Barriers To Medical Administration Error Reporting Among Nurses In Tabuk Region

The time required for Filling out an incident report for medication errors

This chapter of the study aims to provide the summary of the identified barriers to the reporting of medication administration errors among nurses in Tabuk region Saudi Arabia. The primary aim of the study was to explore barriers to medical administration error reporting among nurses in Tabuk and to identify the reason for medication administration errors. This chapter of the study will provide barriers to medical administration error reporting among nurses in the Tabuk region with the assistance of the demographic data.  Medication errors are common and preventable adverse drug events that represent a major cause of harm in the hospital setting.  Consequently, medication errors threaten patient safety in the clinical care setting (Aljadhey, et al., 2014). Therefore, the study aimed to explore the barriers and obtain the data.  The barriers to reporting the medication errors that identified from the data include

•    The time required for Filling out an incident report for medication errors
•    The time required for contact the physician regarding medication errors
•    Unclear definition of the medication error and abbreviation used for the medical term
•    Development of a negative attitude by the patient or family toward the nurse
•    Fear of adverse consequences after reporting medication errors
•    The mismatch between the response by nursing administration and the severity of the error
•    Blame to nurses for breaching patient’s safety.

The demographic data suggested that a significant number of nurses conducted the medication error in their study period and never reported the error where the majority of them were female since female nurses are the dominating in the profession. In every clinical setting there a protocol for filling the incident report if any medication error occurred during administrating any medication to the patients (Vrbnjak et al., 2016).  The demographic data suggested that the majority of the nurses stated lengthy instructions, time taken for filling of the incident report as the issues that is avoided by the majority of nurses. Data obtained from the study reported that 41 participants agreed that the filling of the incident report was time-consuming where 15 of the participants were strongly agreed and 26 were moderately agreed. Therefore, the exploration of the study identified the time for filling the incident report as one of the major barriers to reporting medication error.

The demographic data suggested that while medication errors occur in the clinical setting, the physician must know the details of the medical error. Without the reporting of  the medication  error, the management of the medication is not possible. However, during the interview, the majority of the nurses stated that since it is time-consuming to contact the physician regarding the medication errors they avoid reporting it. Consequently, the question arises regarding patient safety. Post-graduation nursing experience acts as the reason behind the time taken by nurses to contact the physician after identifying the medication error. Data obtained from the study reported that 37 nurses agreed with this issue were 12 individuals strongly agreed and 25 individual moderately agreed. Therefore, Time required for contact the physician is identified as the second barrier.

The time required to contact the physician regarding medication errors

Demographic data suggested that majority of the medication error takes due to the unclear definition of the medicines, similar name of the medications and the shorter abbreviation used for the medication. El Mahalli (2015), stated that the prime reason behind this issues lack of proper knowledge, use of verbal communication rather than and sometimes they do not recognize it as a medication error. Hence, they do not report the medication error. Moreover, the language also acts as a barrier since a considerate number of time nurses failed to follow the orders of the physicians (Alsafi et al., 2015). Therefore, Lack of proper clarity of the orders by a physician in a clinical setting leads to the wrong administration of the medication. Data obtained from the study reported that 33 nurses described this issue, as the barriers to the reporting where 25 nurses moderately agreed and 8 nurses strongly agreed. Therefore, the challenge of the unclear definition of the medication and abbreviation used during the instruction are identified as the third barrier to reporting.

 In the clinical setting, a considerate number of nurses experienced the adverse effect of reporting medication errors, which further leads to affect their mental stability. Significant number nurses suffer from anxiety and trauma due to the adverse consequences of the medication error. In few hospital setting, there is a lack of adequate staffs who are skilled at proper document the medication errors committed by a specific nurse (Mahalli, 2015). Consequently, it breaches the patient safety and leads to the increase of the global burden of disease.  The demographic data suggested that 69 nurses stated that they become apprehensive because of the negative consequences of medication errors. Ethnicity is identified as the major factor for the fear of adverse consequences due to different cultural beliefs. Consequently, it leads to more medication erode in the clinical field.

