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The current research diary is about Medication errors (M.E.) in nursing. Medication administration is nurses' duty; they spend almost 40% of their time on administration, so because of the importance of safe medication administration by nurses, there is a need to focus on the barriers that nurses face (Gadbois et al., 2019). Medication is provided to patients to prevent or treat illness, but when the medicines are taken incorrectly, it can cause harm, disability and even death in severe cases. M.E. is the leading cause of avoidable patient harm in the healthcare system worldwide (Wondmieneh et al., 2020). M.E. can occur at any phase of the medication process, during prescribing, transcribing, dispensing, and administration. However, most of the M.E. occurs during the administration process for which nurses are responsible. These errors in medication administration can occur when nurses fail to follow the principle of medication, which includes the right patient, right medication, right time, correct dose, right route, right education, right to refuse, right assessment, right evaluation/response, and documentation (Wondmieneh et al., 2020). Nurses are accountable for the safety of patients while and after administration and keep track of adverse drug reactions (Escrivá Gracia et al., 2019). The rationale of the current study is to highlight the consequences both nurses and patients face due to M.E. There is a need to focus on the issues nurses experience in delivering safe medicines to patients.
Safe medication administration by nurses is essential to improve patient safety and deliver quality care (Wondmieneh et al., 2020). During the clinical practice of nurses, the nurse must provide person-centred and safe care to the patients during their clinical practice. However, nurses' rapidly increasing incidence of M.E. has become a threat to patients and healthcare settings. So, there is a need to discuss the M.E. and the interventions required to prevent them. M.E. may cause emotional distress, lack of confidence, retarded professional behaviour of nurses, and loss of patients' trust and families. Therefore, in nurses' clinical practice, it is essential to get an education and learn more about the reasons behind medication errors and how they can prevent it. (Wondmieneh et al., 2020).
The current study is based on the review of the studies conducted by the researcher to provide the valid and reliable information about the medication error and prevention. The study used cross-sectional and qualitative approaches for data collection and interpretation. The articles were searched by relevant online databases like CINAHL, PubMed, and EMBASE using keywords like medication error and medication administration. The choice ofa These keywords helped to find the most relevant research articles relevant to the current study (Mutair et al., 2021). The study involved the published review literature, systematic review and research articles about medication error in nursing. Full-text articles of any design, including quantitative and qualitative studies, observational cohorts, clinical trials or systemic reviews, were included. The language and year barrier were also applied while searching the articles and studies published in English, and after the year 2019 were involved. Studies under the process and not published by reliable journals were excluded from the study. Studies in which the case studies and causes of medication errors other than look-alike errors, such as sound-alike errors or failing communication between doctors and nurses were also excluded from the study. A total of 50 published studies were collected through online sources and later reviewed by two researchers to select only reliable studies. The aim and abstracts of the selected articles were reviewed; first, the articles with the relevant information were reviewed by the researcher for full text (Ahsani-Estahbanati et al., 2022). The articles with non-relevant information were excluded, and the reason for exclusion was documented to keep the record. Later, the study used PRISMA to shortlist the articles and to interpret results; only three articles were selected per the inclusion criteria. The researchers used the questionnaire and checklists of the study's selection criteria to ensure the selected articles' quality. For the confirmation of results and collection of missed information the authors of the articles were contacted. The articles were selected because they were related to the current study and their aim and objective were reliable. The selected studies have ethical clearance and are followed other principles like maintaining the confidentiality and autonomy of the participants (Ahsani-Estahbanati et al., 2022).
For the data extraction, two reviewers individually examined the methodology and the results of the selected articles. Any doubt and disagreement related to the results were resolved via unanimity of the third reviewer, and if needed, the fourth reviewer also gets involved (Mutair et al., 2021). The data collected from the selected articles was analysed by using relational qualitative content analysis and by applying inductive reasoning. The extracted data consists of the medicating error reporting system, analysis of medication error reports, appraisal results and the recommendation provided by the study's author to reduce the medication error incidents by nurses. The current study's reviewer for the literature examination performed a narrative synthesis. The narrative synthesis was characterized by the textual methodology that delivered a trustworthy tale of the findings from the selected studies. In the current study, the reviewer addressed the possibility of bias in its design, conduct and analysis. During the data extraction the reviewer used the Excel spreadsheet which included first author’s surname, publication year, country of origin publication, sample size, strength and limitations. The current study explained the results and findings of the selected articles taken
into full account and used to inform the synthesis and interpretation of the results of the recommendations (Mutair et al., 2021).
