Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting

Afshin Fathi; Mohammad Hajizadeh; Khalil Moradi; Hamed Zandian; Maryam Dezhkameh; Shima Kazemzadeh; Satar Rezaei

doi:10.4178/epih.e2017022

Articles

Page Path: HOME > Epidemiol Health > Volume 39; 2017 > Article

Original Article Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting: Afshin Fathi¹, Mohammad Hajizadeh², Khalil Moradi³, Hamed Zandian⁴, Maryam Dezhkameh⁵, Shima Kazemzadeh⁵, Satar Rezaei⁶; Epidemiol Health 2017;39:e2017022.
DOI: https://doi.org/10.4178/epih.e2017022
Published online: May 17, 2017

¹Department of Pediatrics, Ardabil University of Medical Sciences, Ardabil, Iran

²School of Health Administration, Faculty of Health Professions, Dalhousie University, Halifax, Canada

³Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

⁴Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

⁵Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran

⁶Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran

Correspondence: Satar Rezaei Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Shirudi Boulevard, Kermanshah 6714869914, Iran E-mail: satarrezaei@gmail.com

• Received: March 1, 2017 • Accepted: May 17, 2017

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

22,257 Views
543 Download
36 Web of Science
44 Crossref
53 Scopus

Full Article

Download PDF

Abstract
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
ACKNOWLEDGEMENTS
NOTES
REFERENCES

Abstract

OBJECTIVES
This study aimed to examine the prevalence and types of medication errors (MEs), as well as barriers to reporting MEs, among nurses working in 7 teaching hospitals affiliated with Kermanshah University of Medical Sciences in 2016.
METHODS
A convenience sampling method was used to select the study participants (n=500 nurses). A self-constructed questionnaire was employed to collect information on participants’ socio-demographic characteristics (10 items), their perceptions about the main causes of MEs (31 items), and barriers to reporting MEs to nurse managers (11 items). Data were collected from September 1 to November 30, 2016. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses.
RESULTS
The prevalence of MEs was 17.0% (95% confidence interval, 13.7 to 20.3%). The most common types of MEs were administering medications at the wrong time (24.0%), dosage errors (16.8%), and administering medications to the wrong patient (13.8%). A heavy workload and the type of shift work were considered to be the main causes of MEs by nursing staff. Our findings showed that 45.0% of nurses did not report MEs. A heavy workload due to a high number of patients was the most important reason for not reporting MEs (mean score, 3.57±1.03) among nurses. Being male, having a second unrelated job, and fixed shift work significantly increased MEs among nurses (p=0.001).
CONCLUSIONS
Our study documented a high prevalence of MEs among nurses in the west of Iran. A heavy workload was considered to be the most important barrier to reporting MEs among nurses. Thus, appropriate strategies (e.g., reducing the nursing staff workload) should be developed to address MEs and improve patient safety in hospital settings in Iran.
Keywords: Medication errors, Prevalence, Nurses, Iran

INTRODUCTION

Medical errors are an inevitable part of the healthcare system and pose a substantial threat to patient safety [1,2]. Medication errors (MEs) are one of the most common types of medical errors in healthcare systems (10 to 18% of total medical errors) and can cause serious harm to patients, even leading to death [3,4]. MEs are defined as any preventable events that may lead to the improper use of medications or may harm patients while medications are in the control of healthcare workers, patients, or consumers [5,6]. These errors can happen at any step of the medication process (prescription, transcription, dispensing, and administration) where physicians, pharmacists, and nurses are involved. Based on the findings of previous studies [7-9], MEs most commonly occur during the administration step of the medication process (i.e., giving medicine to patients), accounting for 87% of all MEs. Most MEs occurring at this step are committed by nurses. According to previous studies [3,9-13], the most prevalent administration errors are the wrong injection time, administering a medication to the wrong patient, using the wrong dose in the injection, administering the wrong drug, and administering the drug through the wrong route (e.g., intravenous injections instead of intramuscular injections). Other common medication administration errors include failing to order a drug, lack of a drug form, and failing to administer the drug [14].

The financial and non-financial burdens of MEs on the health system are significant. For example, the annual number of deaths occurring due to MEs in the US has been estimated as 44,000 to 98,000, which is greater than the number of deaths due to breast cancer, road traffic accidents, and acquired immune deficiency syndrome [5,15]. MEs lead to longer hospital stays and greater healthcare spending. The cost of hospitalization due to preventable MEs is estimated to be USD 2 billion per year in the US [11,16]. It was estimated that the mean hospitalization costs of patients who experienced MEs were higher than those of patients who did not (USD 109,199 vs. USD 56,913) [17].

Nurses play a crucial role in the provision of inpatient care, and the quality of inpatient care is closely associated with their practice. In order to reduce MEs and to improve patient safety, nurses should follow the 5 principles (“rights”) of medication administration: right patient, right medication, right dose, right route, and right time [18,19]. Understanding the prevalence and determinants of MEs among nurses is an essential first step toward the safe and appropriate administration of medication. Understanding the root causes of MEs can potentially provide useful and necessary information for health policy-makers to design and implement effective interventions to reduce the negative impact of MEs on patients and the healthcare system. Although some studies [10,13] have demonstrated a high prevalence of MEs in Iran, the prevalence and determinants of MEs among Iranian nurses are poorly understood. Thus, in this study, we aimed to examine the prevalence and types of MEs, as well as barriers to reporting MEs, among nurses working in teaching hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), in the west of Iran.

