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Staff nurses' perception of medication errors, perceived causes, and reporting behaviors


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  • hai dear, i'm doing my degree in nursing at one of government university in Malaysia, can i have a copy your complete research , i'will be appreciate if you can share the tools to. kindly please email your research at as soon as possible. tqvm.
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  • Hi! I am currently working on my thesis. Can u please send me a copy of your study as my reference? thank you!!! my email is
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  • Hi. Can I have a copy of the complete research too? :) Thank you in advance :)
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  • Hi! I want to study about medication errors too, Im working on my master's thesis about intravenous medication administration errors in pediatric hospital in Kurdistan region-Iraq country . My email address is
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  • 1. STAFF NURSE’S PERCEPTION OF MEDICATION ERRORS, PERCEIVED CAUSES, AND REPORTING BEHAVIORS A Research Paper Submitted to Dr. Cynthia M. Superable Graduate School Misamis University Ozamiz CityIn partial fulfillment of the requirements in NR 213 (Research Methods in Nursing) REYNEL DAN L. GALICINAO May 2011
  • 2. CHAPTER I THE PROBLEM AND ITS SCOPEBackground of the Study A nurse is an integral part of the health care profession. They performvarious duties in delivering nursing care to their patients. Among this isadministering medications. Nurses drug administration forms a major part of theclinical nurses role. Medication administration by the nurse is only one part of aprocess that also involves doctors and pharmacists (Betz & Levy, 1985). In giving medications, some untoward incident may happen andmedication errors may occur. Medication error is defined as any type of error inthe prescription, transcription, dispensing and administration process which couldbring about serious consequences or not. These events are not infrequent.Medication errors represent the largest single cause of errors in the hospitalsetting. The Institute of Medicine reports 44,000 to 98,000 people die in hospitalsannually as a result of medical errors that could have been prevented (Kohn,Corrigan, & Donaldson, 2000). Medication errors accounted for 7,391 deaths in1993, compared to 2,876 deaths in 1983 (Kohn et al., 2000). Ten to 18% of all reported hospital injuries have been attributed tomedication errors (Hume, 1999). Hospital medication error rates can be as highas 1.9 per patient per day (Fontan, Maneglier, Nguyen, Loirat, and Brion, 2003).United States of America data from 1993 indicates that 7,391 patients died from 2
  • 3. medication errors. Patient stays associated with medication errors also increasedby 4.6 days, with a resulting cost increase of $4,685 per patient (Hume, 1999). There are various causes of medication errors. Errors may occur at any ofthe process steps: prescription, transcription, dispensing, or administration.According to O’shea (1999), mathematical ability of nurses, nurses knowledge ofmedications, workload, length of nursing experience, and length of nursing shiftare all contributing factors to medication errors. It is also believed that there is underreporting of medication errors. Mosterror-reporting systems rely on voluntary self-reporting and are imbedded intowhat remain largely punitive management systems. Nurses widely reportreluctance to disclose medication errors, particularly if an error does not result inpatient harm (Wakefield, Wakefield, Uden-Holman, & Blegen, 1996; Walker &Lowe, 1998). According to Hume (1999), it is estimated that 95% of medicationerrors are not reported because staff fear punishment. There is a lack of research in the Philippines regarding medication errors.There is also a lack of statistics as to its frequency in the hospitals in thePhilippines. Moreover, the researcher realizes this fact and has chosen toexamine this subject to enhance understanding of medication errors in thecountry. The main purpose of this study is to examine the perception ofmedication errors, perceived causes, and reporting behaviors among nurses inthe Philippines. 3