In the study by Sivasubramanian et al (2021), it is stated that ethics and ethical behaviours are the fundamental pillars of maintaining academic and research activities. It is stated that ethics can affect everything we do and help us to improve our living standard, and have a significant role in gaining recognition in all disciplines engaged in research. Therefore, in every healthcare centre, there is essential to set standards, guidelines and ethical values to maintain the quality and integrity of the activities performed (Head, 2020). Ethical guidelines help researchers develop ethical researchers and members of society who uphold ethical principles in practice. Before conducting the research, it is essential to distinguish between what is acceptable and not acceptable in society, especially when animals and humans are involved in the research. The researcher must know the ethical norms related to the research so that he/she can draw a clear line between misconduct and misunderstanding (Taebi et al., 2019).
The basic principles that must be followed in the research include participants' autonomy and confidentiality. It states that the participant must have information about the process of the study and what outcomes the study is approaching. The principle of confidentiality states that the participant's personal information should not be published in the study (Sivasubramaniam et al., 2019). While conducting the interviews or collecting the information, the participant's privacy was maintained. Another essential aspect of ethics in the research that was followed is consent, which means the participant was provided with his/her free will to participate in the study and agreed to share personal information. The consent was taken in two forms, written or verbal; the researcher informed the participant about the researcher's aim and objectives and let the patient choose whether to participate in the study (Head, 2020). In the research, the authors should focus on providing justice to every participant; during the data collection, no participant was discriminated against based on colour, caste or religion.
Here in the current study, the qualitative method has been used for the data collection. To reduce the risk of bias, the researcher used the inclusion and exclusion criteria to select the articles (Taebi et al., 2019). In case of missing information, authors of the selected articles were contacted and informed about the current study and requested to provide their consent for the involvement of the article in the study. Before conducting the study, the participants were trained and educated about the ethical principles to protect each researcher's dignity, rights and welfare. In the current study, the standards of integrity were met, and the quality and transparency of the studies were maintained. In the current study, no unpublished information was included, data were not manipulated, and only relevant and evidence-based information was included. While conducting the study, the researchers did not attempt any misconduct or practices that could lead to a breach of ethical principles. The study's approach was presented before the ethical committee for approval and to ensure ethical standards were upheld (WHO, 2023).
Here the findings of the three selected articles are analyzed and compared. The first article by Escrivá Gracia et al (2019) aimed to identify the nurses' level of knowledge about safe medication administration practices. The study involved 2634 medications administered drug dose units, out of which 316 were detected as potential errors. It has been stated that the route of medication administration is also responsible for medication errors. Escrivá Gracia et al (2019) focused on the relationship between the route of administration and the risk of a medication error; in their findings, it was reported that the intravenous route is majorly associated with a medication error (76.92%) along with pressurized inhalation (8.96%). However, other oral, nasogastric and subcutaneous routes are less included in the medication error. The error rate due to wrong and incomplete prescriptions was 1.32%. Nurses face challenges during the transcription of the prescription, which makes them unable to interpret the omission of dose, which results in the administration of the incorrect dose (Ghorbanzadeh et al., 2019).