This was a cross-sectional study carried out among 500 nurses in 7 teaching hospitals affiliated with KUMS, Kermanshah, Iran. Data collection occurred over an 8-week period from September 1 to November 30, 2016. A convenience sampling method was used to select nurses who had at least 1 year of practical work experience at the hospitals. A self-constructed questionnaire was employed to collect information on the socio-demographic characteristics of nurses and their perceptions about the main causes of MEs and barriers to reporting. The validity and reliability of the study questionnaire were investigated and confirmed in other studies [3,18,20]. Content validity was confirmed through interviews with 10 experts, and reliability was confirmed through the completion of 20 questionnaires by nurses at a 2-week interval (Cronbach alpha, 0.81). The questionnaire was composed of four major sections. The first part contained questions related to the sociodemographic characteristics of the study participants, such as age, sex, marital status, educational attainment, years of work experience in nursing, shift type, type of employment, work in 1 or more hospitals, having a second unrelated job, level of satisfaction with the nursing job, and economic status. The second part consisted of 9 yes-and-no questions designed to collect information on 9 different types of MEs made by nurses within the last 3 months. In this section, there was also a question about the proportion (%) of MEs reported to the nurse manager after their occurrence. The third part included 31 questions designed to obtain nurses’ opinions on the main factors affecting MEs. These questions were grouped into 5 categories: the managerial process (7 questions); the nursing job (7 questions); social, physiological, and psychological conditions of nurses (6 questions); factors relating to medicine and physicians (6 questions); and patient and ward conditions (6 questions). The last part of the questionnaire contained 11 questions designed to assess nurses’ views on the main barriers to reporting MEs. The third and fourth parts of the questionnaire were scored using a 5-point Likert scale, with scores ranging from 1 being ‘not at all important’ to 5 being ‘extremely important.’ The mean score for each scale was calculated by dividing the sum of scores for all questions in each scale by the number of the relevant questions. In each scale, higher scores represented a greater degree of influence on MEs. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses. We used the incidence rate ratio with 95% confidence intervals (CIs) to assess the associations between dependent and explanatory variables. The p-values < 0.05 were defined as indicating statistical significance. All analyses were performed in Stata version 12 (StataCorp, College Station, TX, USA).
Ethics statement: The study protocol was reviewed and approved by the Ethics Committee of the Deputy of Research, KUMS (KUMS.REC. 3004602). Verbal consent, as approved by the Deputy of Research of KUMS, was obtained from each participant after explaining the details of the study, including its purpose. It was explained that participants had the right to withdraw from the study or interrupt at any point during the data collection process.

RESULTS

The sample consisted of 500 nurses, of whom 328 (65.6%) were female and 172 (34.4%) were male. The average age of the nurses in our sample was 31.9 years, with a standard deviation (SD) of 6.5 years. Their mean nursing experience was 5.05 years (SD, 1.02 years). Most of the nurses in our sample had a bachelor’s degree (n= 453, 90.6%). Approximately 19.0% (n= 94) of the study population were working in more than one hospital and 10.0% (n= 50) of nurses had an unrelated second job. Approximately 51.0% (n= 255) of the nurses were satisfied with their career as a nurse. Most of the nurses (n= 420, 84.0%) reported working in a rotating shift system. The descriptive statistics of the socio-demographic characteristics of the study population are presented in Table 1.

Based on the nurses’ own assessment, the prevalence of ME occurrence among nurses within the past 3 months was 17.0% (95% CI, 13.7 to 20.3%). Figure 1 shows the percentages of different types of MEs among the total number of MEs reported by nurses over the study period. As illustrated in Figure 1, the most common type of ME was administering a medication at the wrong time (24.0%), followed by administering the wrong dose (16.8%) and administering a medication to the wrong patient (13.8%).

Table 2 reports nurses’ views on the main causes of MEs. As shown in the Table 2, fatigue caused by excessive work hours (mean score [based on a 5-point Likert scale from 1= not at all important to 5= extremely important], 3.94± 1.02) and type of shift work (mean score, 3.74±1.05) were the two most important factors causing MEs among nurses.

Our study showed that 55% of nurses reported their MEs. Table 3 presents nurses’ opinions about the main barriers to reporting MEs. Based on our results, the most important barrier to reporting MEs was a heavy workload due to a high number of patients (3.57±1.03), followed by concerns about the consequence of MEs for patients (3.56±1.04) and concerns about the reaction of the nurse manager to MEs (3.42±1.08).

Table 4 presents the results of the negative binomial regression analysis. The results indicate the effect of explanatory variables on the number of MEs made by nurses. The regression analysis demonstrated that being male, having an unrelated second job, and fixed shift work were significantly associated with an increased number of MEs made by nurses.

DISCUSSION

Medical errors are an inevitable part of the healthcare system. MEs are one of the most common types of errors among healthcare professionals (especially nurses), and pose a significant threat to patient safety and the quality of healthcare. In this study, we investigated various issues related to MEs among nurses working in all teaching hospitals affiliated with KUMS in 2016. Based on the nurses’ own assessments, the prevalence of MEs was found to be 17.0%. This estimated prevalence of MEs among nurses is similar to the prevalence of 16.7% observed in hospitals in Sanandaj, Iran [21]. Using observational methods in the US, Tisdale [22] also found that the prevalence of MEs in an intensive-care nursery was 17.4%. In contrast to our finding, Sarhadi et al. [4] showed that approximately 28% of nurses working in teaching hospitals affiliated with Zanjan University of Medical Sciences in Iran made at least 1 ME in 2015. The estimated prevalence of MEs was 64.5% among nurses working in a teaching hospital affiliated with Tehran University of Medical Sciences in Tehran (the capital of Iran) [23]. Higher prevalence of MEs have been reported in some international studies. For example, a study by Mrayyan et al. [6] investigated the perceptions of nurses about various issues related to MEs in Jordan and showed that the prevalence of MEs was 42.1%. The lower estimated prevalence of MEs among nurses in our study than has been observed in other similar studies in Iran can be explained by the fact that we measured the prevalence over a 3-month period, while other studies calculated the prevalence over 6 months.