  • 4. Theoretical Framework This study is anchored on two nursing theories: Patricia Benner’s Model ofSkill Acquisition in Nursing and Margaret Newman’s Health as ExpandingConsciousness Theory. Patricia Benner’s Model of Skill Acquisition in Nursing (1948), whichapplies the Dreyfus Model of Skill Acquisition (1980) to nursing, was firstpublished in 1982 entitled “From Novice to Expert”. The model outlines fivestages of skill acquisition: novice, advanced beginner, competent, proficient, andexpert. However, her work is much more encompassing about nursing domainsand specific functions and interventions (McEwen, 2007). Expertise developswhen the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations (Benner, 2001). Figure #. Patricia Benner’s Model of Skill Acquisition in Nursing. This model describes five levels of skill acquisition and development: (1) novice, (2) advanced beginner, (3) competent, (4) proficient, and (5) expert (From: 4
  • 5. The Benner model has been used extensively as a rationale for careerdevelopment and continuing education in nursing (Maynarde, 1996; Garland,1996; Fuller and Conner, 1997; Cusson and Viggiano, 2002; Reynolds, 2002;Gallaher, 1999). As such, this study will use Benner’s theory as the basis fordetermining registered nurses’ perception of medication errors, perceived causesand reporting behaviors and their relationship to the length of work experience. DREYFUS MODEL OF SKILL ACQUISITION Figure 2. Dreyfus Model of skill acquisition describes five stages through which one must pass on the path to mastery. It is originally based on a report created by Hubert and Stuart Dreyfus in 1980 during their research in the area of Artificial Intelligence. The study was updated and popularized by Dr Patricia Benner in the mid Eighties in her work on the Nursing Crisis in the US and effectively applied for training everyone from pilots, nurses, software engineers, and foreign language learners. Five stages of skill acquisition through experience of a subject are Novice, Advanced 5
  • 6. Beginner, Competence, Proficiency, and Expertise (From: Margaret Newman (1999) theorized that humans are continuously activein evolving their own pattern of the whole and are intuitive as well as cognitiveand affective beings. Pattern is what identifies an individual as a person(Newman, 1994). It is a fundamental attribute of all that there is and gives unity indiversity. Newman (1994) stated that the patterns of interaction of person-environment constitute health. Accordingly, nursing education should revolvearound this “pattern” to enable nursing to be an important resource for thecontinued development of healthcare (Newman, 1995). More importantly, Newman saw the theory, the practice, and the researchas a process rather than as a separate domain of nursing discipline. With anupdated contextual and practical knowledge, nurses will have the personaltransformation in learning they ought to have and will be able to recognize healthpatterns in patients better by acting as a participant-observer of phenomenarelated to health (Tomey, 2002). Newman’s work has been used by nurses in a number of settings,providing care for different types of clients, and for a variety of interventions. These studies have a bearing on the present study because they allindicate that the ideal of health as expanding consciousness generates improvedcaring instructions in numerous populations. 6
  • 7. Conceptual Framework This section presents the conceptual framework of the study. Theframework of this study is focused on the relationship of the independent anddependent variables as well as that of the extraneous variables as shown inFigure 3. An action plan will also be proposed based on the results of the study.The proposed action plan will greatly depend upon the results of the nurses’perception of medication errors, perceived causes, and reporting behaviors. Theresult may warrant a need for revision of policies, short-term training programslike continuing education and in-service education or a long-term course likeadvance professional education to update and enhance the knowledge onmedication administration and proper reporting behaviors. The independent variable in this study is the staff nurses’ length of workexperience while the dependent variable is the perception of medication errors,perceived causes, and reporting behaviors. The extraneous variables aredemographic profile including age, sex, civil status, highest level of education,work schedule, employment status, length of nursing shift, and work setting. Alsoapart of the extraneous variables are the self-rated proficiency in medicationadministration, participation in short-term training regarding medicationadministration, and sources of information regarding medication errors. 7
