Assessment of knowledge, attitutes and barriers towards medication error reporting among nurse practioners in Hospital Tengku Ampuan Afzan Kuantan Malaysia

Abstract

Background: Nowadays, Medication Errors (MEs) have appealed more interest of health care organizations because of their complications like higher mortality rate and increased health care cost. The MEs are underreported in all countries. This issue compromises the Medication Error Reporting (MER) systems. Objectives: This study was aimed to explore the knowledge and attitudes of nurses toward ME reporting. Furthermore, barriers and facilitators towards MER practices among nurses have also been investigated. Method: A mixed methodological approach has been adopted to answer the research questions. In the qualitative part, a total of twenty-three nurses were interviewed, using new validated semi structured interview guide. The saturation point was reached after twenty interviews. Three extra interviews were conducted to confirm saturation point. The audio recordings were transcribed verbatim and exposed to thematic content analysis. In order to generalize the initial qualitative study findings, a cross-sectional survey has been carried out with a sample of nurses attached to the same hospital (n = 310). Using new validated self-administered questionnaire. Result: Four major themes were emerged from the transcripts. Almost all the interviewed nurses were aware of the existence of MER system, MER process and the importance of MER. However, although the majority of interviewed nurses did not submit any ME report, they showed a positive attitude towards MER. The main barriers for MER were the impact of time and workload, the shame feeling, fear of being investigated and the impact of MER practices on job record, negative reaction from person in-charge, the confidentiality of the reporting form, and absence of effective feedback. The obtainable response rate was equal to 90.3%. The mean for their total knowledge score was 5.6 (SD= 1.4). Almost all participants considered MER is important (99.3%) but 30 % of those who committed ME last year did not report their errors. Almost all the respondents agreed that MER is part of their professional duties (92.1%). The main reasons for underreporting were fear of liability or lawsuit issues (63.6%), fear of being labelled as an incompetent nurse (52.1%), and lack of effective feedback from the nursing manager (33.6%). The main facilitators toward MER were compulsory MER (90.7%), conducting training program specifically for MER (84.3%), analysis/feedback criteria (80%), encouragement from nurse leaders (75.7%), and using anonymous reporting form (73.2%). Conclusion: This study revealed that although the nurses had reasonably acceptable knowledge and positive attitudes toward MER, there was low involvement of nurses toward MER. Their decisions to report MEs were highly affected by barriers. In order to improve the participation of nurses toward MER, the related authorities should work on strategies which can help to improve the involvement of nurses such as creating a MER environment free from blaming, reporting anonymously, and conducting a training program.