Similar to previous studies in Iran [3,24-26], our study demonstrated that the most common types of MEs among patients were administering medication at the wrong time, in the wrong dose, and to the wrong patient. A study by Tang et al. [9] likewise found that administering the wrong dose (36.1%), using the wrong drug (26.4%), and administering the drug at the wrong time (18.1%) were the 3 most common types of MEs in Taiwan. Another study in Denmark indicated that the most common types of MEs among nurses were use of medication without a physician’s order, using the wrong drug, and administering the wrong dose [14].

A heavy workload was identified as the most important barrier to reporting MEs among nurses in our sample. This finding is consistent with those of previous studies [15,23,27]. For example, studies in Iran [25,28], Taiwan [9], and Germany [29] have suggested a heavy workload to be the main cause of MEs. Based on previous studies [9,19,30,31] that examined MEs from the nurses’ perspective [9,19,30,31], insufficient training, overcrowded and noisy environments, phone call orders by physicians, poor or damaged labels/packaging of medication, difficult and illegible physicians’ orders, insufficient nurse-to-patient ratios, physical and mental problems among nurses, and unfamiliarity with medications are other factors contributing to MEs. The low nurse-to-population ratio was highlighted in previous studies conducted in hospitals in Kermanshah province and other Iranian provinces. For example, Rezaei et al. [32] showed that the total number of nurses per 10,000 population in Kermanshah was 5.8, while this figure was 12.6 in Iran as a whole [33] and 6.7 in Tehran province, the capital province of Iran [34].

There is an ME reporting system in the wards of all hospitals in Iran, and when an ME occurs, nurses are asked to report the patient’s name, the type of the ME, the reason for the ME, and the potential side effects of the ME. Although nurses are asked to complete anonymous ME reports, we found that 45% of nurses did not report their MEs to their nurse managers. Based on the nurses’ opinions, the most important barriers to reporting MEs were a heavy workload due to the high number of patients, concerns about the consequence of MEs (e.g., drug side effects), and concerns about the reaction of the nurse manager. A study by Mirzaei et al. [18] showed that only 28.9% of nurses working in teaching hospitals in Kermanshah (22 out of a total sample of 95) reported their MEs to their nurse manager. Other studies in Jordan [6] and the US [35] likewise showed that the prevalence of reporting MEs to nurse managers was 42.1 and 45.6%, respectively. It is evident that the low reporting rate of MEs by nurses is a serious concern that warrants special attention from health policy-makers and hospital management.

The common causes of not reporting or underreporting MEs vary across different healthcare delivery settings. Chiang & Pepper [36] found that fear, difficulty of the reporting process, and administrative obstacles were the major causes of underreporting MEs. Concerns about the reactions of nurse managers and coworkers, fear of being blamed, and fear of the negative consequence of MEs on patients were stated as other reasons for not reporting MEs [37-39]. An unclear definition of errors among nurses is another major cause of non-reporting or underreporting MEs. The existing literature indicates that 16% of nurses do not know the accurate definition of an ME and that 14% do not know when an ME should be reported [37,38]. Some studies [38,40] have suggested that 95% of MEs were not reported by nurses due to fear of punishment. One of the reported causes of non-reporting or underreporting MEs was related to the nurse managers’ perceptions of the effect of reporting MEs. If nurse managers are concerned about the reputation of their hospitals, they may not be willing to report MEs [40,41]. However, since reporting MEs is considered an ethical responsibility and leads to improvements in the quality of healthcare and increased patient safety, healthcare professionals (especially nurse managers and nurses) should have a positive attitude toward reporting MEs. In this regard, an important step is to increase the awareness of healthcare professionals about MEs and the importance of reporting them. Furthermore, attempts should be made to address some other barriers to the improvement of patient safety through a reduction of MEs. These include barriers such as a blame culture and lack of peer-review protection [42]. To foster a patient safety culture in Iranian hospitals, reductions in the rate of non-reporting could be used as an indicator of patient safety culture.

Our empirical analysis indicated that being male, having a second unrelated job, and the type of shift work were the 3 predictors of the frequency of MEs. Previous studies [7,19,22] have also shown statistically significant associations between MEs and shift work. Shift-related fatigue among nurses working during the night and early morning can be a contributing factor to high ME rates among nurses on fixed shifts. The higher frequency of MEs among nurses with a second job may be explained by the fact that working a second job for supplemental income leads to exhaustion and fatigue among nurses, which, in turn, leads to a higher frequency of MEs among this group of nurses. Yousefi et al. [13] and Hajibabaee et al. [43] suggested a positive association between being male and MEs. Our study did not show any significant association between the frequency of MEs and nurses’ age, marital status, socioeconomic status, level of educational attainment, or years of experience. Recent studies [2,6,35,38] have likewise not suggested any associations between age or years of experience and MEs.

Our study is subject to several limitations. First, this study was carried out among nurses working in teaching hospitals in the city of Kermanshah, in the west of Iran; thus, the results of our study may be not generalizable to other types of hospitals (private hospitals and social security hospitals) or the rest of Iran. Secondly, we used self-reported data to understand the overall picture of MEs, and this method has poorer accuracy than follow-up and observational studies.