  • 8. EXTRANEOUS VARIABLES Demographic Profile: - Self-rated Proficiency in - Age Medication Administration - Sex - Participation in Short-term - Civil Status Training Regarding - Highest Level of Education Medication Administration - Work Schedule - Sources of Information - Employment Status Regarding Medication - Length of Nursing Shift Errors - Work Setting DEPENDENT VARIABLES INDEPENDENT VARIABLE Staff Nurse’s: - Perception of - Length of Work Medication Errors Experience - Perceived Causes of the Errors - Reporting Behaviors PROPOSED ACTION PLAN Figure 3. The Schema of the StudyStatement of the Problem This study intends to look into the respondents’ (staff nurses in thehospitals in Pagadian City) perception of medication errors, their perceivedcauses, and their reporting behaviors. Specifically, it aims to answer the following questions: 1. What is the profile of the respondents in terms of: 1.1 Age; 8
  • 9. 1.2 Sex; 1.3 Civil status; 1.4 Highest level of education; 1.5 Work schedule; 1.6 Employment status; 1.7 Length of nursing shift; 1.8 Length of work experience; 1.9 Work setting; 1.10 Self-rated proficiency in medication administration; and 1.11 Participation in short-term training regarding medication administration?2. What are the respondents’ sources of information regarding medication errors?3. What are the respondents’: 3.1 Perception of medication errors; 3.2 Perceived causes of medication errors; and 3.3 Reporting behaviors related to medication errors?4. Is there a relationship between the respondents’ profile and their perception of medication errors, their perceived causes, and their reporting behaviors?5. Is there a significant relationship between the respondents’ length of work experience and their perception of medication errors, their perceived causes, and their reporting behaviors? 9
  • 10. Hypotheses Ho1: There is no significant relationship between the staff nurses’ profileand their perception of medication errors, their perceived causes, and theirreporting behaviors. Ho2: There is no significant relationship between the staff nurses’ length ofwork experience and their perception of medication errors, their perceivedcauses, and their reporting behaviors.Significance of the Study The study will be beneficial to the following persons and institutions:Nurses and the Nursing Profession The nurses would benefit from this study since their perceptions andreporting behaviors regarding medication errors would be known, their concernswould be addressed. The results of the study would also help in formulating newguidelines to prevent medication errors and improve hasten reporting procedure.Hospital Administrators The hospital administrators will benefit from this study since through theresults of this study, they will be informed as to how the staff nurses perceivemedication errors. Based on the findings, they can revise their present policies orformulate new ones regarding medication errors and reporting behavior.Future Researchers This study will serve as a reference and guide for future researchers whowill be conducting a study on medication errors. 10
  • 11. Scope and Limitation The study will look into the respondents’ perception of medication errors,their perceived causes, and their reporting behaviors. It will also identify therespondents’ profile and sources of information regarding medication errors. Thestudy will also determine the relationship between the respondents profile andtheir perception of medication errors, perceived causes, and reporting behaviors. The respondents will be Bachelor of Science in Nursing (BSN) graduate, aRegistered Nurse (RN) in the Philippines, and working as a staff nurse in theidentified hospitals in Pagadian City. The hospitals are Pagadian City MedicalCenter, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon GeneralHospital, and J. Cabahug Hospital. Convenience sampling will be used. Aftersecuring approval from the hospital administrators, a survey questionnaire will bedistributed to the nurse’s stations and will be collected after one week. The studywill be conducted from April to June 2012.Definition of Terms The following terms are defined operationally to project the functionalmeaning of the words for the purpose of clarity and ease of comprehension inthis study. Age – refers to the length of time since the respondent’s birth up to present; expressed in years. Civil Status – refers to the state of being single, married, separated, or widow/widower. 11