The study by Tsegaye et al (2020) aimed to identify the associated factors that lead to medication administration errors in nursing. They used the institutional-based cross-sectional design in which 414 participants were included in the study. The educational qualification of most participants was BSc in nursing in the age group of 26-30 years and nursing experience of almost five years. The result of the study states that out of 4141 nurses, almost 57.7% of nurses were involved in the MAE, and approx. 34.4% of nurses made MAE more than three times in the last 12 months. In the study, the most common cause of medication error was wrong timing. 38.6% of participants were involved in a medication error in which they provided a dose at the wrong time. However, other reasons involve wrong dose (27.5%) and wrong evaluation (26.1%), which results in overdose and underdose. The study shows that the higher rate of medication error among nurses is because almost 88.4% of nurses did not take the training on safe medication administration practice, and 43.7% of nurses were involved in the error as they hesitated to ask for help and did not have the right information about the dose and its route of administration. Tsegaye et al (2020) identified several factors associated with medication administration errors, like lack of training, burnout, low self-esteem, and less knowledge, nurses' sex, personal life, year of experience, interprofessional skills of nurses and absence of reporting system. The study reported that nurses who did not have the training and lacked the experience were two times more likely to make medication errors (Blume et al., 2021). Studies suggest that burnout, lack of staff, and inappropriate shifting hours affect the quality of care they deliver. For instance, when nurses experience burnout due to double shifts or night shifts, their decision-making capacity gets affected, which may result in mistakes or incidents in the form of MAE (Savva et al., 2022).
While delivering care to patients, nurses should ensure that the safety and health of the patients would not be compromised (Ock et al., 2020). Medication error is the most common practice that affects the health of patients. However, it happens during each part of the medication procedure, like during the prescription of the medicines by a clinician, while dispensing medication, at the time of administration also while registering them. Nurses have a significant role in administering medications to patients, so it is essential to train and educate nurses about safe medication procedures and enable them to implement preventive measures in their clinical practice (Ali et al., 2021).
The third study involved in the research was done by Salar et al (2022), who stated that medication error is one of the worst errors among nurses, resulting in unpleasant patient results. So, in their study, they aimed to identify the preventive measures that can be implemented in the nursing practice to reduce the prevalence of medication error in the healthcare setting of Japan. The study used the qualitative approach by involving 17 participants 16 were nurses, and one was a physician. The participants were selected using the purposive sampling method, and the inclusion criteria were those with a BSc degree and two years of experience. The result of the study was represented under two themes, including acting professionally and presenting technical strategies. One of the significant preventive measures to reduce the medication error among nurses suggested by the study was that nurses should behave professionally in which nurses should involve themselves in awareness programmes, read the medication levels, learn how to deal with legal problems and keep updated about the medication protocols. Another strategy reported in the study by Salar et al (2020) was to motivate nurses to report medication error incidents. Due to fear of legal actions against them, stigmatization, and the chances of losing jobs, nurses did not report the incidents to the higher authorities of the healthcare settings, which can result in the increased prevalence of medication error. So, in their study, it was stated that officials could help nurses by motivating them and ensuring them that reporting the error would not impact their job and profession. Organizations should make nurses aware of professional principles and provide supervision so they can perform their duties without error (Kim and Lee, 2020). In the study, nurses stated that they could not maintain the standard of care due to fatigue and burnout. Salar et al (2020) suggested that healthcare organizations try to identify the factors and cooperate with nurses to ensure patient safety. Actions like providing a proper schedule of shifts and appointing an appropriate number of staff so that nurses would not suffer burnout. Due to a lack of pharmacological knowledge, nurses face challenges in providing the right prescribed medication; organizations should arrange educational sessions to update nurses about the latest pharmacological knowledge (Salar et al., 2020).
Description: Here in the current reflection, the Gibbs model of reflection is being used to summarise the overall journey of this module. The reflection is about the research module in which I choose medication error in nursing as my topic of interest. Through the reflection, I want to express what difficulties I faced while conducting the research and what new I learned.
Feelings: While working on the module, I realized the importance of safe medication administration in nursing. Being a nurse, there is a significant difference between theoretical and practical knowledge, which sometimes leads to incidents like medication administration errors. During the review of articles, I realized that lack of training and improper guidance are the principal reasons for medication errors among nurses. I learned the importance of ethical principles in research and how these principles can help to achieve the most relevant and reliable outcomes. However, I faced difficulties differentiating the published and non-published studies; selecting the articles for the result interpretation was challenging, but using the keywords for the search strategy was beneficial.
