Medication Administration Errors: Perceptions of Jordanian Nurses

Reducing Medication Errors in an Ambulatory Medical Center

BACKGROUND

Medication errors are a significant problem in ambulatory care, occurring at any stage, from prescribing to administration.

LOCAL PROBLEM

Medication error rates due to interruptions were high on an ambulatory medical unit.

METHODS

A quality improvement design was used for the project.

INTERVENTIONS

A Safe Zone protocol was developed by nurses, certified nursing assistants, and unit secretaries. Implementation included clear medication preparation areas, administration checklists, and staff and patient education.

RESULTS

The number of distractions decreased by 20% over a 90-day period. Medication errors decreased from a rate of 0.97 events per 1000 doses administered to a rate of 0.20 after implementing the Safe Zone protocol.

CONCLUSIONS

Due to its flexibility and adaptability, the Safe Zone protocol offers a template that can be replicated in environments needing to address similar issues.

Exploring the influence of nurses' demographics and hospital work environment on medical error reporting practices in Jordan: a cross-sectional study

OBJECTIVE

Nurses have a significant role in maintaining patient and healthcare safety. Thus, healthcare administrators should focus on nurse performance and create a friendly hospital work environment to ensure patient safety and healthcare quality. Limited studies have investigated the impact of nurses' demographics on nurses' error reporting practices and nurses' perceptions of the hospital work environment, especially in Jordan. This study aims to investigate the factors influencing nurses' medical error reporting practices in Jordan, specifically focusing on the role of nurses' demographics and the hospital work environment. Design: This is a descriptive cross-sectional study.

SETTING

Data collection was done in three hospitals (public, university-affiliated and private) in Jordan, using surveys that included demographics, the incident reporting practice scale and the Practice Environment Scale-Nursing Work Index from 11 June 2023 to 13 August 2023.

PARTICIPANTS

350 nurses with a diploma, associate degree, bachelor's degree or postgraduate degree had worked at the targeted hospitals for at least 6 months and were responsible for direct inpatient care.

PRIMARY OUTCOME MEASURE

The level of medical error reporting practices and the nursing work environment. Also, differences were assessed among demographic characteristics and investigated the factors for medical error reporting practices.

RESULTS

Jordanian nurses had low medical error reporting practices (M=2.34; SD=0.57) and nursing work environment (M=2.4; SD=0.56). Nurses who were single and in private hospitals had higher medical error reporting practices (p<0.05). Medical error reporting practices positively correlated with the nursing work environment (r=0.807, p<0.01) and negatively correlated with the average number of patients per shift (r=-0.109, p<0.05). The nursing work environment was a significant predictor, with an 81.0% variance in medical error reporting practices.

CONCLUSIONS

The study found that Jordanian nurses have low perceptions of their work environment and medical error reporting practices, which are influenced by marital status and hospital type. Enhancing the nurse work environment and providing ongoing standards training are critical for improving safety behaviours, patient outcomes and care quality. Future research should investigate the long-term consequences of interventions on reporting practices and patient outcomes.

The patient safety curriculum: An interventional study on the effectiveness of patient safety education for Jordanian nursing students

INTRODUCTION

The purpose of the study was to assess the effectiveness of the World Health Organization's (WHO) patient safety curriculum (PSC) in improving the patient safety education for nursing students in Jordanian higher education programmes.

METHODS

An interventional design adopting a pre-test and post-test was used. A questionnaire survey was administered to 373 nursing students before and after the curriculum. Students were asked to complete pre-test and post-test questionnaires on self-awareness of patient safety.

RESULTS

Students had moderate knowledge of factors that influence patient safety and scored as the highest, (mean 3.45, SD 0.94). The greatest improvement was in the role of the health organisation in error reporting (the mean difference was 0.97, P = 0.001). Taking into consideration the essential measurements, the results obtained after the post-test regarding the two patient safety topics showed a significant increase after completing the training, demonstrating that the patient safety course was effective.

CONCLUSION

The study highlights the importance of developing a curriculum in nursing schools that incorporates patient safety education. The WHO PSC guide can be a great start in this domain.

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.

Medication administration error prevention among nurses working in intensive care units: A secondary analysis

BACKGROUND

The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs.

AIM

To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables.

STUDY DESIGN

This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups.

RESULTS

The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study.

CONCLUSIONS

The findings show a difference between knowledge and attitudes in relation to cultural background.

RELEVANCE TO CLINICAL PRACTICE

Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU.

Original Research: Exploring Medication Safety Practices from the Nurse's Perspective

BACKGROUND

Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.

PURPOSE

The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.

METHODS

A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.

RESULTS

A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.

CONCLUSIONS

The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.

