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 City
In 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 SCOPE
Background of the Study
A nurse is an integral part of the health care profession. They perform
various duties in delivering nursing care to their patients. Among this is
administering medications. Nurses drug administration forms a major part of the
clinical nurse's role. Medication administration by the nurse is only one part of a
process that also involves doctors and pharmacists (Betz & Levy, 1985).
In giving medications, some untoward incident may happen and
medication errors may occur. Medication error is defined as any type of error in
the prescription, transcription, dispensing and administration process which could
bring about serious consequences or not. These events are not infrequent.
Medication errors represent the largest single cause of errors in the hospital
setting. The Institute of Medicine reports 44,000 to 98,000 people die in hospitals
annually as a result of medical errors that could have been prevented (Kohn,
Corrigan, & Donaldson, 2000). Medication errors accounted for 7,391 deaths in
1993, compared to 2,876 deaths in 1983 (Kohn et al., 2000).
Ten to 18% of all reported hospital injuries have been attributed to
medication errors (Hume, 1999). Hospital medication error rates can be as high
as 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 increased
by 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 of
the process steps: prescription, transcription, dispensing, or administration.
According to O’shea (1999), mathematical ability of nurses, nurse's knowledge of
medications, workload, length of nursing experience, and length of nursing shift
are all contributing factors to medication errors.
It is also believed that there is underreporting of medication errors. Most
error-reporting systems rely on voluntary self-reporting and are imbedded into
what remain largely punitive management systems. Nurses widely report
reluctance to disclose medication errors, particularly if an error does not result in
patient harm (Wakefield, Wakefield, Uden-Holman, & Blegen, 1996; Walker &
Lowe, 1998). According to Hume (1999), it is estimated that 95% of medication
errors 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 the
Philippines. Moreover, the researcher realizes this fact and has chosen to
examine this subject to enhance understanding of medication errors in the
country. The main purpose of this study is to examine the perception of
medication errors, perceived causes, and reporting behaviors among nurses in
the Philippines.
3

4. Theoretical Framework
This study is anchored on two nursing theories: Patricia Benner’s Model of
Skill Acquisition in Nursing and Margaret Newman’s Health as Expanding
Consciousness Theory.
Patricia Benner’s Model of Skill Acquisition in Nursing (1948), which
applies the Dreyfus Model of Skill Acquisition (1980) to nursing, was first
published in 1982 entitled “From Novice to Expert”. The model outlines five
stages of skill acquisition: novice, advanced beginner, competent, proficient, and
expert. However, her work is much more encompassing about nursing domains
and specific functions and interventions (McEwen, 2007). Expertise develops
when 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:
http://visiblenurse.com.)
4

5. The Benner model has been used extensively as a rationale for career
development 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 for
determining registered nurses’ perception of medication errors, perceived causes
and 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:
http://visiblenurse.com.).
Margaret Newman (1999) theorized that humans are continuously active
in evolving their own pattern of the whole and are intuitive as well as cognitive
and 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 in
diversity. Newman (1994) stated that the patterns of interaction of person-
environment constitute health. Accordingly, nursing education should revolve
around this “pattern” to enable nursing to be an important resource for the
continued development of healthcare (Newman, 1995).
More importantly, Newman saw the theory, the practice, and the research
as a process rather than as a separate domain of nursing discipline. With an
updated contextual and practical knowledge, nurses will have the personal
transformation in learning they ought to have and will be able to recognize health
patterns in patients better by acting as a participant-observer of phenomena
related 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 all
indicate that the ideal of health as expanding consciousness generates improved
caring instructions in numerous populations.
6

