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


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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    • "14.1% of nurses reported that they were interrupted while preparing chemotherapy by environmental factors (telephone, patients' relatives, and the closeness of outpatient and chemotherapy service). Nurses considered interruption during preparation and administration of medication as a primary reason for medication errors (Mayo and Duncan, 2004; Ulanimo et al., 2007). Therefore, nursing managers should provide enough nursing staff and a proper environment for nurses during preparation and administration of medication to prevent medication errors. "
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    ABSTRACT: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.
    Full-text · Article · Mar 2015 · Asian Pacific journal of cancer prevention: APJCP
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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.
    Full-text · Article · Aug 2014 · PLoS ONE
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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: 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.
    Full-text · Article · Apr 2014 · Journal of Psychiatric and Mental Health Nursing
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