In conclusion, due to the negative consequences of MEs on the quality of care, patient safety, and performance of hospitals, nursing managers in Iran should intervene to prevent and reduce MEs among nurses. As a heavy workload was the main factor affecting MEs and the non-reporting or underreporting of MEs in our study, reducing the working hours of nursing staff can play a major role in reducing MEs among staff and in facilitating proper reporting. In addition, nursing and hospital managers should hold periodic retraining courses on the proper and safe use of a variety of medications for nurses to reduce the frequency of MEs among nurses. Moreover, since our results indicated that being male, having an unrelated second job, and fixed shift work were significantly associated with increased ME rates among nurses, nursing and hospital managers should pay more attention to the role of these factors in MEs among nurses. Considering that approximately 32 to 69% of MEs are partially or completely avoidable [11], appropriate strategies (e.g., reducing nursing staff workload) should be developed to reduce MEs and to reduce barriers to reporting MEs among nurses working in hospital settings in Iran.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the research council of Kermanshah University of Medical Sciences for providing financial support.

NOTES

The authors have no conflicts of interest to declare for this study.

Figure 1.

Proportion of different types of medication errors (MEs) as a percentage of total MEs among nurses in Kermanshah, west of Iran, 2016 (n = 500): nurse’s own assessment.

Table 1.

Demographic, practice-related, and socioeconomic characteristics of nurses in Kermanshah, western Iran (n = 500)

Variables	n	%
Socio-demographic characteristics
Age (yr)
<25	85	17.0
25-35	289	57.8
≥36	126	25.2
Mean士SD	31.9 ± 6.5
Sex
Male	172	34.4
Female	328	65.6
Marital status
Single	197	39.4
Married	298	59.6
Widowed or divorced	7	1.0
Practice-related characteristics
Years of experience
1-4	186	37.2
≥ 5	314	62.8
Mean士SD	5.0 ± 1.0
Worked in more than 1 hospital
Yes	95	19.0
No	405	81.0
Satisfied with nursing career
Yes	255	51.0
No	245	49.0
Had an unrelated second job
Yes	50	10.0
No	450	90.0
Shift type
Rotating	420	84.0
Fixed	80	16.0
Socioeconomic characteristics
Employment status
Full-time	385	77.0
Part-time	65	23.0
Educational attainment
Bachelor's degree	453	90.6
Master's degree	47	9.4
Socioeconomic status
Poor	51	10.2
Middle	363	72.6
High	86	17.2

Table 2.

Nurses’ assessments of the main causes of MEs among nurses in Kermanshah, western Iran (n = 500)

Categories	Items	Mean	SD
Managerial process	Lack of monitoring and supervisory mechanism for the healthcare process	2.58	1.07
	Shortages of nursing staff on the wards	3.51	1.3
	Lack of recording and reporting mechanism for MEs	2.88	1.14
	Inappropriate communication between nurses and their mangers	2.82	1.18
	Unmotivated nurses because of discrimination in the workplace	3.27	1.24
	Change in Kardex when patients are transferred to other wards	2.97	1.17
	Lack of drug information in wards	2.83	1.09
	Total	2.98	0.81
Nursing job	Failure to properly convey physicians' order to Kardex	2.70	1.23
	Give a medication at the wrong time	2.63	1.11
	Give wrong dose of a medication	2.52	1.18
	Give inaccurate diffusion rate of medication	2.56	1.15
	Use the wrong route of mediation	2.54	1.18
	Wrong patient receiving the drug	2.45	1.28
	Lack of adequate knowledge about medication	2.58	1.16
	Total	2.57	0.95
Social, physiological, and psychological conditions of nurses	Job dissatisfaction	3.29	1.19
	Economic problems	3.57	1.05
	Family problems	3.52	1.03
	Psychological and emotional problems	3.65	1.06
	Fatigue caused by excessive work hours	3.94	1.02
	Type of shift work	3.74	1.05
	Total	3.62	0.81
Medicine and physicians	Inappropriate labeling of medications	3.09	1.16
	Look-alike medications	3.12	1.08
	Availability of a variety of mediations in wards	3.07	1.07
	Phone call order by physicians	3.13	1.10
	Physician's written orders (prescriptions) is difficult to read	3.49	1.12
	Total	3.18	0.87
Patient and ward conditions	Inappropriate behaviors of patients	3.57	1.07
	Presence of patients' companions in wards	3.66	1.04
	Higher number of patients with severe illnesses in wards	3.71	0.98
	Environmental conditions of wards (e.g., light, ventilation and temperature)	3.24	1.12
	Excessive high noise levels in wards	3.34	1.07
	Drug arrangement on the shelves	3.09	1.12
	Total	3.43	0.76

ME, medication error; SD, standard deviation.

Table 3.

Nurses’ assessments of the main barriers to reporting MEs in Kermanshah, western Iran, 2016 (n = 500)

Type of barrier	Mean	SD
Lack of information about how to report MEs	2.27	1.01
Forget to report MEs to the nurse manager	2.59	1.08
Attitude and personality of nurses	3.13	1.07
Heavy workload due to the high number of patients	3.57	1.03
Fear of disciplinary punishment	3.39	1.05
Afraid of the reaction from coworkers	3.38	1.05
Not giving priority to report after occurring MEs	3.12	1.06
Concern about the reaction of the nurse manager	3.42	1.08
Worry about the consequence of MEs (e.g., drug side effects)	3.56	1.04
Concerns about the effect of MEs on individual's earnings	3.37	1.11
Lack of clarity about the definition of MEs	2.77	0.98

ME, medication error; SD, standard deviation.

Table 4.