7. Conceptual Framework
This section presents the conceptual framework of the study. The
framework of this study is focused on the relationship of the independent and
dependent variables as well as that of the extraneous variables as shown in
Figure 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. The
result may warrant a need for revision of policies, short-term training programs
like continuing education and in-service education or a long-term course like
advance professional education to update and enhance the knowledge on
medication administration and proper reporting behaviors.
The independent variable in this study is the staff nurses’ length of work
experience while the dependent variable is the perception of medication errors,
perceived causes, and reporting behaviors. The extraneous variables are
demographic profile including age, sex, civil status, highest level of education,
work schedule, employment status, length of nursing shift, and work setting. Also
apart of the extraneous variables are the self-rated proficiency in medication
administration, participation in short-term training regarding medication
administration, 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 Study
Statement of the Problem
This study intends to look into the respondents’ (staff nurses in the
hospitals in Pagadian City) perception of medication errors, their perceived
causes, 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’ profile
and their perception of medication errors, their perceived causes, and their
reporting behaviors.
Ho2: There is no significant relationship between the staff nurses’ length of
work experience and their perception of medication errors, their perceived
causes, 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 and
reporting behaviors regarding medication errors would be known, their concerns
would be addressed. The results of the study would also help in formulating new
guidelines to prevent medication errors and improve hasten reporting procedure.
Hospital Administrators
The hospital administrators will benefit from this study since through the
results of this study, they will be informed as to how the staff nurses perceive
medication errors. Based on the findings, they can revise their present policies or
formulate new ones regarding medication errors and reporting behavior.
Future Researchers
This study will serve as a reference and guide for future researchers who
will 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 the
respondents’ profile and sources of information regarding medication errors. The
study will also determine the relationship between the respondents profile and
their perception of medication errors, perceived causes, and reporting behaviors.
The respondents will be Bachelor of Science in Nursing (BSN) graduate, a
Registered Nurse (RN) in the Philippines, and working as a staff nurse in the
identified hospitals in Pagadian City. The hospitals are Pagadian City Medical
Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon General
Hospital, and J. Cabahug Hospital. Convenience sampling will be used. After
securing approval from the hospital administrators, a survey questionnaire will be
distributed to the nurse’s stations and will be collected after one week. The study
will be conducted from April to June 2012.
Definition of Terms
The following terms are defined operationally to project the functional
meaning of the words for the purpose of clarity and ease of comprehension in
this 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 were
reviewed about medication errors, its causes, and reporting behaviors to give
clarity to the present study.
Related Literature
Medication Administration (Delaune and Ladner, 2002)
Medication management requires the collaborative efforts of many health
care providers. Medications may be prescribed by a physician, dentist, or other
authorized prescriber such as advanced practice registered nurses as
determined by individual state licensing bodies. Pharmacists are licensed to
prepare and dispense medications. Nurses are responsible for administering
medications. Dietitians are often involved in identifying possible food and drug
interactions.
Nurses play an essential role in the administration of, education about,
and evaluation of the effectiveness of prescribed medications. The nurse’s role
changes with the setting of the client. In the home ore community setting,
referred to as primary care, clients take their own medication as prescribed by
the health care practitioner. Nurses are responsible for educating the client about
his 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 administering
medications and evaluating their effectiveness. Nurses are responsible for
teaching clients how to take their medications safely when they are discharged.
Medication administration requires specialized knowledge, judgment, and
nursing 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 nurses
take seriously, and to assist in this procedure the five Rights (5 Rs) of drug
administration have been devised:
Right patient
Check the identity of the patient with his identification band, using hospital
number or date of birth as additional verification. If patients are long-stay
residents, identification may be by photograph, rather than an impersonal name
band (Williams 1996). In the home setting you should satisfy yourself that you
have identified the right patient for medication by asking them their full name or
date 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 medication
container. 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 the
cupboard or trolley, before you pour it into the medication receiver, matching it to
the drug name on the prescription sheet, as you return it to the cupboard or
trolley.
Right dose
This should be clearly written on the prescription sheet. If the dose is very
small, then micrograms should be written out in full (BNF). Calculate the dose
carefully and check to see if there is a drug with the same name but dispensed in
different strengths.
Right time
Most drugs are designed to be given with an interval of several hours
apart to provide a consistent therapeutic blood level. If given haphazardly, then
the medication will be less effective or may cause the patient to develop
unwanted side effects. Therefore, it is essential to give doses at prescribed
intervals and to record the actual time of administration.
Right route
Medications are given licences for specific routes of administration. It is
possible to give medication by the wrong route, for example, an intramuscular
injection may be given intravenously if sited in the wrong place.
16

17. Related Studies
Perceptions 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 showing
situations from nursing practice. The study group was composed of 256
professionals and 89 questionnaires were analyzed. The answers given by the
registered nurses were compared with those of licensed practical nurses and
care aids. They should express their opinion if the situations represented a
medication error or not, if it had to be communicated to the physician or an
incident report had to be written. The two groups showed uniform answers. They
expressed the same doubts to label the situation as an error and which
measures should be taken, suggesting the need for further discussion on the
matter 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 study
period, for a reported rate of 0.04% of medication administrations. Twenty-one
percent of these were order writing and transcribing errors, 38% were nurse or
pharmacy dispensing errors, and 41% were nurse administration errors. Only
three MAEs resulted in adverse drug events. Nurses were less likely to report
MAEs that they felt were innocuous, especially late-arriving medications from the
17