Exploring the relationship between nursing work environment and medical error reporting among Jordanian nurses: a cross-sectional study

Objectives

This study was conducted to explore the relationship between the nursing work environment and medical error reporting practices among Jordanian nurses.

Methods

This study was a cross-sectional survey of 334 participants who were conveniently selected from three types of hospitals (private, teaching and public) in Amman city, Jordan. The data were collected using a standardized questionnaire which was adopted from previous studies and consisted of three main sections including demographics, nursing work environment (The Practice Environment Scale-Nursing Work Index) and medical error reporting practices (incident reporting practice scale). SPSS version 26 was used for data analysis.

Key findings

The study findings detected a strong positive relationship between the nursing work environment and medical error reporting practices. ‘Nurse’s participation in hospital affairs’ showed the highest impact on medical error reporting practices among nurses. Based on the regression model, the nursing work environment explained 65.1% of variations in nurses’ medical error reporting practices. It was found that medical error reporting practices were statistically different across marital status and hospital type.

Conclusions

Based on data analysis findings, the nursing work environment was statistically strongly correlated to medical error reporting practices. To improve medical error reporting practices among nurses, decision-makers and hospital administrators should redesign their nursing work environment to create a more positive and favourable work environment.

Instruction strategies for drug calculation skills: A systematic review of the literature

BACKGROUND

Medication errors and unsafe medication practices are a leading cause of injury and avoidable harm worldwide.

OBJECTIVES

The aim of this review was to (i) explore and identify evidence-based strategies to teach medication calculation skills by determining the most common errors and assess the quality, level, and role of the evidence, and (ii) describe instruction strategies for drug calculation skills development or improvement based on seven research-based principles for smart teaching.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, PubMed, and PsycINFO.

REVIEW METHODS

The review followed Whittemore and Knafl's framework steps with an assessment of the studies reporting using PRISMA, STROBE, COREQ and categorizing their methods by evidence hierarchy and roles. Two authors independently assessed eligibility and extracted data.

RESULTS

From the total 1793 articles, 51 studies met the eligibility criteria. The studies included 9210 nursing students/nurses and mainly used a quantitative approach (67.5%), followed by qualitative (22.5%) and mixed methods (10.0%), with the students/nurses doing arithmetic and conceptual mistakes. The findings presented were low levels of evidence III (23.5%) and V (41.2%), quality Level B (82.4%), and 47.1% focused on choosing the appropriate teaching and intervention approaches (role of the evidence). The teaching strategies addressed multiple smart teaching principles, but mainly prior knowledge (principle 1, 39.2%). The least used strategies were those addressing the levers that influence motivation and behaviors such as value, expectations, and environment climate (principle 3, 13.7%). Two studies addressed five principles simultaneously.

CONCLUSIONS

Regarding teaching strategies, the most recurring strategies were early diagnostic assessments on knowledge, anxiety and/or self-confidence, considering knowledge organization with scaffolding complex tasks, being explicit about objectives and expectations, and usage of e-learning. However, e-learning was mainly used after 2018. Considering the low levels and quality of evidence, we recommend higher levels of research design for future research. Randomized Controlled Trials could be conducted when randomizing teaching methods per semester or questions embedded in software. Web-base software could be used to support teaching and research approaches.

Medication errors in Jordan: A systematic review

Medication errors (MEs) present a significant issue in health care area, as they pose a threat to patient safety and could occur at any stage of the medication use process. The objective of this systematic review was to review studies reporting the rates, prevalence, and/or incidence of various MEs in different health care clinical settings in Jordan. We searched PubMed, HINARI, Google, and SCOPUS for relevant published studies. We included observational, cross-sectional or cohort studies on MEs targeting adults in different health-care settings in Jordan. A total of 411 records were identified through searching different databases. Following the removal of duplicates, screening of title, abstract and full-text screening, 24 papers were included for the final review step. Prescribing errors was the most common error reported in the included studies, where it was reported in 15 studies. The prevalence of prescribing errors ranged from 0.1% to 96%. Two studies reported unintentional discrepancies and documentation errors as other types of MEs, where the prevalence of unintentional discrepancies ranged from 47% to 67.9%, and the prevalence of documentation errors ranged from 33.7% to 65%. In conclusion, a wide variation was found between the reviewed studies in the error prevalence rates. This variation may be due to the variation in the clinical settings, targeted populations, methodologies employed. There is an imperative need for addressing the issue of MEs and improving drug therapy practice among health-care professionals by introducing education and training.

Medication calculation skills of graduating nursing students within European context

AIM

The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors.

BACKGROUND

Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students.

DESIGN

As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients.

METHODS

The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied.

RESULTS

Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested.

CONCLUSIONS

Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed.

RELEVANCE TO CLINICAL PRACTICE

Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research.