Results of negative binomial regression analysis of the frequency of medication errors among nurses in Kermanshah, western Iran (n = 500)

Explanatory variables	Unadjusted	Adjusted
Socio-demographic characteristics
Age (yr)	1.01 (0.99, 1.03)	1.02 (0.99, 1.05)
Sex
Female	1.00	1.00
Male^*	2.30 (1.76, 3.03)	2.16 (1.63, 2.87)
Marital status
Single	1.00	1.00
Married	1.01 (0.57, 1.81)	1.13 (0.58, 2.20)
Practice characteristics
Years of experience
1-4	1.00	1.00
≥5	1.01 (0.76, 1.33)	0.83 (0.56, 1.21)
Worked in more than 1 hospital
Yes	1.00	1.00
No	1.04 (0.74, 1.49)	1.20 (0.82, 1.74)
Satisfied with nursing career
Yes	1.00	1.00
No	1.14 (0.87,1.50)	1.20 (0.92, 1.59)
Had an unrelated second job
Yes	1.00	1.00
No^*	1.82 (1.26, 2.61)	1.72 (1.16, 2.54)
Shift type
Rotating	1.00	1.00
Fixed^*	2.01 (1.23, 3.26)	2.18 (1.33, 3.54)
Socioeconomic characteristics
Educational attainment
Bachelor's degree	1.00	1.00
Master's degree	0.64 (0.36,1.12)	0.64 (0.36, 1.13)
Socioeconomic status
Poor	1.00	1.00
Middle	0.62 (0.24,1.55)	0.60 (0.23, 1.59)
High	0.89 (0.30, 2.62)	1.10 (0.34, 3.49)
Log likelihood	−502.23
Pseudo-R²	0.06

Values are presented as incidence rate ratio (95% confidence interval).

^* p<0.05.