  • 12. Employment Status – refers to the status of the staff nurses employment; either regular, contractual, reliever, or volunteer.Highest Level of Education – refers to the highest level of education attained by the respondents; either bachelor’s degree, master’s degree, or doctorate degree.Length of Nursing Shift – refers to the length of time of each nursing shift as expressed in hours; usually eight or twelve hours.Length of Work Experience – refers to the nurses’ length of time working as a staff nurse.Medication Error – refers to the erroneous administration of medication; either wrong patient, time, dose, route,Self-rated Efficiency in Medication Administration – refers to how the nurses rate their efficiency in administering medications; either Expert, Proficient, Competent, Advance beginner, or Novice.Sex – refers to the gender; either male or female.Staff Nurse – refers to the nurses’ working in any area of the hospital with at least Bachelor’s of Science in Nursing degree and a Registered Nurse in the Philippines.Perceived Cause of Medication Error – refers to what the nurses perceive as the usual causes of medication errors.Reporting Behavior – refers to whether the nurses perceive a medication error as reportable to the physician and nurse manager through an incident report. 12
  • 13. Sources of Information – refers to the nurses’ source of information regarding medication errors.Work Schedule – refers to the schedule of the nurses’ duty; either on a full- time or part-time basis.Work Setting – refers to the nurses’ area of duty in the hospital; either ward or the special areas. 13
  • 14. CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES This chapter discusses the related literature and studies that werereviewed about medication errors, its causes, and reporting behaviors to giveclarity to the present study.Related LiteratureMedication Administration (Delaune and Ladner, 2002) Medication management requires the collaborative efforts of many healthcare providers. Medications may be prescribed by a physician, dentist, or otherauthorized prescriber such as advanced practice registered nurses asdetermined by individual state licensing bodies. Pharmacists are licensed toprepare and dispense medications. Nurses are responsible for administeringmedications. Dietitians are often involved in identifying possible food and druginteractions. Nurses play an essential role in the administration of, education about,and evaluation of the effectiveness of prescribed medications. The nurse’s rolechanges with the setting of the client. In the home ore community setting,referred to as primary care, clients take their own medication as prescribed bythe health care practitioner. Nurses are responsible for educating the client abouthis or her medications and its possible side effects as well as for evaluating the 14
  • 15. outcome of the prescribed therapy in restoring and maintaining the client’s health.In the acute care setting, nurses spend a great deal of time administeringmedications and evaluating their effectiveness. Nurses are responsible forteaching clients how to take their medications safely when they are discharged. Medication administration requires specialized knowledge, judgment, andnursing skill based on the principles of pharmacology.The Five Rights (5 Rs) of Drug Administration (Workmann And Bennett, 2003) The responsibility for administering medication safely is one which nursestake seriously, and to assist in this procedure the five Rights (5 Rs) of drugadministration have been devised:Right patient Check the identity of the patient with his identification band, using hospitalnumber or date of birth as additional verification. If patients are long-stayresidents, identification may be by photograph, rather than an impersonal nameband (Williams 1996). In the home setting you should satisfy yourself that youhave identified the right patient for medication by asking them their full name ordate of birth to verify against the prescription.Right drug Drug names can be complex, and have similarities between names.Check for clearly written prescriptions, matching the name on the medicationcontainer. In hospital, drugs are prescribed by their generic names, and patients 15
  • 16. may be confused and think that they are having a new medication. If in doubt,consult the BNF for the generic and trade name of the drug. Check three times during the procedure: when you take the drug from thecupboard or trolley, before you pour it into the medication receiver, matching it tothe drug name on the prescription sheet, as you return it to the cupboard ortrolley.Right dose This should be clearly written on the prescription sheet. If the dose is verysmall, then micrograms should be written out in full (BNF). Calculate the dosecarefully and check to see if there is a drug with the same name but dispensed indifferent strengths.Right time Most drugs are designed to be given with an interval of several hoursapart to provide a consistent therapeutic blood level. If given haphazardly, thenthe medication will be less effective or may cause the patient to developunwanted side effects. Therefore, it is essential to give doses at prescribedintervals and to record the actual time of administration.Right route Medications are given licences for specific routes of administration. It ispossible to give medication by the wrong route, for example, an intramuscularinjection may be given intravenously if sited in the wrong place. 16