18. pharmacy. A retrospective review of 200 chemotherapy administrations found
only one clear MAE, a miscalculated dose that should have been intercepted.
Significant reported MAE rates on our ward (0.04% of drug administrations
and 0.03 MAEs/patient admission) appear to be relatively low due to application
of current safety guidelines. An emphasis on studying MAEs at individual
institutions is likely to result in meaningful process changes, improved efficiency
of MAE reporting, and other benefits.
Medication Errors In Relation To Education & Medication Errors In Relation To
Years of Nursing Experience (Bailey, C.G., Engel, B.S., Luescher, J.N., and
Taylor, M.L., 2008)
The results of the study suggested that there is a direct relationship
between education and medication errors, rather than an inverse relationship,
wherein as education increased number of errors decreased. The study showed
that Licensed Practical Nurses (LPN) made the least number of medications
errors followed by Registered Nurses with Associate Degrees, with BSN
Registered Nurses having the highest incidence of medication errors. The results
indicate that as the education level increased so did the number of medication
errors. The study showed that nurses made the most medication errors either in
their first five years of nursing experience or after twenty years of nursing.This
study also indicated that giving medication at the wrong time was the most
common type of medication error made by the participants.The shift that reported
having 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 “by
mouth”.
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 the
legality of the prescription were the three strongest predictors of nurses’ actions
regarding 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. It
includes the research design, research setting, research respondents, research
instruments, data gathering procedure and statistical treatment.
Research Design
This non-experimental research will utilize the descriptive survey and
descriptive-correlational designs. The purpose these design is to describe the
variables and examine the relationships among these variables. No attempt will
be made to control or manipulate the situation. An anonymous, self-report survey
method will be applied using a questionnaire checklist in gathering the needed
data for the study.
Research Setting
This study will be conducted at in the hospitals of Pagadian City. Pagadian
is a chartered city in the southwestern Philippines, capital of Zamboanga del Sur
Province, on the island of Mindanao, on the south coast of the Zamboanga
Peninsula. Pagadian is a port on Pagadian Bay, a part of the much larger Illana
Bay. Pagadian is an important processing center for rice, maize (corn), and
coconuts produced in the surrounding area. Fishing is also a major economic
activity, as is lumber processing due to the peninsula's excellent stands of
Philippine hardwood trees. National roads connect Pagadian with most other
20

21. cities on Mindanao. A small airport has interisland commercial service. The total
area of the city (378 sq km/146 sq mi) includes a large portion of farmland. Its
population (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 City
Medical Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon
General Hospital, and J. Cabahug Hospital. Four of which are secondary and
one 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 rest
of the hospitals are secondary. Jamelarin Hospital has a 40-bed capacity situated
at Balangasan Dist. Borbon General Hospital is located at Rizal Ave., Sta. Lucia
Dist. and has 15-bed capacity. J. Cabahug Hospital has 10-bed capacity and is
situated at Rizal Ave., San Pedro Dist. The only public hospital is the Zamboanga
del Sur Medical Center, with 130-bed capacity located at Barangay Dao.
These hospitals are all accessible by local transportation such as tricycle
or public utility jeepney. These hospitals cater the health needs of the people.
Research Respondents
The target population will be Bachelor of Science in Nursing graduates
and are Registered Nurses (RN’s) in the Philippines who are staff of the chosen
hospitals in Pagadian City. All of the staff nurses in Pagadian City Medical
Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon General
Hospital, and J. Cabahug Hospital will be given the questionnaire and will be
instructed to return it to the researcher as soon as they complete the survey-
questionnaire. Convenience sampling will be used by providing questionnaire to
each 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, and
Hayes (1999) and Goldstone (1995). In addition, Osborne et al established
22

23. reliability using the test-retest method (0.78) in their sample. The Modified
Gladstone was revised by the researcher and added additional items to suit the
objectives of this study.
This instrument measured (1) nurses’ perceived causes of medication
errors – 10 items; (2) estimated percentage of drug errors reported to nurse
managers – 1 item; (3) types of incidents that would be classified as (a)
medication errors, (b) reportable to physicians, or (c) reportable using an incident
report – 6 items; (4) nurses’ views about reporting medication errors – 8 items; (5)
nurses’ demographic data – 12 items; and (6) nurses’ source(s) of information
regarding medication errors – 2 items.
Data Gathering Procedure
Written permission to conduct the study will be obtained from the chief
nurses and medical directors of the respective hospitals. A letter to the
respondent stating the study’s purpose and significance will be attached to the
front page of each questionnaire to obtain a free and informed consent.
Participants will be assured that their responses would remain confidential, any
information that may reveal their identity would not be recorded, and only
aggregated data will be communicated.
The questionnaires will be placed on each nurse’s station in a labeled
envelope with instructions concerning the survey. The researcher will collect the
completed 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 will
be treated using the following formula.
To provide an average picture of the data, the sample mean will be
determined 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 relationships
exist 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. REFERENCES
Books
Berman, 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.
Journals
Betz 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.
O'shes, 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 Reources
Microsoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation.
Google Maps 2011
http://visiblenurse.com
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 No
IV. 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 No
V. 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 ________ No
14. 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