REFERENCES

1. Wilfred Bonney W. Medical errors: moral and ethical considerations. J Hosp Adm 2013;32:80-88.
2. Anderson JG. A systems approach to preventing adverse drug events. Stud Health Technol Inform 2003;92:95-102.PubMed
3. Jolaee S, Hajibabaee F, Peyravi H, Haghani H. Nursing medication errors and its relationship with work condition in Iran University of Medical Sciences. Iran J Med Ethics Hist Med 2009;3:65-76 (Persian).
4. Sarhadi M, Abdollhyar A, Navidian A, Sheikh Bardsiri H, Sarhadi T. The investment of effective factors on medical errors and nonreporting from nurse’s perspective. J Sabzevar Univ Med Sci 2015;22:132-142 (Persian).
5. In: Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000. p 100-101.
6. Mrayyan MT, Shishani K, Al-Faouri I. Rate, causes and reporting of medication errors in Jordan: nurses’ perspectives. J Nurs Manag 2007;15:659-670.Article PubMed
7. Rosen RK. Medication errors: a 21st-century perspective. Proc (Bayl Univ Med Cent) 2004;17:464-467.Article PubMed PMC
8. Benjamin DM. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology. J Clin Pharmacol 2003;43:768-783.Article PubMed
9. Tang FI, Sheu SJ, Yu S, Wei IL, Chen CH. Nurses relate the contributing factors involved in medication errors. J Clin Nurs 2007;16:447-457.Article PubMed
10. Ebrahimi Rigi Tanha Z, Baghaei R, Feizi A. A survey of frequency and type of medical errors done by nursing students of Urmia Medical Sciences University in 1390. J Urmia Nurs Midwifery Fac 2012;10:13-144 (Persian).
11. Eslami S, Abu-Hanna A, de Keizer NF. Evaluation of outpatient computerized physician medication order entry systems: a systematic review. J Am Med Inform Assoc 2007;14:400-406.Article PubMed PMC PDF
12. Brady AM, Malone AM, Fleming S. A literature review of the individual and systems factors that contribute to medication errors in nursing practice. J Nurs Manag 2009;17:679-697.Article PubMed
13. Yousefi MS, Abed Saeedi Z, Maleki M, Sarbakhsh P. Frequency and causes of medication errors of nurses in different shift works in educational hospitals affiliated to Shahid Beheshti University of Medical Sciences. J Shahid Beheshti Sch Nurs Midwifery 2014;24:27-34 (Persian).
14. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care 2005;17:15-22.Article PubMed PDF
15. Stratton KM, Blegen MA, Pepper G, Vaughn T. Reporting of medication errors by pediatric nurses. J Pediatr Nurs 2004;19:385-392.Article PubMed
16. Grissinger MC, Kelly K. Reducing the risk of medication errors in women. J Womens Health (Larchmt) 2005;14:61-67.Article PubMed
17. Choi I, Lee SM, Flynn L, Kim CM, Lee S, Kim NK, et al. Incidence and treatment costs attributable to medication errors in hospitalized patients. Res Social Adm Pharm 2016;12:428-437.Article PubMed
18. Mirzaei M, Khatony A, Safari Faramani R, Sepahvand E. Prevalence, types of medication errors and barriers to reporting errors by nurses in an educational hospital in Kermanshah. J Hayat 2013;19:28-37 (Persian).
19. Souzani A, Bagheri H, Pourheydari M. Survey nurse’s view about factors affects medication errors in different care units of Imam Hossein hospital in Shahroud. Knowl Health 2007;2:8-13 (Persian).
20. Mardani Hamooleh M, Shahraki Vahed A. The obstacles in reporting nursing error: a nurses’ perspective. Iran J Med Ethics Hist Med 2009;2:55-62 (Persian).
21. Penjvini S. Investigation of the rate and type of medication errors of nurses in Sanandaj hospitals. Iran J Nurs Res 2006;1:59-64 (Persian).
22. Tisdale JE. Justifying a pediatric critical-care satellite pharmacy by medication-error reporting. Am J Hosp Pharm 1986;43:368-371.Article PubMed
23. Cheragi MA, Manoocheri H, Mohammadnejad E, Ehsani SR. Types and causes of medication errors from nurse’s viewpoint. Iran J Nurs Midwifery Res 2013;18:228-231.PubMed PMC
24. Taheri E, Nourian M, Rasouli M, Kavousi A. The study of type and amount of medication errors in neonatal intensive care units and neonatal units. Iran J Crit Care Nurs 2013;6:21-28.
25. Ebrahimipour H, Hosseini SE, Haghighi H, Tabatabaee SS, Badiee SH, Vafaee Najjar A, et al. Evaluation of medication errors by nurses in hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran. J Patient Saf Qual Improv 2016;4:400-404.
26. Alsulami Z, Conroy S, Choonara I. Medication errors in the Middle East countries: a systematic review of the literature. Eur J Clin Pharmacol 2013;69:995-1008.Article PubMed PMC
27. Dibbi HM, Al-Abrashy HF, Hussain WA, Fatani MI, Karima TM. Causes and outcome of medication errors in hospitalized patients. Saudi Med J 2006;27:1489-1492.PubMed
28. Bizhani M, Kouhpayeh SA, Abadi R, Tavacool Z. Effective factors on the incidence of medication errors from the nursing staff perspective in various department of Fasa Hospital. J Fasa Univ Med Sci 2013;3:88-93 (Persian).
29. Cramer H, Pohlabeln H. Habermann M. Factors causing or influencing nursing errors as perceived by nurses: findings of a crosssectional study in German nursing homes and hospitals. J Public Health 2013;21:145 –153.Article
30. Haw CM, Dickens G, Stubbs J. A review of medication administration errors reported in a large psychiatric hospital in the United Kingdom. Psychiatr Serv 2005;56:1610-1613.Article PubMed
31. Seidi M, Zardosht R. Survey of nurses’ viewpoints on causes of medicinal errors and barriers to reporting in pediatric units in hospitals of Mashhad University of Medical Sciences. J Fasa Univ Med Sci 2012;2:142-147 (Persian).
32. Rezaei S, Ghazanfari S, Kazemi Z, Karyani AK. Access to healthcare facilities: case study of Kermanshah province. J Kermanshah Univ Med Sci 2014;18:416-425 (Persian).
33. Zarea K, Negarandeh R, Dehghan-Nayeri N, Rezaei-Adaryani M. Nursing staff shortages and job satisfaction in Iran: issues and challenges. Nurs Health Sci 2009;11:326-331.Article PubMed
34. Sefiddashti SE, Arab M, Ghazanfari S, Kazemi Z, Rezaei S, Karyani AK. Trends of geographic inequalities in the distribution of human resources in healthcare system: the case of Iran. Electron Physician 2016;8:2607-2613.Article PubMed PMC
35. Mayo AM, Duncan D. Nurse perceptions of medication errors: what we need to know for patient safety. J Nurs Care Qual 2004;19:209-217.Article PubMed
36. Chiang HY, Pepper GA. Barriers to nurses’ reporting of medication administration errors in Taiwan. J Nurs Scholarsh 2006;38:392-399.Article PubMed
37. Wakefield DS, Wakefield BJ, Uden-Holman T, Borders T, Blegen M, Vaughn T. Understanding why medication administration errors may not be reported. Am J Med Qual 1999;14:81-88.Article PubMed
38. Osborne J, Blais K, Hayes JS. Nurses’ perceptions: when is it a medication error? J Nurs Adm 1999;29:33-38.Article
39. Anoosheh M, Ahmadi F, Faghihzadeh S, Vaismoradi M. Survey of predisposing causes of working errors in nursing cares from perspective of nurses and their mangers perspectives. Iran J Nurs 2007;20:25-36 (Persian).
40. Kapborg I, Svensson H. The nurse’s role in drug handling within municipal health and medical care. J Adv Nurs 1999;30:950-957.Article PubMed
41. Dunn D. Incident reports--correcting processes and reducing errors. AORN J 2003;78:212, 214 216, 219-220.Article PubMed
42. David U. Medication error and patient safety. Healthc Pap 2001;2:71-76.Article PubMed
43. Hajibabaee F, Joolaee S, Peyravi H, Haghani H. The relationship of medication errors among nurses with some organizational and demographic characteristics. Iran J Nurs Res 2011;6:83-92 (Persian).

