Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety

Kaiser Permanente, California Division, San Diego, Calif 92109, USA.
Journal of nursing care quality (Impact Factor: 1.39). 09/2004; 19(3):209-17.
Source: PubMed

ABSTRACT This study describes nurse perceptions about medication errors. Findings reveal that there are differences in the perceptions of nurses about the causes and reporting of medication errors. Causes include illegible physician handwriting and distracted, tired, and exhausted nurses. Only 45.6% of the 983 nurses believed that all drug errors are reported, and reasons for not reporting include fear of manager and peer reactions. The study findings can be used in programs designed to promote medication error recognition and reduce or eliminate barriers to reporting.

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    • "Medication errors (MEs) may occur by both medical and paramedical personnel at various levels of patient care, hence multilevel monitoring is required. There are many reports of errors in medication committed by nurses [4]–[5]. Even in intensive care units (ICUs), where the medical and paramedical personnel are more skilled, the frequency of medication errors is reported to be 52.5% [6]. "
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    ABSTRACT: The knowledge of medication errors is an essential prerequisite for better healthcare delivery. The present study investigated prescribing errors in prescriptions from outpatient departments (OPDs) and emergency wards of two public sector hospitals in Lahore, Pakistan. A manual prescription system was followed in Hospital A. Hospital B was running a semi-computerised prescription system in the OPD and a fully computerised prescription system in the emergency ward. A total of 510 prescriptions from both departments of these two hospitals were evaluated for patient characteristics, demographics and medication errors. The data was analysed using a chi square test for comparison of errors between both the hospitals. The medical departments in OPDs of both hospitals were the highest prescribers at 45%-60%. The age group receiving the most treatment in emergency wards of both the hospitals was 21-30 years (21%-24%). A trend of omitting patient addresses and diagnoses was observed in almost all prescriptions from both of the hospitals. Nevertheless, patient information such as name, age, gender and legibility of the prescriber's signature were found in almost 100% of the electronic-prescriptions. In addition, no prescribing error was found pertaining to drug concentrations, quantity and rate of administration in e-prescriptions. The total prescribing errors in the OPD and emergency ward of Hospital A were found to be 44% and 60%, respectively. In hospital B, the OPD had 39% medication errors and the emergency department had 73.5% errors; this unexpected difference between the emergency ward and OPD of hospital B was mainly due to the inclusion of 69.4% omissions of route of administration in the prescriptions. The incidence of prescription overdose was approximately 7%-19% in the manual system and approximately 8% in semi and fully electronic system. The omission of information and incomplete information are contributors of prescribing errors in both manual and electronic prescriptions.
    PLoS ONE 08/2014; 9(8):e106080. DOI:10.1371/journal.pone.0106080 · 3.23 Impact Factor
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    • "In a survey of 1,384 nursing staff working in 24 US general hospitals, factor analysis revealed four main factors to be responsible for the failure to report administration errors: fear, disagreement over whether or not an error had occurred, administrative responses to medication errors and the effort involved in the reporting process (Wakefield et al, 1996). Fear (Chiang et al, 2011; Chiang & Pepper, 2006; Hartnell et al, 2012; Koohestani & Baghcheghi, 2009; Mrayyan et al, 2007; Mayo & Duncan, 2004; Osborn et al, 1999) and administrative burden (Almutary & Lewis, 2012; Chiang & Pepper, 2006; Hartnell et al, 2012; Sanghera et al, 2001) are commonly reported as barriers to reporting across a number of studies. Interestingly, Ulanimo et al (2007) found that the fear associated with reporting was largely about the potential reaction of managers and colleagues but was largely not related to a specific fear of disciplinary action or job-loss. "
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    ABSTRACT: Accessible summary: Medication administration errors and near misses are common including in mental health settings. Nurses should report all errors and near misses so that lessons can be learned and future mistakes avoided. We interviewed 50 nurses to find out if they would report an error that a colleague had made or if they would report a near-miss that they had. Less than half of nurses said they would report an error made by a colleague or a near-miss involving themselves. Nurses commonly said they would not report the errors or near misses because there was a good excuse for the error/near miss, because they lacked knowledge about whether it was an error/near miss or how to report it, because they feared the consequences of reporting it, or because reporting it was too much work. Mental health nurses mostly report similar reasons for not reporting errors and near misses as nurses working in general medical settings. We have not seen another study where nurses would not report an error or near miss because they thought there was a good excuse for it. Training programmes and policies should address all the reasons that prevent reporting of errors and near misses. Medication errors are a common and preventable cause of patient harm. Guidance for nurses indicates that all errors and near misses should be immediately reported in order to facilitate the development of a learning culture. However, medication errors and near misses have been under-researched in mental health settings. This study explored the reasons given by psychiatric nurses for not reporting a medication error made by a colleague, and the perceived barriers to near-miss reporting. We presented 50 nurses with clinical vignettes about error and near-miss reporting and interviewed them about their likely actions and about their views and perceptions. Less than half of participants would report an error made by a colleague (48%) or a near-miss involving themselves (40%). Thematic analysis revealed common themes for both not reporting an error or a near-miss were knowledge, fear, burden of work, and excusing the error. The first three themes are similar to results obtained from research in general medical settings, but the fourth appears to be novel. Many mental health nurses are not yet fully convinced of the need to report all errors and near misses, and that improvements could be made by increasing knowledge while reducing fear, burden of work, and excusing of errors.
    Journal of Psychiatric and Mental Health Nursing 04/2014; 21(9):797-805. DOI:10.1111/jpm.12143 · 0.84 Impact Factor
    • "These medication administration errors (MAEs) occur when one or more of the seven rights of medication administration (right patient, right drug, right dose, right time, right route, right reason and right documentation) are violated (Wakefield et al. 1999, Pape 2003). The medication administration process is error-prone because of the many environmental and workload issues encountered by nurses (Pape 2001, Mayo & Duncan 2004, Tang et al. 2007, Armutlu et al. 2008, Brady et al. 2009). "
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    ABSTRACT: To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge.
    Journal of Nursing Management 03/2014; 22(3). DOI:10.1111/jonm.12225 · 1.50 Impact Factor
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