Patient safety has long been a major concern for healthcare professionals and its signiﬁcance has been expanded with the increasing need for hospital accreditation. Therefore, the researcher will do additional study to find out nurses’ opinion of medication error and their contributing factors on the (wards at hospital). A cross-sectional study will be utilized and a sample of twenty (20) nurses, ten (10) from each ward will be chosen. A convenience sampling method will be used and data will be collected with the use of questionnaires and interviews. In this study, the perspectives of the experienced nurses concerning medication errors will be investigated. Information gathered will be kept confidential by putting password on the computer and storing all collected data in a locked draw. Data will further be analyzed. In addition, ethical considerations will be highlighted. At the end, it is expected that information gathered will be used to find out nurses’ opinion of medication error and their contributing factors.
Keywords: medication errors, nurses’ opinion, contributing factors Literature Review Action to improve patient safety in health care systems and, in particular, to reduce the frequency of serious medication errors, is a major priority in some member states. Errors may involve prescribing, dispensing or administration of medicines, or failure to give proper advice, for example, about side effects or cautions. They occur in primary, secondary and tertiary care settings, and often occur at the interface between hospital and primary care. Currently, the health services, especially nursing services, are striving to achieve ever-higher levels of service excellence, aiming to provide care that is free of risk and harm to patients. Adverse events have been considered important indicators of quality of health service and care delivery. Although these are undesirable events, they are commonly observed in care practice and those related to medication errors are themselves frequent. Among patient safety issues such as patient identiﬁcation, transfusion error, falls and suicide, medication safety has been considered as a major indicator of health-care quality (Mrayyan, Shishani, and Al-Faouri, 2007).
The literature on medication errors lacks universally accepted definitions of medication errors as well as different methods and criteria, leaving us with an incomplete knowledge of the actual rate of medication errors. Medication error is defined as any preventable event that may cause or lead to inappropriate use of medications or patient harm (Bates, 2007). Therefore, as stated above, medication errors can be prevented. According to Institute of Medicine (IOM), medication errors injure at least 1.5 million people and the medical costs of treating medication errors related injuries occurring in hospitals alone are approximately 3.5 billion dollars per year (IOM 2007). The rate of medication errors varies from 2 to 14% of hospitalized patients. Medication errors have been estimated to kill 7000 patients per annum and account for nearly one in 20 hospital admissions in the USA and the UK (Tang, Sheu, Yu, Wei, and Chen, 2007).
Considering that medication errors are universally under-reported the incidence rate of medication errors is speculated to be even higher. According to (Sanghera et al. 2007), despite the wide variety of health-care professionals involved in the entire process of prescribing, transcribing, dispensing and administering medication, nurses are more frequently involved in medication errors than physicians, pharmacists or other health-care professionals. Administration errors are the most common followed by prescribing errors. In addition, the most common types of medication errors are incorrect medication prescription, inappropriate medication use, wrong administration, and omission of administration (Pepper and Towsley 2007). These ﬁndings suggest that medication errors commonly occur during prescription and administration. During medication administration, nurses play a significant role in securing patient safety. Furthermore, it is for just these reasons that standards for medication administration were developed.
Standards are those actions that ensure safe nursing practice. The standards, in this case, are called the “rights” of medication administration. All medication errors can be linked, in some way, to an inconsistency in adhering to these “rights” of medication administration. The “rights” are taught from early on in nursing education and training, they are reinforced in the workplace and the FDA, drug companies and healthcare organizations issue signs, posters and plaques that hang in every facility where medications are given, reminding the providers to check and recheck what they do. Nurses are responsible for checking whether a prescription is appropriate and administering the right medication, with right dose, to the right patient through the right route at the right time (the five rights). Therefore, nursing-related prevention strategies should be developed to reduce medication errors (Crespin, 2010). Furthermore, reporting is important to developing strategies to prevent and reduce medication errors because the health-care community can learn from mistakes. Data obtained from the reporting system provide useful information on the causes of medication errors and important mechanisms that can be modified.
