Examining Barriers and Perceptions in Reporting Medication Administration Errors among Nurses at the Tertiary Care Hospitals in Peshawar Pakistan

Objectives: To explore the barriers and perceptions of nurses' regarding medication errors reporting in public sector tertiary care hospitals. Methods: A convenient sample of 209 staff nurses participated in this cross-sectional survey from June to October 2022. A three-part questionnaire was used to gather information on the general characteristics of nurses, the causes of medication errors, and the justi�cations for not reporting them. Results: The Pharmacy supplies inappropriate doses to this unit with a mean of (2.53 ± 1.28) and an insu�cient number of staff nurses in each working shift (4.23 ± 0.76) were the two least and most signi�cant contributing factors to medication errors. Additionally, the two most and least signi�cant factors for not reporting medication errors were that nurses may be held accountable if the patient suffered harm (3.94 ± 1.16) and that nurses did not agree with the hospital's de�nition of a medication error (2.33 ± 1.26) on average. Conclusions: The main causes of drug mistakes and failure to reveal them were nursing and management issues. Moreover, attempt to establish a blame-free culture to motivate reporting errors.


Original Article
One of the most important nursing tasks is giving a patient their medication.Nurses spend roughly 40% of their working hours giving patients their medications and the most important duty of nurses is to carry them out safely [1].The cost of medication errors is estimated to be around 42 billion US dollars annually globally, in line with a 2017 World Health Organization (WHO) report [2], and hospitalized patients who experience medication administration errors may extend their stay by up to two days, increasing it expenses up to 2000-2500 US dollars [3].An estimated 1.5 million Americans are impacted by MAEs each year, according to statistics.Every year, MAEs cause the deaths of 7.6 outpatients and 1.2 inpatients per Examining Barriers and Perceptions in Reporting Medication Administration Errors among Nurses at the Tertiary Care Hospitals in Peshawar Pakistan 1,000 patients [4].Medication errors are the most frequent type of medical errors in hospitals and rank as the eighth leading cause of mortality in the USA, surpassing vehicle accidents, carcinoma, and HIV combined [5].They are also the most common avoidable factor contributing to adverse events for hospitalized patients.Multiple factors, such as inadequate verbal communication, distractibility, high client-to-nurse ratios, unclear writing, sta ng shortages, insu cient training, nursing incompetence, and excessive workloads, can contribute to these errors.Medication errors have far-reaching consequences affecting various parties' health and well-being.They signi cantly increase the risk of patient harm, leading to prolonged hospital

I N T R O D U C T I O N
Medication administration is vital for patient safety, yet medication errors can lead to lifethreatening situations and increased mortality rates.Nurses, being essential members of the healthcare team, are constantly present with patients and regularly tasked with drug administration, facing a signi cant burden of medication errors compared to other healthcare providers.Objectives: To explore the barriers and perceptions of nurses' regarding medication errors reporting in public sector tertiary care hospitals.Methods: A convenient sample of 209 staff nurses participated in this cross-sectional survey from June to October 2022.A three-part questionnaire was used to gather information on the general characteristics of nurses, the causes of medication errors, and the justi cations for not reporting them.Results: The Pharmacy supplies inappropriate doses to this unit with a mean of (2.53 ± 1.28) and an insu cient number of staff nurses in each working shift (4.23 ± 0.76) were the two least and most signi cant contributing factors to medication errors.Additionally, the two most and least signi cant factors for not reporting medication errors were that nurses may be held accountable if the patient suffered harm (3.94 ± 1.16) and that nurses did not agree with the hospital's de nition of a medication error (2.33 ± 1.26) on average.Conclusions: The main causes of drug mistakes and failure to reveal them were nursing and management issues.Moreover, attempt to establish a blame-free culture to motivate reporting errors.