Evaluation: After completing the research, I learned much about the process, factual knowledge, and prescribing skills. After analyzing several published research articles, I learned what practice I need to implicate in my future clinical practice to prevent incidents of medication errors. I also realized that every nurse must know the guidelines of the medication administration process and follow their scope of practice to prevent errors.
Analysis: The standard of NSQHS (2017) states that nurses are responsible and accountable for their actions; they must deliver safe and effective patient care. From the research studies, I analyzed that several factors can lead the medication error, including lack of knowledge of medication administration, burnout, distraction and inappropriate prescription. Also, these studies highlight the other significant issue in which nurses do not report the medication error incident to the healthcare authorities. After completing the module, I realized there is a need to highlight the barriers nurses face in performing effective and safe medication administration. More studies are required in such a field to determine the effectiveness of the interventions implicated in preventing medication errors in nursing.
Action: From the experience, I gained while conducting this research module, I have learned a valuable lesson and identified the seriousness of the consequences of medication error. In my future research, I will collect the primary data with ethical approval, as I used secondary data in this study. Due to this, I missed the chance to interact directly with the participant. Also, in my future clinical practice, I will apply the strategies to prevent medication errors, and if I experience some time, then do I immediately reporting of errors or incidents. I will develop skills like effective communication, time management and self-care to improve patient care.
| Authors/ Year of publication | Country | Aim | Methodology (qualitative/ quantitative) | Findings (Key points) | Strengths | Limitations | Comments on the overall value of articles |
| Tsegaye et al., (2020) | USA | Medication administration errors and associated factors among nurses | The study was qualitative and used a cross-sectional design. It used a self-administered questionnaire and observational checklist involving 422 participants | The findings of the study state that wrong time, wrong assessment and wrong evaluation were the most common reasons for medication error. | The study used the appropriate tools, like the single population proportion formula, to determine the sample size. The study collected data from nurses working in five different hospitals, which caused the variation in the information collected. | The study did not define the cause and relationship between the different variables. The fear of being reported may lead to the wrong answers. | The study identified significant areas like lack of knowledge, unavailability of guidelines and poor communication among nurses as the cause that can lead to medication error. |
| Escrivá Gracia et al., (2019) | Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study | The study used the multi-method with three phases, including quantitative and qualitative techniques. | The study reported that the global medication error index was 1.93%. Medication administration errors via nasogastric tubes have the highest error rate, i.e. 11.16%. | The study uses different variables and socio-demographic characteristics to measure medication errors. | The study's analysis sample was small and limited to the M.E. incidents in the ICU. It could not make solid inferences about the general population because it focused on the areas of medication errors in the ICU. | The study provides information that a more significant number of medication errors are committed in the ICU. Nurses working in ICU must know appropriately about the medication errors cause and their prevention. | |
| Salar et al., (2020). | Africa | Preventing medication errors in hospitals | It is a qualitative study using the thematic method to extract the methods of preventing medication errors. | The result of the study stated that nurses should act professionally to prevent medication errors; also, the presence of technical strategies can reduce the risk of medication errors. | The study collects the primary data by conducting an in-person interview with nurses, which decreases the risk of bias. | The study failed to provide any statistical data, so it would not be able to compare the effectiveness of the result. | The article discovers ways to prevent similar errors in future and shares the information that can help nurses prevent incidents of medication error. |