A significant number of nurses avoid reporting medication errors because of apprehension. The prime reason behind it is the negative attitude of the patients or family member towards the nurses, which is partially influenced by age, gender, and previous personal experiences (Sears et al., 2016). Lack of communication and identified as another reason where nurse avoids reporting the medication error in order to avoid further negative outcomes. Demographic data of the study reported that seven nurses described this issue as the significant one where 44 nurses moderate agreed and 27 nurses strongly agreed. Although, this is identified as the barriers to report the existence of the barriers also varies depending on the perspective.

Unclear definition of the medication and abbreviation used for terms

A study by Almutairi (2015), suggested that due to lack of sound knowledge about the medication and associated errorS, even if the majority of nurses report medication error, they failed to recognize the severity of the medication error, which affected the patient safety. Since nurses are the frontline health professional, a considerate number of time physicians blindly follow the improper documentation of the medication error (Sears et al., 2016). Furthermore, the interventions are also designed based on the improper documentation. The demographic data of the study suggested that 63 nurses identified this as the barriers of proper reporting of the medication error where 19 nurses strongly agreed with this issue and 44 nurses moderately agreed with this issue.

In the clinical setting, a considerate number of nurses stated that reporting the medication to have negative consequences such as nurses portrayed as the liable for committing medication error and breaching associated patient safety (Talal, 2015). In the majority of the cases, hospital authority focused on the individual nurse responsible for the medication error rather than focusing on the system, which is a potential reason for the medication error (Aboshaiqah, 2016). Therefore, these adverse consequences implant fear and anxiety within nurses. They suffer from anxiety, depression, and professional burn out where post-graduation years and personal experience as nurses plays huge (Sears et al., 2016). Demographic data suggested that 114 nurses identified this issue as the major issue since the highest number of nurses described it as the major barrier of the reporting. Seventy-five nurses strongly agreed with the issues whereas thirty-nine nurses moderately agreed with the nursing interventions.

These major barriers can be resolved by the proper implementation of the policies, legislation and proper interventions.

References:

Aboshaiqah, A. (2016). Strategies to address the nursing shortage in Saudi Arabia. International nursing review, 63(3), 499-506.

Aljadhey, H., Mahmoud, M. A., Hassali, M. A., Alrasheedy, A., Alahmad, A., Saleem, F., … & Bates, D. W. (2014). Challenges to and the future of medication safety in Saudi Arabia: A qualitative study. Saudi Pharmaceutical Journal, 22(4), 326-332.

Almutairi, K. M. (2015). Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal, 36(4), 425.

Alsafi, E., Baharoon, S., Ahmed, A., Al Jahdali, H. H., Al Zahrani, S., & Al Sayyari, A. (2015). Physicians’ knowledge and practice towards medical error reporting: a cross-sectional hospital-based study in Saudi Arabia. EMHJ-Eastern Mediterranean Health Journal, 21(9), 655-664.

Archer, S., Hull, L., Soukup, T., Mayer, E., Athanasiou, T., Sevdalis, N., & Darzi, A. (2017). Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature. BMJ open, 7(12), e017155.

El Mahalli, A. (2015). Electronic health records: Use and barriers among physicians in eastern province of Saudi Arabia. Saudi Journal for Health Sciences, 4(1), 32-32.

Mahalli, A. E. (2015). Adoption and barriers to adoption of electronic health records by nurses in three governmental hospitals in Eastern province, Saudi Arabia. Perspectives in health information management, 12(Fall).

Sears, K., O’Brien-Pallas, L., Stevens, B., & Murphy, G. T. (2016). The relationship between nursing experience and education and the occurrence of reported pediatric medication administration errors. Journal of pediatric nursing, 31(4), e283-e290.

Talal, A. (2015). Nurse perceptions regarding medication administration errors in Hail region hospitals of Saudi Arabia. Journal of Infection and Public Health, 8(4), 401.

Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. International journal of nursing studies, 63(1), 162-178.