A R T I C L E I N F O A B S T R A C T
Volume 4, Issue 1 (Jan-Mar 2024) stays, disabilities, or even death [6].Medication errors could sometimes result from nurses being dissatis ed with their jobs.Job dissatisfaction has a variety of basic reasons.Previous studies showed that a shortage of nurses, severe exhaustion brought on by a hard workload, and job demands not only hurt nurses' job satisfaction but also raised the likelihood that medicine dosage estimates would be incorrect [7].Medication mistakes also harm organizations, a fall in the standard of care services, frustration and ethical issues for nurses, and patients' mistrust and unhappiness with healthcare delivery systems [8].Although any member of a healthcare team can make a medication error, nurses make the most frequent and common errors.It might be because, in hospitals, nurses spend 40% of their time giving medication and carrying out a signi cant portion of doctor's orders.Nurses were in charge of 54% of medication errors, which most frequently occurred during the drug administration phase.More than 60% of the participating nurses were found to have made medication mistakes, 31% of them had been on the verge of making medical mistakes [9].On the other side, other studies say that these potential causes are the use of shortened names rather than full names, drug name similarity, carelessness, and distraction on the part of nurses, emergencies, increased workload, fatigue brought on by a heavy workload, low nurse to patient ratio, psychological issues with nurses, a lack of pharmacological knowledge, lack of work experience for nurses, and incorrect use of the medication administration procedure.Zarea et al., found that 54% of medication errors were the responsibility of nurses and that they most frequently happened during the medication administration phase [8].Error detection is viewed as a crucial strategy to prevent medication administration errors, which occur when professionals provide the wrong medications to patients.Professionals must be able to identify MAE when it occurs and then report it through authorized methods.Obstacles that prevent nurses from reporting MAE include system design, administration, and individual own knowledge and attitudes toward MAEs [10].Finding accurate statistics on drug errors in developing and underdeveloped countries is often highly challenging.This problem arises from the lack of suitable recordkeeping, reporting, and data registration methods [11].How practical a reporting system is for nurses to utilize is re ected in system design factors.The rates of MAE reporting have been seen to decline under complex reporting methods and handwritten reporting forms.In a centralized setting, nurses may be afraid of being held accountable, facing punishment, or suffering negative outcomes.In an unpleasant setting, nurses could worry that their peers will view them as incompetent or troublemakers [12].

M E T H O D S
A descriptive cross-sectional study was conducted in two public sector tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa.The study lasted six months, collecting data from 209 staff nurses using consecutive sampling.Only nurses directly involved in patient care were included, excluding those in management or administration roles.Data were gathered using a self-reported questionnaire by Wake eld et al., (1999) and Wake eld et al., (2001) focusing on medication administration errors (MAEs) and nurses' perceptions of reporting obstacles [13,14].The questionnaire comprised three sections: general participant characteristics, causes of MAEs, and factors for unreported MAEs, utilizing a 5-point Likert scale.Cronbach's alpha for questionnaire reliability was 0.899.Permission for data collection was obtained from hospital administration, and informed consent was secured from participating nurses.Ethical Approval was also granted from INS KMU No: KMU-INS/14-10/5792 dated 18/08/2022.Data analysis was performed using SPSS version 22.0, calculating means and standard deviations for quantitative variables, and frequencies and percentages for qualitative data like demographics.2 presents the causes for the occurrence of medication administration errors, along with respondents' ratings ranging from "Strongly Disagree" to "Strongly Agree."Each cause is numbered, and the table includes counts and percentages for each rating category, as well as the mean and standard deviation of the ratings."Heavy workload in the ward" and "Inadequate number of staff in each working shift" are the highest-rated causes, with mean ratings of 3.94 and 4.23, respectively, indicating strong agreement that these factors medication administration errors."Similardrug names or labels" and "Different medications look alike" also received high mean ratings of 3.74 each, suggesting agreement on their impact on errors.Conversely, "Nurse is unaware of a known allergy" received a relatively low mean rating of 2.56, indicating less agreement on its contribution to errors compared to other factors."Table 3 outlines reasons why nurses might not report medication administration errors, along with distribution and mean scores.Notable ndings include high agreement that nurses fear blame for patient outcomes which has the highest mean score of 3.94, excessive emphasis on medication errors in assessing nursing care quality with mean ratings of 3.51 potential negative attitudes from patients or families, and fear of adverse consequences from reporting errors also have relatively high mean scores of 3.19 and 3.24, respectively.The reason that nurses believe other nurses will think they are incompetent has a mean score of 3.00, re ecting moderate agreement with the fear of being perceived as incompetent by colleagues.