Nevertheless, nurses are unwilling to report medication errors because of the fear of punishment (Crespin, 2010). In addition, most hospitals are reluctant to reveal incident reports of medication errors because of potential damage to the hospitals reputation. Therefore, it is very difficult to obtain useful and accurate data on medication errors. Additionally, incident report analysis does not clearly point out nurses’ opinions of medication errors. It is also still uncertain as to why nurses defy the five rights and make mistakes while administering medications even though the principle of five rights is emphasized in various levels of nursing education. Moreover, based on the background information it can be understood that the side effects of chemotherapy was well researched. Therefore, a research will be conducted to identify the types of medication errors that occur in nursing practice, the contributing factors for medication errors and the nurses’ opinions of medication errors and reporting. Definition of Variables
* Independent Variables
Medication Error: is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer (Bates, 2007). * Dependent Variables
Nurses’ Opinion: nurses’ view, judgment, or appraisal formed in the mind about a particular matter (The Free Dictionary, 2011). Contributing Factors: A group of situations (hazardous conditions and/or actions) that were existing well before the accident and which were not corrected. Some of these situations may be defects in the organization, worker, task, moment, place or equipment (The Free Dictionary, 2011). Research Question
What are nurses’ opinion of medication error and their contributing factors on the (wards at hospital)? Objectives
While carrying out this research, the researcher seeks to:
* Identify the types of medication errors that occur in nursing practice * Investigate the contributing factors for medication errors * Find out nurses’ opinions of medication errors and reporting Methodology
In this quantitative research, a cross-sectional design will be utilized. With a cross-sectional study, it is observational in nature and are known as descriptive research. Researchers record the information that is present in a population, but they do not manipulate variables. This type of research can be used to describe characteristics that exist in a population, but not to determine cause-and-effect relationships between different variables. Additionally, these methods are often used to make inferences about possible relationships or to gather preliminary data to support further research and experimentation (Beck, 2009). As such, this will provide adequate and relevant information on medication error and their contributing factors. Population and Setting
In carrying out this study, twenty (20) nurses from (hospital), ten (10) nurses from each of the following wards; (wards) will be asked to participate in this research. These participants will be chosen only from the (hospital) and each participant will be given adequate time to complete the instruments that will be provided. Additionally, confidentiality will be maintained as files will be locked away and files will be kept in unknown folders on the computer which will have a security password. Additionally, the nurses will be interviewed in a room suitable to maintain privacy. Sample and Sampling Strategy
The sample size will be used in order to obtain sufficient information on the nature of the problem under study. In doing so, a non-probability sampling which involves convenience sampling will be utilized. According to Beck (2009), in convenience sampling, the questionnaire is given to whoever happens to be available. The advantage about this sampling technique is that it is convenient. The disadvantage is that absolutely no conclusions about the population can be made. Data Collection Measures
Data will be collected with the use of questionnaires. The questionnaires will be hand delivered to each participant who signs the consent form, and there will be ten (10) questions in the form of open-ended and closed-ended questions. Data Collection Procedures
During this period, participants will be given their questionnaires all at once. The questionnaires will be hand delivered to the participants for them to complete after the consent form is signed. Please note, at the end, all data will be collected by the researcher and not other nurses or health care staff because confidentiality should be maintained. Data Analysis
Since data will be collected and recorded, it is important to analyze the information first. In doing so, the researcher will look at the completed questionnaires then analyze the data using descriptive statistics along with Microsoft Excel. With the use of descriptive statistics which involve central tendency (the mean and mode), data will be collected, organize, interpret and communicate numeric information (average and percentage) to describe and synthesize the data (Beck, 2009). Limitations of the Study
Based on the fact that it is a cross-sectional study, there can be limitations because cross-sectional studies can say that the two are related somehow, but they cannot positively determine if one caused the other. Cross-sectional studies also fail on the part of confounding factors. Additional variables may affect the relationship between the variables of interest but not affect those variables themselves. Additionally, limitations can result from participants answering, cannot answer questions involving past events with perfect accuracy, giving incorrect answers on the instruments or failing to return the questionnaires (Beck, 2009). As such, sufficient data may not be collected. This either magnifies or minimizes the effects of certain variables, affecting the results. Ethical Considerations
Ethical issues are vital in every study. There are three primary ethical principles in the Belmont Report; beneficence, respect for human dignity, and justice. Beneficence refers to maximizing to act for the benefit of others, helping them to further their important and legitimate interests, often by preventing or removing possible harm. According to Beck (2009), the right to protection from exploitation will reassure participants that information obtained will not be used against them. With the right to protection from harm and discomfort will help to avoid, and prevent harm to the participants. Respect of human dignity speaks of the participant’s right to self-determination and full disclosure. Self-Determination speaks to participants not be coerced into participating in research. This is especially relevant where researchers rely on ‘captive audiences’ for their subjects.
Whereas, with the right to full disclosure it’s the researcher responsibility to ensure that participants fully understand the topic being studied before consenting to participate (Beck, 2009). Justice includes the participant’s right to fair treatment and privacy. These two elements are considered relevant since some of the questions require participants to express their feelings. According to Beck (2009), fair treatment considers that the selection of study participants should be based on the research and not on vulnerability; while, the right of privacy should be evident throughout the study. Privacy, anonymity and confidence should be maintained as well. With confidentiality they are assured that identifying information will not be made available to anyone who is not directly involved in the study. The stricter standard is the principle of anonymity which essentially means that the participant will remain anonymous throughout the study even to the researchers themselves. Clearly, the anonymity standard is a stronger guarantee of privacy.