidence of MAEs being influenced by the age and gender of nurses. Other nurse characteristics, such as cognitive load, frustration with technology, negligence, lack of attentiveness, and nurse ethnicity, are not adequately examined across the reviewed studies necessitates further research.

Conclusion

Focusing on nurses' characteristics might facilitate other researchers to suggest appropriate interventions that may reduce the incidence of MAEs. Interventional studies may provide convincing evidence as to whether one variable has a causal effect on another variable, and control the influence of confounding variables to enhance the generalizability of the findings.

Barriers to and facilitators of medication error reporting from the viewpoints of nurses and midwives working in gynecology wards of Tabriz hospitals

Medication error reporting (MER) is an effective way to prevent their repetition in the future. The present study aimed to determine the frequency and factors associated with the causes of MEs and to identify barriers to and facilitators of MER. This descriptive-analytical cross- sectional study was conducted with proportional random sampling on 220 midwives or nurses working in public and private hospitals in Tabriz, Iran. In this study, data were collected using Haddon’s matrix. Data were analyzed using descriptive and inferential statistics. The prevalence of MEs in this study was 36.2%. The most common causes of MEs related to weakness of nurses, wards, management and physicians were nursing staff shortage (30.5%), ward work density (51.8%), low ratio of nurses and midwives per patient (70.7%), and illegible prescriptions (76.4%), respectively. Major barriers to MER reported by nurses and midwives were blaming the individual rather than the system (67.7%). Facilitators of MER were anonymous MRE system and feeling safe about working environment. Staff also reported that if reporting is beneficial (preventing future errors, correcting practice, increasing accountability), the odds of reporting MER will increase (54.5%). Given the underlying cause of MEs from the participants' point of view (staff shortage, fear of reprisal and reprimand), it is suggested that the system and health managers adopt appropriate strategies to reduce these important factors (reducing work density and creating a friendly environment).

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).

Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape

BACKGROUND

Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors.

OBJECTIVES

This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication.

METHOD

A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted.

RESULTS

The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication.

CONCLUSION

The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.

End of Occupational Segregation in the Nursing Profession

This chapter focuses on how female nurses make sense of their occupations as the perception of their profession changes from gender-biased to gender-neutral. Nursing is one of those rare professions with occupational segregation in favor of females, but one that is changing as more males enter the profession. While there are many occupational segregation studies to explain male and female nurses' perspectives, research on how female nurses reconsider their views about the profession is scarce. Therefore, this chapter will address this change for females by utilizing a conceptual analysis, specifically the cognitive sense-making perspective. Referring to the phases of the cognitive sense-making (ecological change, enactment, selection, and retention), this chapter examines how the meaning of the nursing profession and the meaning of work in general is changing for females.