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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 4  |  Page : 153-157

Nurses' perception of medication administration errors in benghazi children hospital


1 Dietician, Faculty of Public Health, University of Benghazi, Children Hospital, Benghazi, Libya
2 Department of Paediatric, Faculty of Medicine, University of Benghazi, Benghazi, Libya

Date of Submission01-Aug-2021
Date of Acceptance10-Sep-2021
Date of Web Publication28-Feb-2022

Correspondence Address:
Dr. Ainas Salem Eltarhuni
Department of Health Services Administration, Faculty of Public Health, University of Benghazi, Benghazi
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ljms.ljms_49_21

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  Abstract 


Background/Aims: Medication Administration Errors (MAEs) are a global problem, common among nurses and can threaten all patients' outcomes. Variation of factors makes pediatrics more vulnerable to medication errors (MEs) and its consequences. Therefore, his study aimed to explore the perspective of pediatric nurses regarding the types, causes of errors, and barriers of reporting errors. Methods: A descriptive, cross-sectional study carried out between January and May 2021. A self-administered was the instrument for the study, distributed to 150 nurses working in Benghazi Children Hospital and 102 questionnaires were valid and complete. Data analyses were performed by descriptive statistics, using SPSS. Results: Administering medication at a wrong time was the most common type of error, followed by wrong rate (62.8% and 47.1%), respectively. The most frequently identified causative factors of MEs were a shortage of nurse staffing compared to the number of patients 76.4% and workload 73.5%. The majority of nurses did not report any MEs, the reasons for not reporting was 46.1% of nurses fear of concentration of personal more than error and 34.3% of them not sure when should report the MEs. Conclusion: MEs are a common problem in the health system. Therefore, this study recommended that strategies to eliminate MEs are required, create blame-free environment for reporting, and encouraging an effective communication.

Keywords: Medication administration error, nursing, pediatric nurses, perception, reporting


How to cite this article:
Eltarhuni AS, Tawfeeq HO, El-Abidi JS. Nurses' perception of medication administration errors in benghazi children hospital. Libyan J Med Sci 2021;5:153-7

How to cite this URL:
Eltarhuni AS, Tawfeeq HO, El-Abidi JS. Nurses' perception of medication administration errors in benghazi children hospital. Libyan J Med Sci [serial online] 2021 [cited 2022 Jul 1];5:153-7. Available from: https://www.ljmsonline.com/text.asp?2021/5/4/153/338630




  Introduction Top


Medication error (ME) is a major public health problem in many healthcare systems around the world, which may increase morbidity and mortality as well as raised duration of hospitalization and medical expenses.[1],[2] Furthermore, it is indicator of quality care and patient safety in hospitals because of their common occurrence and potential risk of patients.[3]

MEs are one of the most common medical errors in healthcare systems (10%–18% of total medical errors) and 18.7%–56% of hospitalized patients face medication administration errors (MAEs).[4],[5]

MEs can have severe consequences for patients, nurses, and the organization.[6] Although it is serious consequences, MEs are preventable.[7]

According to NCCMERP, ME can be defined as “s any preventable error that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.[8]

A failure to achieve planned action is another definition for MEs. These errors are an unintentional act either of commission or omission.[9]

MEs occur at any step of the medication delivery process during prescribing, dispensing, transcribing, and administration of medications; and in primary, secondary, and tertiary care settings.[1],[10]

Despite MEs can be caused by all healthcare professionals, nursing MEs are the most common as nurses spend up to 40% of their work time on medication administration.[2],[11] Health care providers have a responsibility to identify and minimize high-risk areas or conditions, and the administration of medication safely.

These errors can threaten all patients' outcomes, but mainly the pediatric population, due to their growth, physiological and psychological characteristics.[12],[13]

MEs are underreported as a result of fear of punitive actions, particularly in developing countries.[6] That's why it is important to assess the process of administration of medication by nurses in hospital, and barriers to reporting them, as the reporting of errors are essential to prevent or reduce MEs.

There are no official statistics on MEs in Libya, and to date, no research has investigated this main issue. Therefore, the main objective of this study was to explore the causes, associated factors, and barriers to report of MEs from a pediatric nursing perspective view in Benghazi Children Hospital, Libya.


  Methods Top


This descriptive cross-sectional study was based on nurses who working in different units at Benghazi children's hospital. The hospital is concerned a referral, tertiary, educational, and the largest multi-specialty hospital in the eastern region in Libya, therefore susceptible to MEs. The study was conducted within 5 months from January to May 2021.

A self-administrated questionnaire was employed in the study. All nurses (n = 150), who are working at the target hospital were included in the study. One hundred and eight retrieved, but only 102 were satisfactory filled with return rates of 68%.