Perceptions of nurses about reporting medication administration errors in Jordanian hospitals: A qualitative study

INTRODUCTION

Reporting Medication Errors (MEs) is a critical issue that confronts healthcare providers and institutions all over the world, yet this issue has only recently been examined in developing countries.

PURPOSE

To explore the perceptions of Jordanian nurses around reporting MEs and to identify potential barriers to reportage in their context.

METHODOLOGY

A qualitative descriptive approach was followed; whereby24 Jordanian nurses were interviewed.

RESULTS

Two main themes emerged. The first revolved around nurses' perceptions of ME reporting, and the second theme pertained to the daily barriers that prevented them from reporting MEs.

CONCLUSION

This study identified many individual behaviors and system defects that exacerbate the lack of ME reporting in Jordan. The results point to an opportunity for Jordanian hospital managers to acknowledge these problems and thereby facilitate their resolution and increase the quality of healthcare in their organizations.

Perceptions of Clinical Nurses About the Causes of Medication Administration Errors: A Cross-Sectional Study

AIM

This study was conducted to determine the perceptions of nurses about the causes of medication administration errors and the rates of reporting errors made or witnessed by them.

METHOD

This methodological, descriptive, multicenter, and cross-sectional study sample of this study included 590 clinical nurses working in an inpatient setting in Turkey. The data were collected using the Medication Administration Error Reporting Survey, which is a self-report questionnaire.

RESULTS

In the study, it was determined that insufficient number of nurses, heavy workloads, and illegible medication orders of physicians were the most common causes leading to medication errors as stated by the nurses. Moreover, 26.1% of the nurses reported that they had made an medication error, and more than half of the nurses reported that they had witnessed medication errors. It was found that 68.8% of medication errors were not reported.

CONCLUSION

It is important to determine the nurses' perceptions about the causes of medication errors to prevent repetition of medication errors and to establish standards for medication safety. Therefore, it may be recommended to reduce workloads of nurses and develop methods to increase the rate of reporting medication errors.

The Influence of Nursing Work Environment on Patient Safety

Background: Patient safety has been a concern over the past two decades. The value of nurses and their work environment in relation to patient safety has been acknowledged by studies and international organizations. This study aimed to examine the relationship between patient safety practices and the nursing work environment. Methods: In total, 570 registered nurses were invited from the inpatient units in public and private hospitals. Perceived patient safety was evaluated using the Overall Perceptions of Patient Safety subscale from the Hospital Survey of Patient Safety Culture (HSPSC). The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Findings: Of the 350 of 570 (64.6%) nurses surveyed, 35.2% (125) reported positive levels of perceived patient safety. Staffing and resource adequacy, professional communication style, and nurses’ participation in hospital quality improvement activities were associated with higher levels of perceived patient safety. Conclusion/Application to Practice: This study provided empirical results about perceived patient safety culture in relation to nursing work environment. It is paramount to focus on specific dimensions of the nursing work environment, such as staffing and resource adequacy, nurses’ participation and advancement, and communication style to improve the quality of care provided to patients. Hospitals are considered one of the most hazardous places compared with industries. Policy makers would help reduce injuries, save resources, and build a culture of safety when taking into consideration the importance of the nursing work environment in relation to patient safety.

Medication errors among registered nurses in Jordan

Objectives

Medication error (ME) is like a venom dispersing in clinical practice, particularly the process of drugs’ administration. Nurses, as the direct drug administrators, are in critical defense lines to prevent its occurrence. Therefore, our aims were to explore nurses’ understanding, perception, attitude and prevalence of MEs and thereafter defining the main factors associated with its occurrence and needed for designing proper policies for its sufficient prevention.

Methods

Self-reported questionnaires were obtained from 156 nurses distributed almost equally between the 3 major teaching hospitals in Jordan. The questionnaires aimed at measuring their understanding, attitudes, and the prevalence of MEs.

Key findings

The majority of respondents were males (51.3%), young (25–34, 75%), hold a BSc degree (84.6%). Most of their experiences were less than 5 years (67.3%). The level of understanding of the definition, associated factors, and the consequences of ME was acceptable between registered nurses in Jordanian teaching hospitals. Nurses who had the lowest experience (0–5 years) were the highest in committing MEs (P-value = 0.006). Otherwise, gender, age, and education were not significantly associated with MEs. The participants reported that the most common causes of medication error were setting the infusion devices incorrectly, distraction, labeling and packaging problems. Participants declared that the incidents of MEs are underreported (Reporting rate (28.3%)) and they believed that it was most likely due to the fear of losing their job, misjudgment on the seriousness of the incidence that warrant reporting, and fear from coworkers' actions.

Conclusions

MEs are common and may be underreported among registered nurses in Jordan. National policymakers should take critical steps to encourage the nurses to report any error in medication administration and therefore reducing its occurrence.