  • 17. Related StudiesPerceptions about Medication Errors: Analysis of Answers by the Nursing Team(Bohomol, E. and Ramos, L.H., 2006) This descriptive and exploratory study assesses four scenarios showingsituations from nursing practice. The study group was composed of 256professionals and 89 questionnaires were analyzed. The answers given by theregistered nurses were compared with those of licensed practical nurses andcare aids. They should express their opinion if the situations represented amedication error or not, if it had to be communicated to the physician or anincident report had to be written. The two groups showed uniform answers. Theyexpressed the same doubts to label the situation as an error and whichmeasures should be taken, suggesting the need for further discussion on thematter within the institution.Study of Medication Errors on a Community Hospital Oncology Ward (Ford, C.D.,Killebrew, J., Fugitt,P., Jacobsen, J. and Prystas, E.M., 2006) Our nurses reported 141 medication administration errors during the studyperiod, for a reported rate of 0.04% of medication administrations. Twenty-onepercent of these were order writing and transcribing errors, 38% were nurse orpharmacy dispensing errors, and 41% were nurse administration errors. Onlythree MAEs resulted in adverse drug events. Nurses were less likely to reportMAEs that they felt were innocuous, especially late-arriving medications from the 17
  • 18. pharmacy. A retrospective review of 200 chemotherapy administrations foundonly one clear MAE, a miscalculated dose that should have been intercepted. Significant reported MAE rates on our ward (0.04% of drug administrationsand 0.03 MAEs/patient admission) appear to be relatively low due to applicationof current safety guidelines. An emphasis on studying MAEs at individualinstitutions is likely to result in meaningful process changes, improved efficiencyof MAE reporting, and other benefits.Medication Errors In Relation To Education & Medication Errors In Relation ToYears of Nursing Experience (Bailey, C.G., Engel, B.S., Luescher, J.N., andTaylor, M.L., 2008) The results of the study suggested that there is a direct relationshipbetween education and medication errors, rather than an inverse relationship,wherein as education increased number of errors decreased. The study showedthat Licensed Practical Nurses (LPN) made the least number of medicationserrors followed by Registered Nurses with Associate Degrees, with BSNRegistered Nurses having the highest incidence of medication errors. The resultsindicate that as the education level increased so did the number of medicationerrors. The study showed that nurses made the most medication errors either intheir first five years of nursing experience or after twenty years of nursing.Thisstudy also indicated that giving medication at the wrong time was the mostcommon type of medication error made by the participants.The shift that reportedhaving the most medication errors was 7 am-7 pm, when most medications are 18
  • 19. administered. The most common route for medications errors was PO or “bymouth”.Factors influencing paediatric nurses’ responses to medication administration(Davis, L., Ware, R.S., McCann,D., Keogh,S. and Watson, K., 2011) Double checking the patient, double checking the drug and checking thelegality of the prescription were the three strongest predictors of nurses’ actionsregarding medication administration. Policy factors, and not contextual factors,drive nurses’ judgement in response to hypothetical scenarios. 19
  • 20. CHAPTER III RESEARCH METHODOLOGY This chapter presents the methods of research used in this study. Itincludes the research design, research setting, research respondents, researchinstruments, data gathering procedure and statistical treatment.Research Design This non-experimental research will utilize the descriptive survey anddescriptive-correlational designs. The purpose these design is to describe thevariables and examine the relationships among these variables. No attempt willbe made to control or manipulate the situation. An anonymous, self-report surveymethod will be applied using a questionnaire checklist in gathering the neededdata for the study.Research Setting This study will be conducted at in the hospitals of Pagadian City. Pagadianis a chartered city in the southwestern Philippines, capital of Zamboanga del SurProvince, on the island of Mindanao, on the south coast of the ZamboangaPeninsula. Pagadian is a port on Pagadian Bay, a part of the much larger IllanaBay. Pagadian is an important processing center for rice, maize (corn), andcoconuts produced in the surrounding area. Fishing is also a major economicactivity, as is lumber processing due to the peninsulas excellent stands ofPhilippine hardwood trees. National roads connect Pagadian with most other 20