The questionnaire from the review of literature comprised of four parts. The first part included demographic characteristics, as listed in [Table 1]. In the second part, types of MEs were covered according to its occurrence frequency, from occurring frequently, to not occur.
Table 1: Nurses' demographic characteristics

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The third part included contributing factors of MEs, which were evaluated using a five-point scale ranging from (strongly disagree = 1) to (strongly agree = 5).

The last part was notification of errors and the most common barriers to reporting, nurses answered questions either “Yes” or “No” for each statement.

Ethics approval was granted by University of Benghazi, then the approval from hospital director was obtained and a formal permission to conduct the study was obtained from the head of nurses of the units. In addition to that, a verbal consent was obtained from those who agreed to complete the questionnaire. Furthermore, the nurses were informed about the purpose and the data would be anonymous, confidential also assured that their participation was voluntary. Nurses were asked to complete the questionnaire and return back on the same day.

Pretesting of the questionnaire was conducted to test the feasibility and applicability of the tool. The pilot study was carried out on a limited number (n = 15) of nurses at another hospital. Minor modifications were made according to the feedback of the nurses. Cronbach's alpha reliability coefficient of the scale was very satisfactory (0.903).

After data collection, all received questionnaires were revised for completeness. The statistical package for the social sciences, version 21 was used to evaluate data. Frequencies and percentages were used for descriptive analysis.


  Results Top


Demographic information

A total of 102 returned valid questionnaires, nurses recruited from different units at pediatric hospital. The majority (n = 96, 94.1%) were female, around half (n = 52, 50.9%) were aged <35 years and (n = 47, 46.1%) were equally percentage of single and married.

In terms of the level of nursing education, the greatest percentage (91.9%) of nurses was holding a diploma and higher diploma in nursing, whereas, only (7.8%) held a bachelor degree. Considering the education level, slightly more than half (n = 56, 54.9%) of the participants had nursing experience 16 years and more.

Types of medication errors

The types of MEs are illustrated in [Table 2]. Wrong time (1 h before or after the intended time) was the most frequent type of error that occurs (62.8%), followed by wrong rate (too fast or too slow), wrong amount of the dose and wrong number of doses (47.1%, 31.3%, and 31.3%), respectively.
Table 2: Types of medication errors from pediatric nurse's perspective

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While other types of errors, such as omission of the dose and giving medication to the wrong patient (19.6% and 18.7%) respectively, had the lowest rate of MEs.

Factors contributing to medication errors

[Table 3] highlights the factors that were perceived by pediatric nurses as primarily contributing to MEs in the selected hospital.
Table 3: Factors contributing to medication errors as perceived by nurses

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The highest-scored system-, nurse-, physician-, and medication-related factors behind MEs were, respectively, lack of adequate staffing (76.4%), poor communication between nurses (60.8%), physicians' medication orders are not legible (71.5%), the name of many medications is similar (54.9%), and different medications look like (54.9%).

Barriers to reporting errors

Most nurses in this study (79%) indicated that they never reported MEs. Verbal notification predominated more than written notification.

In terms of nurses' views about the major important barrier to not reporting MEs the nurses answered that nursing administration focused on the personal rather than looking at the potential cause of the error (46.1%). 34.3% of nurses also not sure when should report the ME, followed by 33.3% of them the fear of negative consequences from the patients and their relatives [Table 4].
Table 4: Reasons of not reporting medication errors, according to pediatric nurses

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  Discussion Top


Medical errors are a predictable part of the healthcare system. MEs are one of the most common types of errors among healthcare workers particularly nurse. MEs were a serious problem which affects patient safety, quality of healthcare and needs attention of all healthcare professionals and decision-makers. Nurses play a crucial role in reducing MEs. Therefore, this study aimed to assess the types, contributing factors, and barriers of MEs among pediatric nurses.

The top outlined ME types in this study were administering medication at the wrong time, by the wrong rate, in the wrong amount of dose and by the wrong number of doses.

Wrong time was the most common type of MEs which nurses had to administer medication either earlier or later than the actual time of administration. This was in line with a study in Iraq, which described the wrong time as the most common errors which around half of the medications were not administrated at the regular time.[14] When medications are not administrated at the regularly scheduled time the patient may develop toxicities or resistance to the drug. However, this finding was much higher than a study conducted in South Korea and Saudi.[15],[16]

Administering drugs at a wrong rate was the second-highest type of error which nurses had to administer medication too fast or too slow to patient, followed by the wrong amount of the dose was a third error type. Pediatric medications need more calculation and more time compared to adults as it depends on weight-based dose calculation and prepared in small amounts.[17] Baraki et al. concluded that administering an inappropriate dosage and wrong time could be because patients received more than one drug at a time.[18] Another study (Al-Shara) reported wrong patient and wrong dose was the highest type of error in the study while the changing of medication was the lowest type.[19]

