Iran Journal of Nursing

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Ghanbari Afra M, Mohammad Aliha J, Mardani Hamooleh M, Ghanbari Afra L, Haghani S. Medication Errors in Intensive Care Units in the Viewpoint of Nurses: A Descriptive Study. IJN 2019; 32 (121) :1-13
URL: http://ijn.iums.ac.ir/article-1-3033-en.html

Background & Aims: Among healthcare professionals, nurses spend the most time with patients and monitor them throughout the medication process from the time of admission until discharge. Since nurses are responsible for the direct care of patients and participate in their medication process, the risk of medication errors by nurses increases. The process of medication involves prescription, copying the instructions of physicians, medication distribution, delivery of medication to the patient, and medication control. Failure in any of the mentioned stages is referred to as medication error. In the nursing profession, medication errors include the incorrect dosage of medication, elimination of medication, negligence of the symptoms of drug poisoning, and choosing the wrong site for the administration of medication. Medication error is a preventable incident, which could cause damage to the patient if not managed. The patients admitted to intensive care units (ICUs) receive more drugs compared to the patients admitted to other wards. Furthermore, due to drowsiness or unconsciousness, the process of patient identification and monitoring of drug side-effects in these patients is associated with more challenges in these patients. The importance of medication errors is considered in terms of consequences such as increased disabilities, patient dissatisfaction with healthcare systems, increased length of hospital stay, and increased treatment costs. ICU nurses experience higher stress levels due to special working conditions, such as heavy workload, the need to respond quickly to emergency situations, heavy responsibility of the care of critically ill patients, frequent encounters with emotional situations, and being in unwanted and enforced situations for delivering unpleasant news to patients' families. The present study aimed to determine the causes of the incidence of medication errors, their lack of reporting, and their frequency in ICUs.
Materials & Methods: This cross-sectional, descriptive study was conducted on 300 ICU and CCU nurses in three teaching hospitals affiliated to Qom University of Medical Sciences in Qom, Iran in 2019. The subjects were selected via census sampling. Data were collected using a demographic questionnaire to determine the variables of age, gender, marital status, education level, ward of employment, work shift, nursing experience, work experience in the current ward, type of employment, number of overtime hours per month, overtime work in one/more hospitals, other overtime work than nursing, number of the working hours per week, and valid and reliable tool of medication errors. The content validity method was used to assess the validity of the tool, which was provided to five nursing professors at Iran University of Medical Sciences (IUMS), and their corrective comments were applied. The Cronbach's alpha coefficient was also used to measure the reliability of the tool. For this purpose, 15 nurses who matched the research samples and were not members of the research units completed the tool in one turn. Data analysis was performed in SPSS version 21 using descriptive statistics (percentage, frequency, mean, and standard deviation) and inferential statistics (analysis of variance and independent t-test), and the P-value of less than 0.05 was considered significant. The ethics code of the study was IR.IUMS.REC 1397.102. In order to comply with ethical considerations, a written letter of introduction was obtained from IUMS to perform the research at Qom University of Medical Sciences. In addition, the nurses were enrolled after obtaining written consent and were assured of the confidentiality of their responses in the questionnaires without mention.
Results: Systemic errors (mean score: 4.1±1.2) and pharmacy errors (mean score: 2.5±1.1) had the highest and lowest mean scores among the causes of medication errors, respectively. Furthermore, managerial causes with the mean score of 3.8±1 and causes associated with disagreement with the mean score of 2.6±1.1 had the highest and lowest mean scores among the causes of the non-reporting of medication errors, respectively. Intravenous errors (22.56%) had a higher frequency compared to non-intravenous errors (21.89%). Among the demographic variables, significant correlations were observed medications errors with age (P=0.029) and work experience in the current ward (P=0.007) according to the analysis of variance.
Conclusion: According to the results, the highest to lowest mean scores of the causes of medication errors belonged to systemic causes, drug packaging, medical and nursing causes, document registration, and pharmacy causes, respectively. Among the demographic variables, significant correlations were denoted between medication errors, ICU work experience, and age, so that with the increased work experience and age of the nurses, the incidence of medication errors would decrease. It seems that the increased calendar age and working age resulted in their increased dominance over the work environment, so that the incidence of medication errors would decrease. Therefore, it could be stated that knowledge of the influential factors in the incidence of medication errors is essential to the development of proper strategies by nurses to prevent these errors. In this regard, it is critical that special attention be paid by nursing managers to proposing strategies to enhance the knowledge of nurses regarding medication errors in order to reduce these errors through holding clinical management workshops based on the approach of medication errors, accompanied by obtaining points from the continuous education system for nurses. The results of this study indicated that in order to reduce the incidence of errors by nurses, it is necessary to create the conditions to reduce systemic errors in hospitals. In addition, it is imperative for nursing managers to lay the foundations for nurses to report their errors. On the other hand, nursing managers should closely monitor the administration of medications by nurses, especially in the case of intravenous medications. Since the findings of this study were obtained using a questionnaire, the perceptions of nurses toward medication errors could not be assessed in depth. Therefore, it is suggested that studies with a qualitative approach be performed in order to achieve a complete picture of this concept. Furthermore, the results of this study could lay the groundwork for interventional studies to reduce the incidence of medication errors for nurses.