A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm [11]. Medication error is a global issue where 5% of the MEs are deadly and almost 50% are preventable [12]. Medication error reporting is one of the major issues in today’s health care and prevention is linked to accurate reporting of errors [7]. Voluntary reporting is indispensable to appreciate the extent and impact of MEs [13]. Nurses’ interception of 86% of the MEs was presented in a descriptive cross-sectional study conducted in one large medical center hospital in southern Taiwan with sample size of 597 nurses using self-administered questionnaires and the significance of error reporting was given a weight as intercepting [8]. Moreover, consideration of nurses’ perceived barriers to medication error reporting (MER) is a crucial step to strengthen medication safety [8] and it was shown in a study that more than 90% of healthcare consumers believe that errors should be reported [3].
Incidence and prevalence of medication errors
Medication errors which are made during prescription, dispensing and administration [14] are common and preventable causes of patient harm [15]. Precise figure of the incidence and prevalence of MEs is difficult to obtain because the rate varies from study to study [7]. Studies showed a range of rate of serious patient injuries due to medication errors as 1 to 2% [16], 9 to 13% [2], 29% [17], and as high of 51.8% [9], and estimated 30.5% deaths per year in a survey in the United States of America (USA) were attributable to MEs [15]. A study conducted in Southern Iran with the purpose of determining the frequency of MEs in an emergency department of a teaching hospital revealed that 96.5% of patients had experienced at least one medication error, making the rate of errors 3.5 per patient [18]. A descriptive survey of 300 nurses working in hospitals affiliated to Iran University of Medical Sciences using stratified multistage sampling disclosed a mean of 19.5 medication errors that the nurses acknowledged within 3-months period however the mean of error reporting was only 1.3 of error cases [19, 20].
Factors related to medication error reporting
A focus group study on barriers to MER in Canada identified barriers as an individual, organizational and cultural [21]. According to a descriptive cross-sectional study with sample size of 799 nurses conducted in Jordan, the proportion of medication error reporting was relatively high among female nurses than male nurses [7]. Twenty-six percent of nurses in a study conducted in Israel indicated that all MEs in their wards were reported and 46% of the nurses showed self-reporting of MEs. The nurses emphasized on a personal barrier to non-reporting such as ME experiences and error reporting experiences [22].
A perception that incidence reports do not result in significant changes or benefits and errors that did not result in harm were among the factors that affected the attitude of nurses to report medication errors [23, 24]. Perceived barriers which affect attitude of nurses to report medication errors were fear of adverse consequences from reporting and being subjected to disciplinary actions, fear of being blamed, fear of reaction from the nurse manager, from peers and fear of loss of jobs [6,7,8, 19, 25]. Other barriers for not reporting MEs include nurses not being aware that an error had occurred, process of reporting (detailed paperwork, time constraints, not understanding incident reporting process), forgetting to make a report when the ward is busy, lack of time for reporting and lack of awareness of the importance of reporting [19, 23, 26].
Two-thirds (66.7%) of nurses involved in a study conducted in two state hospitals in Turkey who stated that they involved in medication errors in the preceding 6 months had not reported the errors. The reported reasons (social factors) for not reporting MEs included fear of consequences, fear of a culture of blame and the need to cover up for the colleague involved [27].
Modifiable barriers to MER for nurses reported in different studies as organizational factors were revealed as lack of feedback to the reporter, lack of a readily available MER system, lack of information on how to report a ME, no positive feedback for giving medication correctly, too much emphasis on ME as a quality indicator of nursing care and motivational factors (such as no encouragement by management, fear of loss of professional registration), lack of organizational leadership and support [3, 8, 19, 25, 28]. Similarly taking medical responsibility and fear of distrust from patients were barriers of medication error reporting [29].
Encouraging administrative attitudes and responses to MER were appreciated in a study to enhance nurses’ voluntary reporting [30]. It is indicated in the literature that strategies should be implemented to establish reporting mechanisms to reduce medication errors at national as well as international levels [31]. Establishing structured protocols on drug administration and adopting a non-punitive approach to reporting medication errors were shown to decrease medication errors and improve patient safety [32]. Proportion of medication error reporting by nurses might be affected by multiple factors such as socio-demographic, social, attitude of nurses, and organizational factors [7, 8, 12, 19] (Fig. 1 indicates the factors involved in medication error reporting).
Health care systems in most developing countries suffer from serious deficiencies in quality, equity, efficiency and financing [33]. The quality of care is evaluated in the light of the provider’s technical standards and clients’ expectations. Medication administration is among the routine and highly complex nursing care activities which plays a great role in patient care and outcome. Medication safety and medication errors are important concerns for health-care consumers, health-care professionals, researchers and policy makers worldwide.
Nurses are more prone to making medication errors because of the increasing demands and pressures placed on them. Critical incidents must be detected and reported and turned into positive situations, from which lessons are learned and used to design better patient care practices and systems. So far nurses are at the front line of defense to intercept and report medication errors, yet the errors are severely under-detected and under-reported in practice.
Medication errors affect the quality of health care delivery. Improving patient safety and learning from errors relies on voluntary error reporting which gives the complete picture of medication errors. Thus, exploration of the proportion of nurses reporting medication errors and associated factors is important to inform service providers, program implementers and policy makers to improve the quality of the healthcare service.