  • 21. cities on Mindanao. A small airport has interisland commercial service. The totalarea of the city (378 sq km/146 sq mi) includes a large portion of farmland. Itspopulation (2000) is 143,000. (Microsoft Encarta 2009) Figure #. The Map of Pagadian City (Google Maps 2011) Five hospitals will be included in this study. They are Pagadian CityMedical Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, BorbonGeneral Hospital, and J. Cabahug Hospital. Four of which are secondary andone tertiary hospital. Four of these hospitals are privately owned and only one is a government-owned hospital. The only tertiary hospital the city is the Pagadian City Medical 21
  • 22. Center, with 100-bed capacity, and is located at Alano cor. Cabrera Sts. The restof the hospitals are secondary. Jamelarin Hospital has a 40-bed capacity situatedat Balangasan Dist. Borbon General Hospital is located at Rizal Ave., Sta. LuciaDist. and has 15-bed capacity. J. Cabahug Hospital has 10-bed capacity and issituated at Rizal Ave., San Pedro Dist. The only public hospital is the Zamboangadel Sur Medical Center, with 130-bed capacity located at Barangay Dao. These hospitals are all accessible by local transportation such as tricycleor public utility jeepney. These hospitals cater the health needs of the people.Research Respondents The target population will be Bachelor of Science in Nursing graduatesand are Registered Nurses (RN’s) in the Philippines who are staff of the chosenhospitals in Pagadian City. All of the staff nurses in Pagadian City MedicalCenter, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon GeneralHospital, and J. Cabahug Hospital will be given the questionnaire and will beinstructed to return it to the researcher as soon as they complete the survey-questionnaire. Convenience sampling will be used by providing questionnaire toeach nurse’s station and leaving it to be completed within one week.Research Instrument The instrument to be used in this study is the Modified Gladstone (2001).Instrument content validity was determined acceptable by Osborne, Blais, andHayes (1999) and Goldstone (1995). In addition, Osborne et al established 22
  • 23. reliability using the test-retest method (0.78) in their sample. The ModifiedGladstone was revised by the researcher and added additional items to suit theobjectives of this study. This instrument measured (1) nurses’ perceived causes of medicationerrors – 10 items; (2) estimated percentage of drug errors reported to nursemanagers – 1 item; (3) types of incidents that would be classified as (a)medication errors, (b) reportable to physicians, or (c) reportable using an incidentreport – 6 items; (4) nurses’ views about reporting medication errors – 8 items; (5)nurses’ demographic data – 12 items; and (6) nurses’ source(s) of informationregarding medication errors – 2 items.Data Gathering Procedure Written permission to conduct the study will be obtained from the chiefnurses and medical directors of the respective hospitals. A letter to therespondent stating the study’s purpose and significance will be attached to thefront page of each questionnaire to obtain a free and informed consent.Participants will be assured that their responses would remain confidential, anyinformation that may reveal their identity would not be recorded, and onlyaggregated data will be communicated. The questionnaires will be placed on each nurse’s station in a labeledenvelope with instructions concerning the survey. The researcher will collect thecompleted surveys after one week. The results will be compiled and analyzed. 23
  • 24. Statistical Treatment The frequency of the respondents profile and answers to the questions willbe treated using the following formula. To provide an average picture of the data, the sample mean will bedetermined using this formula: ∑ ̅Where: ̅= mean; ∑ = sum of observations; and n= number of observations. To determine the percentage, this formula will be used :Where: P = percentage; ƒ = frequency; and n = number of samples. The chi-square test will be used to determine if significant relationshipsexist between the variables. This is the formula of chi-square test: ( ) ∑Where: x2 = the test statistic that asymptotically approaches a x2 distribution; Oi = an observed frequency; Ei = an expected frequency, asserted by the null hypothesis; and n = the number of possible outcomes of each event. 24