Figure & Data

References

Citations

Citations to this article as recorded by

Sleep deprivation and medication administration errors in registered nurses—A scoping review
Christopher Vincent Martin, Joanne Joyce‐McCoach, Monica Peddle, Christine Elizabeth East
Journal of Clinical Nursing.2024; 33(3): 859. CrossRef
Barriers to reporting adverse events from the perspective of ICU nurses: A mixed-method study
D. Kohanová, D. Bartoníčková
Enfermería Intensiva.2024;[Epub] CrossRef
Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis
Hadis Fathizadeh, Samaneh-Sadat Mousavi, Zahra Gharibi, Hamidreza Rezaeipour, Abdol-Rahim Biojmajd
BMC Nursing.2024;[Epub] CrossRef
Awareness, Practices, and Contributing Factors toward Medication Errors in Children among Pediatric Nurses
Sonali Singh, S. Malar Kodi, Rupinder Deol
Asian Journal of Pharmaceutical Research and Health Care.2024; 16(1): 37. CrossRef
Iranian nurses’ attitudes towards the disclosure of patient safety incidents: a qualitative study
Parichehr Sabbaghzadeh Irani, Mahlagha Dehghan, Roghayeh Mehdipour
BMJ Open.2024; 14(3): e076498. CrossRef
Fatigue in nurses and medication administration errors: A scoping review
Tracey Bell, Madeline Sprajcer, Tracey Flenady, Ashlyn Sahay
Journal of Clinical Nursing.2023; 32(17-18): 5445. CrossRef
Nurses’ perceptions of the influence of leadership behaviours and organisational culture on patient safety incident reporting practices
Islam Ali Al-Oweidat, Ali Saleh, Anas Husam Khalifeh, Nazih Abu Tabar, Mohammad Rafe Al Said, Malek Mohammad Khalil, Huthaifah Khrais
Nursing Management.2023; 30(6): 33. CrossRef
Awareness of reporting practices and barriers to incident reporting among nurses
Islam Oweidat, Khalid Al-Mugheed, Samira Ahmed Alsenany, Sally Mohammed Farghaly Abdelaliem, Majdi M. Alzoubi
BMC Nursing.2023;[Epub] CrossRef
Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review
Moataz Mohamed Maamoun Hamed, Stathis Konstantinidis
Western Journal of Nursing Research.2022; 44(5): 506. CrossRef
Nurses’ knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine
Rawan I. Qedan, Marah A. Daibes, Samah W. Al-Jabi, Amer A. Koni, Sa’ed H. Zyoud
BMC Nursing.2022;[Epub] CrossRef
Effects of a standardized patient-based simulation in anaphylactic shock management for new graduate nurses
Qi Ren, Fang Chen, Huijuan Zhang, Juanhua Tu, Xiaowei Xu, Caixia Liu
BMC Nursing.2022;[Epub] CrossRef
Factors contributing to medication errors: A descriptive qualitative study of Italian nursing students
Anna Castaldo, Monica Ferrentino, Elisa Ferrario, Marzia Papini, Maura Lusignani
Nurse Education Today.2022; 118: 105511. CrossRef
Analysis of medication and prescription background risk factors contributing to oral medication administration errors by nurses: A case–control study
Ryohei Suzuki, Takamasa Sakai, Mariyo Kato, Masaaki Takahashi, Akira Inukai, Fumiko Ohtsu
Medicine.2022; 101(33): e30122. CrossRef
Medication administration errors and associated factors among nurses in Addis Ababa federal hospitals, Ethiopia: a hospital-based cross-sectional study
Tihitena Mohammed, Sindew Mahmud, Binyam Gintamo, Zelalem Negash Mekuria, Zemichael Gizaw
BMJ Open.2022; 12(12): e066531. CrossRef
Medication errors: a focus on nursing practice
Nasr Alrabadi, Shaima Shawagfeh, Razan Haddad, Tareq Mukattash, Sawsan Abuhammad, Daher Al-rabadi, Rana Abu Farha, Suzan AlRabadi, Ibrahim Al-Faouri
Journal of Pharmaceutical Health Services Research.2021; 12(1): 78. CrossRef
The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors
Mohammad S Alyahya, Heba H Hijazi, Main Naser Alolayyan, Farah Jehad Ajayneh, Yousef S Khader, Nihaya A Al-Sheyab
Risk Management and Healthcare Policy.2021; Volume 14: 415. CrossRef
Barriers to and facilitators of medication error reporting from the viewpoints of nurses and midwives working in gynecology wards of Tabriz hospitals
Mojgan Mirghafourvand, Khadije Hajizadeh, Jafar Kondori, Mahin Kamalifard, Ziba Bazaz Javid
Journal of Patient Safety and Risk Management.2021; 26(3): 104. CrossRef
Common Barriers to Reporting Medical Errors
Salim Aljabari, Zuhal Kadhim, Sylvia H. Hsu
The Scientific World Journal.2021; 2021: 1. CrossRef
A Systematic Review and Meta-analysis of the Medical Error Rate in Iran: 2005-2019
M. Khammarnia, A. R. Ansari-Moghaddam, Fatemeh Setoodehzadeh, K. Rezaei, C. C. T. Clark, M. Peyvand
Quality Management in Health Care.2021; 30(3): 166. CrossRef
Nursing students' perception of medical errors: A cross‐sectional study in a university
Victoria Bam, Adwoa Safowaa, Alberta Yemotsoo Lomotey, Abena Safoa Nkansah
Nursing Open.2021; 8(6): 3152. CrossRef
Patient Safety in the Process of Pharmacotherapy Carried Out by Nurses—A Polish–Slovak Prospective Observational Study
Izabela Witczak, Łukasz Rypicz, Mária Šupínová, Elena Janiczeková, Piotr Pobrotyn, Agnieszka Młynarska, Olga Fedorowicz
International Journal of Environmental Research and Public Health.2021; 18(19): 10066. CrossRef
Nurses' perception of medication administration errors in benghazi children hospital
AinasSalem Eltarhuni, HajirOmar Tawfeeq, JebrilS El-Abidi
Libyan Journal of Medical Sciences.2021; 5(4): 153. CrossRef
Příčiny a intervence medikačního pochybení ve zdravotnických zařízeních
Neugebauer Jan, Tóthová Valérie, Chloubová Ivana, Hajduchová Hana, Brabcová Iva, Prokešová Radka
Česká a slovenská farmacie.2021; 70(1): 43. CrossRef
Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia
Adam Wondmieneh, Wudma Alemu, Niguse Tadele, Asmamaw Demis
BMC Nursing.2020;[Epub] CrossRef
The effect of education around ethical principles on nurses’ perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study
Behzad Razzani, Foroozan Atashzadeh-Shoorideh, Tayebeh Jamshidi, Maasoumeh Barkhordari-Sharifabad, Zahra Lotfi, Victoria Skerrett
BMC Nursing.2020;[Epub] CrossRef
Medication errors among registered nurses in Jordan
Nasr Alrabadi, Rabia Haddad, Razan Haddad, Shaima Shawagfeh, Tareq Mukatash, Daher Al-rabadi, Sawsan Abuhammad
Journal of Pharmaceutical Health Services Research.2020; 11(3): 237. CrossRef
Examining the Influence of Workplace Incivility on Nurses’ Patient Safety Competence
Nahed Alquwez
Journal of Nursing Scholarship.2020; 52(3): 292. CrossRef
Preventing Shift Work Disorder in Shift Health-care Workers
Gabriele d’Ettorre, Vincenza Pellicani
Safety and Health at Work.2020; 11(2): 244. CrossRef
Missed nursing care and related factors in Iranian hospitals: A cross‐sectional survey
Zahra Chegini, Tohid Jafari‐Koshki, Marzieh Kheiri, Ali Behforoz, Saeedeh Aliyari, Udita Mitra, Sheikh Mohammed Shariful Islam
Journal of Nursing Management.2020; 28(8): 2205. CrossRef
Investigating the Causes of Nursing Errors and Its Reduction Countermeasures in Recent Studies: A review
Ali Salehi sahlabadi, Afsaneh Riazat, Sheari Sury, Negar Saffarinia, Zahra Damerchi, Mostafa Pouyakian
Journal of Ergonomics.2020; 8(1): 74. CrossRef
Preventing the medication errors in hospitals: A qualitative study
Alireza Salar, Fatemeh Kiani, Nasrin Rezaee
International Journal of Africa Nursing Sciences.2020; 13: 100235. CrossRef
Magnitude and associated factors of medication administration error among nurses working in Amhara Region Referral Hospitals, Northwest Ethiopia
Enyew Getaneh Mekonen, Mignote Hailu Gebrie, Senetsehuf Melkamu Jemberie
Journal of Drug Assessment.2020; : 1. CrossRef
Safety Assessment of the Pharmacotherapy Process at the Nurse and Midwife Level – An Observational Study