According to this study, shortage of workforce compared to the number of patients and a heavy workload was identified as the most important system-related factors to MEs among pediatric nurses; these findings were congruent with previous studies done in Iraq and Ethiopia.[4],[14] In contrast, Ehsani et al.'s study mentioned that 12.7% of the nurses considered the shortage of nursing staff associated with MEs.[20] A study was conducted in a pediatric ward of a university hospital in Izmir mentioned that workload contributed to all types of MAEs, particularly to the wrong time.[17]

Tiredness due to excessive overtime, poor communication with other nurses, working with low experience nurses and lack of adequate training were among the nurses' factors associated with MEs.

Studies in Malta by Petrova and in Egypt by Araby et al. reported that nurses' tiredness and exhaustion were ranked as the highest factor relating to MEs.[21],[22] Furthermore, the inadequacy of job training was highlighted as one of the most factors relating to MEs in a previous study conducted in hospitals in Ethiopia.[4] Conversely, Al-Shara reported that only 4.8% of the nursing staff considered insufficient training as a cause of MEs.[19]

Distraction from other nurses or patients might lead to failure to check a patient's name also stresses and poor communication between nurses might contribute to errors.

Illegible physicians' medication orders were physician-related factors of MEs. MEs occur because the physician's handwriting was difficult to read. This concurred with the findings of Alemu et al. mentioned that lack of sufficient training for nurses, workload, high patient-nurse ratio and illegible handwriting by prescribers were the most frequent factors associated with MEs. Reducing the high magnitude of MEs could by giving in-service training to the nurses on the administration of medication safely, reducing distracters, and using a computerized physician order entry system.[23]

Moreover, the similarity of many medications and looking-like drugs were found to be contributing medication factors to the MEs that were consistent with previous studies.[14],[15],[20]

The finding of this study indicated that most of nurses never reported MEs. According to Benghazi Children Hospital statistics, the degree of reporting MAEs in the hospital reporting system was very low and far less than the MEs they had made. This was in line with Alemu et al.'s study, which indicated a few levels of reporting and no measure had been taken to counteract or mitigate the impact of the most of the MAEs. Hence, the high prevalence of MAEs not only threatened the safety of hospitalized patients who received medications in the hospitals but further the underreporting of the MAEs.[23]

MEs occur very often, but only some of them are noticed and smaller number of them is reported. Pediatric patients are more susceptible to MEs and are affected by the negative consequences of these errors more.[12] Fathi et al. concluded that the low rate of MEs reporting among nurses needs a serious concern that warrants health policy-makers and hospital management attention.[5]

Based on the nurses' opinions in this study, the fear of concentration on personal more than error was the most important barriers associated with the low level of reporting MAEs which was in accordance with the previous study.[21]

Following by around one-third of nurses did not know when MEs should be reported and fear of patients or their relatives may develop a negative attitude towards them. Nurses may not have been aware of making an error. An unclear definition of errors among nurses was one of the causes of nonreporting MEs in many studies including this study.[22]

Concerns about the reactions of nurse managers and afraid of disciplinary action or even losing their job were the major causes of underreporting MEs among nurses in numerous studies,[1],[6] Mrayyan et al. found that fear of disciplinary punishment, thinking the error was not serious, and afraid of the reaction from coworkers and managers were the most frequent reason for underreporting of MEs.[6]

The current study has some limitations. It was conducted in one hospital and the participants were the nursing staff only, therefore this result cannot be generalized. Future studies should include physicians and other paramedical staff from public and private hospitals and using qualitative methods such as interviews to have knowledge more in-depth. In addition, concentration on the factors contributing to the low reporting of MEs at hospitals should be emphasized. This study recommended that hospital managers should establish strategies to reduce the incidence of MAEs and encourage them to report any incidence of MAEs by creating a conductive and a blame-free environment for reporting.

The elimination of the factors that contribute to cause the MEs such as heavy workload and increase nurse staffing. Encouraging an effective communication between healthcare professionals, especially nurses, and focusing on the training of nurses on safe medication administration is to ensure better patient safety. Further studies are recommended for addressing the problem of MEs underreporting.


  Conclusion Top


Wrong time, wrong rate, and wrong amount and number of doses were the most common types of MEs as perceived by pediatric nurses. The highest factors contributing to MEs are a lack of adequate staffing compared to the number of patients, workload and physicians' medication orders are not legible. The majority of MAEs were not reported. The fear of concentration of personal more than error was the most common barrier of reporting MAEs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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