Nurses’ Perceptions of Medication Errors in South India

Medication use in hospitals is a complex process and depends on successful interaction among health care professionals functioning at different areas. Errors may occur at any stage of prescribing, documenting, dispensing, preparation, or administration. This descriptive survey was conducted in the cardiac wing at a private tertiary care teaching hospital in Kerala, South India during January- February 2013 among 50 registered nurses with an aim to investigate what constitutes a medication error (ME), types of commonly observed errors, drugs involved, causes of error, reasons and existing barriers to reporting medication errors and characteristics of good and effecting ME reporting system among nurses working in a cardiac care center. Analysis revealed that the overall mean of medication errors they could remember making was 3.52, over the course of their career. Antibiotics, digoxin, warfarin / acitrom, dopamine/dobutamine were mostly involved in medication errors. The most common types of errors observed were drug administering without a physician order, omission error, followed by drug calculation error, Incorrect IV therapy timing/dosage/administered technique, and wrong time. Culture of blame within team members (15), Degree of harm occurred to the patient (15),patient aware of error(14), Sense of shame(13), Lack of familiarity/skills with how best to handle a situation (12), Error tolerance of institution(10), Rapport between patient and provider(6) influenced the decision to disclose a medication error. The most common barriers to reporting medication errors were , not getting any positive feedback for passing medications error (22) possible adverse consequences like loss of job/ disciplinary action (21), not agreeing with hospital's definition of a medication error (16), feeling of incompetency from team members (15) and not recognizing occurred error (15). According to nurses the top 5 characteristics of a good and effective ME reporting system were the systems in which Medication orders are rewritten at transfer, Reasons for medication changes made at transfer are documented, non-punitive approach to reporting , Feedback of the results of the error analysis given those healthcare professionals involved, Home medications are brought in by patients. Despite a desire to deliver high quality care, errors occur on both a systems and personal level. Nurses have to take a front seat role in initiatives that have sought to address issues related to medication error, develop significant expertise in medication administration and associated systems to tackle issues of medication error.