  • 25. REFERENCESBooksBerman, A., Synder, S.J., Kozier, B., Erb, G.L., Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed. Singapore: Pearson Education South Asia Pte. Ltd., 2008.DeLaune, S.C., Ladner, P.K., Fundamentals of Nursing: Standards and Practice, 2nd Ed. United States of America: Thomson Learning, Inc., 1998.Ignatavicius, D., Workman, M., Medical-Surgical Nursing: Critical Thinking for Collaborative Care 5th Ed. Philadelphia: W.B. Saunders, 2006.Lehne, R.A., Pharmacology for Nursing Care 5th Ed. Singapore: Elsevier Pte Ltd, 2005.Nettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8th Ed. United States of America: Lippincott, Williams & Wilkins, 2006.Potter, P., Perry, A., Fundamentals of Nursing 6th Ed. St. Louis: Mosby, 2005.Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. United States of America: Lippincott Williams and Wilkins, 2008.Workman, B.A., Bennett, C. L. Key Nursing Skills. London, England: Whurr Publishers, Ltd., 2003.JournalsBetz R. & Levy B. (1985) An interdisciplinary method of classifying and monitoring medication errors. American Journal of Hospital Pharmacy 42(8), 1724-1732.Fontan, J., Maneglier, V., Nguyen, V.X., Loirat, C., and Brion, F. (2003) Medication errors in hospitals: computerized unit drug dispensing systems versus ward stock distribution system. Pharmacy World Science. 25(3):112–117. 25
  • 26. Hume, M. (1999) Changing hospital culture, systems reduce drug errors. Excellent Solution Healthcare Management. 2(4): 4–9.Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.Osborne, J., Blais, K., and Hayes, J.,S.(1999) Nurses’ perceptions: when is it a medication error? Journal of Nursing Administration. 29(4):33–38.Oshes, E. (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing (8), 496-504.Wakefield, D.S., Wakefield, B.J., Uden-Holman, T., & Blegen, M.A. (1996). Perceived barriers in reporting medication administration errors. Best Practices and Benchmarking in Healthcare, 1(4), 191-197.Internet ReourcesMicrosoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation.Google Maps 2011 26
  • 27. QUESTIONNAIRE Nurse’s Perception of Medication Errors, Perceived Causes, and Reporting Behaviors (Revised from Modified Gladstone 2001) I. Why do you think medication errors occur? The following ten statements are all possible causes of medication errors. Please read them carefully and rank 1 to 10. (Where 1 is the most frequent and 10 the least frequent.) a. Drug errors occur when the nurse fails to check the patient’s name band with the Medication Administration Record (MAR). __________ b. Drug errors occur when the physician’s writing on the doctor’s order form is difficult to read or illegible. __________ c. Drug errors occur when the medication labels/packaging are of poor quality or damaged. __________ d. Drug errors occur when there is confusion between two drugs with similar names. __________ e. Drug errors occur when the physician prescribes the wrong dose. __________ f. Drug errors occur when the nurse miscalculates the dose. __________ g. Drug errors occur when the nurse sets up or adjusts an infusion device incorrectly. __________ h. Drug errors occur when nurses are confused by the different types and functions of infusion devices. __________ i. Drug errors occur when nurses are distracted by other patients, coworkers or events on the unit. __________ j. Drug errors occur when nurses are tired and exhausted. __________ II. In your estimate, what percentage of all drug errors is reported to the Nurse Manager by the completion of an incident report? (Please mark an “X” on the line that corresponds most closely to your estimation.) ______________________________________________________________________ 1% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%III. It is not always clear to nurses whether what they view as a minor drug discrepancy should be reported as a medication error. In the following examples you are asked to indicate: a. Whether or not a medication error occurred. b. Whether or not the physician should be notified. c. Whether or not an incident report should be completed. Please check YES or NO for each of the following statements: 1. A patient missed his midday dose of oral Ampicillin because he was in X-ray for 3 hours. 27