| Search Strategy | CINAHL | PubMed |
| Medication error, not mental health | 255 | 103 |
| Medication error and physical health burden | 167 | 138 |
| Medication error increased health burden, or prolonged hospital stay | 236 | 187 |
| Medication error, not physical injury and health complications or death | 156 | 137 |
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Ali, L., Saifan, A., Alrimawi, I. and Atout, M., 2021. A qualitative study of nurses' perceptions of factors that cause medication errors in Jordan. Perspectives in Psychiatric Care, 57(3), pp.1417-1424. Available at: https://doi.org/10.1111/ppc.12707 [Accessed on :06-01-2023]
Blume, K.S., Dietermann, K., Kirchner‐Heklau, U., Winter, V., Fleischer, S., Kreidl, L.M., Meyer, G. and Schreyögg, J., 2021. Staffing levels and nursing‐sensitive patient outcomes: Umbrella review and qualitative study. Health Services Research, 56(5), pp.885-907. Available at :https://doi.org/10.1111/1475-6773.13647 [Accessed on :06-01-2023]
Escrivá Gracia, J., Brage Serrano, R. and Fernández Garrido, J., 2019. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Services Research, 19(1), pp.1-9. Available at :https://doi.org/10.1186/s12913-019-4481-7 .[Accessed on :06-01-2023]
Gadbois, E.A., Tyler, D.A., Shield, R., McHugh, J., Winblad, U., Teno, J.M. and Mor, V., 2019. Lost in transition: a qualitative study of patients discharged from hospital to skilled nursing facility. Journal of General Internal Medicine, 34(1), pp.102-109. Available at: https://doi.org/10.1007/s11606-018-4695-0 [Accessed on :06-01-2023]
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Head, G., 2020. Ethics in educational research: Review boards, ethical issues and researcher development. European Educational Research Journal, 19(1), pp.72-83. Available at :https://doi.org/10.1177/1474904118796315 [Accessed on :06-01-2023]
Kim, Y. and Lee, H., 2020. Nurses’ experiences with disclosure of patient safety incidents: a qualitative study. Risk Management and Healthcare Policy, 13, p.453. Available at :https://doi.org/10.2147%2FRMHP.S253399 [Accessed on :06-01-2023]
Mutair, A.A., Alhumaid, S., Shamsan, A., Zaidi, A.R.Z., Mohaini, M.A., Al Mutairi, A., Rabaan, A.A., Awad, M. and Al-Omari, A., 2021. The Effective Strategies to Avoid Medication Errors and Improving Reporting Systems. Medicines, 8(9), p.46. . Available at: https://doi.org/10.3390%2Fmedicines8090046 [Accessed on :06-01-2023]
Ock, M., Choi, E.Y., Jo, M.W. and Lee, S.I., 2020. General public's attitudes toward disclosure of patient safety incidents in Korea: results of disclosure of patient safety incidents survey I. Journal of Patient Safety, 16(1), p.84. Available at: https://doi.org/10.1097%2FPTS.0000000000000428 [Accessed on :06-01-2023]
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Savva, G., Papastavrou, E., Charalambous, A., Vryonides, S. and Merkouris, A., 2022. Exploring Nurses’ Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study. Global Qualitative Nursing Research, 9, p.23333936221094857. Available at: https://journals.sagepub.com/doi/pdf/10.1177/23333936221094857 [Accessed on :06-01-2023]
Sivasubramaniam, S., Dlabolová, D.H., Kralikova, V. and Khan, Z.R., 2021. Assisting you to advance with ethics in research: an introduction to ethical governance and application procedures. International Journal for Educational Integrity, 17(1), pp.1-18. Available at: https://doi.org/10.1007/s40979-021-00078-6 [Accessed on :06-01-2023]
Taebi, B., van den Hoven, J. and Bird, S.J., 2019. The importance of ethics in modern universities of technology. Science and Engineering Ethics, 25(6), pp.1625-1632. Available at: https://doi.org/10.1007/s11948-019-00164-6 [Accessed on :06-01-2023]
Tsegaye, D., Alem, G., Tessema, Z. and Alebachew, W., 2020. Medication administration errors and associated factors among nurses. International Journal of General Medicine, 13, p.1621. Available at:https://doi.org/10.2147%2FIJGM.S289452 [Accessed on :06-01-2023]
WHO. (2023). Ensuring ethical standards and procedures for research with human beings. Available at:https://www.who.int/activities/ensuring-ethical-standards-and-procedures-for-research-with-human-beings
Wondmieneh, A., Alemu, W., Tadele, N. and Demis, A., 2020. Medication administration errors and contributing factors among nurses: a cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), pp.1-9. Available at: https://doi.org/10.1186/s12912-020-0397-0 [Accessed on :06-01-2023]
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