Izabela Witczak, Izabella Uchmanowicz, Riccardo Tartaglia, Łukasz Rypicz
Therapeutics and Clinical Risk Management.2020; Volume 16: 1057. CrossRef
Medication Administration Errors and Associated Factors Among Nurses
Dejene Tsegaye, Girma Alem, Zenaw Tessema, Wubet Alebachew
International Journal of General Medicine.2020; Volume 13: 1621. CrossRef
Transgresiones y errores potenciales de medicación en estudiantes de enfermería en ambiente simulado
Karen Dominguez-Cancino, Carola Bravo-Tare, Karen Vergara-Arias, Eliana Escudero
Revista de Investigación de la Universidad Privada Norbert Wiener.2020; 8(1): 75. CrossRef
Medication administration – nursing workload and patient safety in clinical wards
Ana Maria Müller de Magalhães, Angélica Kreling, Enaura Helena Brandão Chaves, Simone Silveira Pasin, Bárbara Motta Castilho
Revista Brasileira de Enfermagem.2019; 72(1): 183. CrossRef
Frequency and potential causes of medication errors from nurses’ viewpoint in hospitals affiliated to a medical sciences University in Iran
Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Hossein Safari, Mohammad Amerzadeh, Ghobad Moradi, Dalir Usefi, Arian Azadnia, Serajaddin Gray
International Journal of Human Rights in Healthcare.2019;[Epub] CrossRef
Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors
Binny Thomas, Vibhu Paudyal, Katie MacLure, Abdulrouf Pallivalapila, James McLay, Wessam El Kassem, Moza Al Hail, Derek Stewart
European Journal of Clinical Pharmacology.2019; 75(9): 1269. CrossRef
How Do Nurses Cope with Shift Work? A Qualitative Analysis of Open-Ended Responses from a Survey of Nurses
Michael Savic, Rowan P. Ogeil, Megan J. Sechtig, Peta Lee-Tobin, Nyssa Ferguson, Dan I. Lubman
International Journal of Environmental Research and Public Health.2019; 16(20): 3821. CrossRef
Patient safety awareness among 309 surgeons in Enugu, Nigeria: a cross-sectional survey
Arinze Duke George Nwosu, Fidelis Anayo Onyekwulu, Elias Chikee Aniwada
Patient Safety in Surgery.2019;[Epub] CrossRef
Period prevalence and reporting rate of medication errors among nurses in Iran: A systematic review and meta-analysis
Behzad Karami Matin, Mohammad Hajizadeh, Bijan Nouri, Shahab Rezaeian, Masoud Mohammadi, Satar Rezaei
Journal of Nursing Management.2018; 26(5): 498. CrossRef
Multi‐level analysis of national nursing students’ disclosure of patient safety concerns
Alvisa Palese, Silvia Gonella, Luca Grassetti, Irene Mansutti, Anna Brugnolli, Luisa Saiani, Stefano Terzoni, Lucia Zannini, Anne Destrebecq, Valerio Dimonte
Medical Education.2018; 52(11): 1156. CrossRef
Outcomes of a Drug Dosage Calculation Training Smartphone App on Learning Achievement, Metacognition, and Flow State According to Prior Knowledge
Kyung Yeon Park, Myoung Soo Kim
EURASIA Journal of Mathematics, Science and Technology Education.2018;[Epub] CrossRef
Adapter-based Safety Injection System for Prevention of Wrong Route and Wrong Patient Medication Errors
Yong Chan Cho, Seung Ho Lee, Yang Hyun Cho, Young Bin Choy
Journal of Korean Medical Science.2017; 32(12): 1938. CrossRef