C O N C L U S I O N S
In the current study, MAEs occur frequently Due to a lack of staff, a high workload, similar-sounding medications, distracting substances, and looking-alike drugs.The majority of MAEs were not reported because nurses might be held accountable if the patient suffers harm, too much focus is placed on MAEs, and fear negative also played a key role in the low rate of reporting MAEs.Consideration must be given to investing in human capital to keep patients secure.Giving drugs to hospitalized patients is a di cult process that necessitates an in-depth understanding of each drug prescribed.

D I S C U S S I O N
In the current study, nurses' severe workloads and the insu cient number of nurses working each shift were the most often cited reasons for errors.The system was judged to be mostly responsible for these problems.Supporting the ndings of the current study, another study reported that the lack of nurses and the heavy workload of nurses are among the factors that contribute to medication administration errors (MAEs) across surveys [15,16].Furthermore, another study also supported the ndings of the current study and reported that increased nurse workload was found to increase mortality risk by 7%.[17].In the current study, one of the signi cant obstacles to revealing MAEs, according to the nurses starts blaming nurses, an overemphasis on MAEs as an indicator of the quality of nursing care provided, an emphasis by nursing leadership on the individual as a possible source for a mistake, and fear of unfavorable outcomes for reporting MAEs.Supporting the ndings of the current study a study reported that the senior nursing staff treated the nurses fairly and with the respect that's why they reported the medication error [18].In this study the administrative response is the main reason among the nurses that medication error is under-reported.Similar to these ndings, studies reported that the Fear was considered the second most in uential factor underlying the failure of

Anwar M et al.,
Table 1 presents the general characteristics of nurses participating in the study.It outlines demographic variables such as sex, age distribution, education level, working unit type, nursing experience in the current unit, total clinical career, average patients care, experience with Medication Administration Errors (MAEs), and routes of Medication Administration Errors.The counts and percentages are provided for each category, with a total sample size of 209 nurses.The majority of nurses were female (79.9%), with only 20.1% being male.The largest age group among nurses was 26-30 years old (48.8%).Most nurses had a Bachelor of Science in Nursing (BSN) or Post RN quali cation (63.2%).The highest proportion of nurses worked in medical units (28.2%), followed closely by ICU/CCU/ER units (27.8%).Nearly half of the nurses (45.0%) took care for more than 15 patients on average.A signi cant majority of nurses (67.9%) had experienced Medication Administration Errors (MAEs), with the most common route being intravenous (55.0%).In Pakistan, nurses are scared of reporting medication errors, leading to underreporting and making medication errors the eighth leading cause of death.This study in Peshawar aimed to investigate barriers to medication error reporting among nurses, which could assist policymakers and hospital administrators in creating an environment free of fear to eradicate reporting barriers.https://doi.org/10.54393/nrs.v4i01.71 DOI: LLP Copyright © 2024.Nursearcher, Published by Lahore Medical Research Center Nursearcher VOL.

4 Issue. 1 Jan-Mar 2024Table 1 :
General Characteristics of the Nurses

Nursearcher VOL. 4 Issue. 1 Jan-Mar 2024 nurses
to report MAEs.Many studies suggest that fear is the main barriers reporting of medication errors[19,20].

Table 3 :
Reasons for Unreported Medication Administration Errors