  • 28. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 2. Four patients on a busy surgical unit received their 6:00 pm doses of IV antibiotics 4 hours late. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 3. A patient receiving TPN feeding via an infusion pump was given 200 ml/hr instead of the correct rate of 125 ml/hr for the first three hours of the 24-hour infusion. The pump was reset to the correct rate after the change of shift at 7:00 am when the incoming nurse realized that the pump was set at the incorrect rate. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 4. A patient admitted with status asthmaticus on 04/30/2011 at 2:00 am is prescribed Ventolin nebulization every 4 hours. The nurse omitted the 6:00 am dose on 04/30/2011 as the patient is asleep. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 5. A physician ordered percocet 1-2 tabs for post-op pain every 4 hours. At 4:00 pm, the patient complained of pain, requested one pill and is medicated. At 6:30 pm the patient requested the second pain pill. The nurse administered the pill. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 6. A patient is receiving a routine 9 am dose of digoxin every day. Yesterday’s digoxin level was 1.8 (the high side of normal). A digoxin level was drawn at 6 am today. At 9 am the nurse holds the digoxin because the lab value is not available yet. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes NoIV. What are your views about reporting medication errors? Please check the most appropriate response: 1. I am usually sure what constitutes a medication error. Yes No 2. I am usually sure when to notify the physician in case of a medication error. Yes No 3. I am usually sure when a medication error should be reported using an incident report. Yes No 4. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from 28
  • 29. the Nurse Manager. 5. Some medication errors are not reported because nurses are afraid of the reaction they will receive from their coworkers. Yes No 6. Have you known an incident when a coworker did not report a medication error? Yes No 7. Have you ever failed to report a drug error because you did not think the error was serious to warrant reporting? Yes No 8. Have you ever failed to report a medication error because you were afraid that you might be subject to disciplinary action or even lose your job? Yes NoV. Respondent’s Profile. Please fill in the answers below. 1. Age: ________ years old 2. Sex: ________ Male ________ Female 3. Civil Status: ________ Single ________ Separated ________ Married ________ Widower/Widow 4. Highest level of education: ________ Bachelor of Science in ________ Master of Science in Nursing (BSN) Nursing (MSN) ________ Undergraduate in Master’s ________ Master, in other field: Degree _______________ ________ Master in Nursing (MN) ________ Undergraduate in Doctorate ________ Master of Arts in Nursing ________ Doctor of Nursing (DN) (MAN) ________ Doctorate, in other field: _______________ 5. How long have you been working as a nurse? _______ year(s) & _______ month(s) 6. What is your proficiency in administering medications: ________ Expert ________ Advance Beginner ________ Proficient ________ Novice ________ Competent 7. What is your work schedule? ________ Full-time ________ Part-time 8. Employment Status: ________ Regular ________ Reliever ________ Contractual ________ Volunteer 9. Length of nursing shift: _______ hours 29
  • 30. 10. What is your PRIMARY hospital work setting? (Please choose one.) ________ General Ward ________ Operating Room (OR) ________ Surgical Ward ________ Post-Anesthesia Care ________ Medical Ward Unit/Recovery Room ________ OB-GYN Ward ________ Labor & Delivery Rooms ________ Pedia Ward (DR) ________ Intensive/Critical Care Unit ________ Neonatal Intensive Care (ICU) Unit (NICU) ________ Emergency Department ________ Out Patient Department (ER) (OPD)11. How many medication errors do you remember making over the course of your career? (Please encircle your answer.) 0 1 2 3 4 5 6 7 8 9 10 More than ten please specify ________12. How many incident reports related to medication errors do you remember making over the course of your career? (Please encircle your answer.) 0 1 2 3 4 5 6 7 8 9 10 More than ten please specify ________13. Have you joined any short-term training program regarding medication error? ________ Yes ________ No14. What are your source(s) of information regarding medication errors? (Please check all that applies.) ________ Nursing/Medical Journals ________ Discussions with other ________ Nursing/Medical Websites medical professionals and Blogs Others, please specify: ________ Medical Text and ________________________ Reference Books ________ Trainings/Seminars/ Symposia 30