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ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 933-938
Demonstration measure of medical errors using self-reporting method and its relation with gender and work experience in nurses of university of medical science in Kermanshah in the second half of 2014


1 Department of Health Services Management, School of Health Management and Information Science, Health Management and Economics Research Center, University of Medical Sciences, Tehran, Iran
2 Department of Health Services Management, School of Health Management and Information Sciences, University of Medical Sciences, Tehran, Iran
3 Department of Medical Science, Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Life Style Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

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Date of Web Publication5-Oct-2017
 

   Abstract 


Introduction: Error is an integral part of human life because most of the errors are derived from natural psychological process (cognitive) and behavioral adaptations which are created by correct skill behaviors. The objective of this study was evolution of medication errors using self-reporting method and its relation with gender and work experience in nurses of one of the educational medical Centers of Kermanshah University of Medical Sciences in the second half of 2014. Research Methods: This is a descriptive-analytical single group and single-stage study. The study population included 540 nurses working in Imam Reza Hospital at the time of the study, and sample was calculated to be n = 225 using Cochran formula based on pilot study considering the average incidence of errors observed. Researcher-made questionnaire was the data gathering tool. Questionnaire was initially distributed in all sections and was then completed by nurses. Content validity and reliability were tested based on the evaluation of opinions of 7 experts and using retest method, respectively, in such a way that questionnaire was given to 20 nurses in 2 steps with an interval of 2 weeks. Reliability was calculated to be averagely 0.69 for these questions using kappa coefficient. Data were analyzed by SPSS 20 software. Results: There was no significant relation between 18 cases of medication errors evaluated using self-reporting method and work experience. From all evaluated errors, there was a significant relation between the error of lack of compliance with the time of prescription of medicine as well as giving a medicine more or less than the prescribed dose and gender. Discussion and Conclusion: Based on the obtained results, we suggest that parallelism and extensive studies be carried out in all hospitals in the province for identified of the highest cases of errors and providing suggestions for reducing those. On the other hand, the possible causes fear or negligence of nurses about reporting of errors is essential, and use of training, control, and close monitoring is necessary in the field of medication errors.

Keywords: Medication errors, monitoring system, nurses, self-reporting

How to cite this article:
Vatankhah S, Moradi F, Esfandnia A, Seroush A, Eghbali A, Ovaisi M, Bayatmoghadam S. Demonstration measure of medical errors using self-reporting method and its relation with gender and work experience in nurses of university of medical science in Kermanshah in the second half of 2014. Ann Trop Med Public Health 2017;10:933-8

How to cite this URL:
Vatankhah S, Moradi F, Esfandnia A, Seroush A, Eghbali A, Ovaisi M, Bayatmoghadam S. Demonstration measure of medical errors using self-reporting method and its relation with gender and work experience in nurses of university of medical science in Kermanshah in the second half of 2014. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:933-8. Available from: http://www.atmph.org/text.asp?2017/10/4/933/215868



   Introduction Top


The error is an un separable part of human life due to sources, most of the errors are derived from natural psychological process (cognitive) and behavioral adaptations which is created by correct skill behaviors.[1],[2] Not only mistaken in human is inevitable but also all employees of health and health-care team can make mistakes in their professional skills regardless of how much skilled, committed, and careful they are.[1],[3] One of the main duties in nurses is giving medicine to the patient which requires skill, technique, and attention to patient safety in patient is one of the concerns in healthy and remedy nurses.[4] Based on applied studies, about 40% of their time in hospital for giving medicine to the patients.[5] Medication errors have been known to be among the most common and well-known medical errors.[6] Medication errors cause serious problems for public health and are considered to be a threat to patient safety.[7] Studies show that medication mistaken have consequences such as increased mortality, increased the length of hospital stay, and increased health-care costs. Based on carried out studies, many patients hospitalized in America a year die due to medication errors and also financial costs associated with adverse drug reactions have been estimated to be close to 77 million dollars a year.[8] Five cases must be fully respected to ensure medicine prescription with standard procedure and reduction of medication errors which are (1) The right medication, (2) The right dose, (3) The right patient, (4) The right method, and (5) The right time.[9] One of the main cases causing damage to patients during health care is incidents related to medicines. Medication errors occur during procure, prescription, dispensing, and administration of medicine and its monitoring, but the incidence of error is estimated to be more during prescription and administration of it to the patient. In the United States of America, annually almost 5.1 million people are affected by these errors, and thousands of people lose their lives which in itself involve a cost of at least 5.3 billion dollars. Based on different studies, between 4.9% and 7.1% of hospitalizations are drug-related morbidities (DRMs) with four times the prevalence of elderly compared to younger people. The important note is that nearly two-thirds of these cases are preventable DRMs (PDRMs). The majority of medical errors and adverse events during the course of care occur during transition which includes movement of patients between the various components (physical or nonphysical rotation) and patient handover and sign over between different providers (rotation of providers) which this matter jeopardizes patient's health in three major forms more than other forms which are (1) The omission of not pay attention important points about the patient's condition and treatment and disease. (2) Delaying pending laboraory tests results for patient and prescriber not being aware of results. (3) Issues related to medications that the patient receives. Even though some sources consider the effect of first two cases to be more in treatment outcomes by citing to carried out studies, many sources and centers including the World Health Organization and created coalitions such as 100 lives in America safer health care now in Canada consider the third case to be main by citing on their own sources and have provided or carried out practical actions in this regard.[10] Medication errors have negative effects on patients, nurses, and organizations and will reduce the quality of care. Thus, identification of causes and taking measures to reduce those can be among research priorities of health system. The objective of this research was evaluation of the rate of medication errors in different wards of one of the medical centers of Kermanshah University of Medical Sciences. Based on results of study of Mohammed et al. showed that medication errors have occurred in 17.9% of students among whom 42.30 were responsible for medication error. The most common types of medication errors were amount of medicine, wrong dose, and infusion rate. In addition, the highest medication errors have occurred in the emergency ward, and majority of medication errors have been intravenous injections (51.35%).[11] Results of study of Soudabeh et al. showed that creation of an effective system for reporting and recording error will reduce medication errors.[12] Results of study of Soudabeh et al. (2009) showed that the average of medication errors was higher in male nurses (40.85 ± 37.4) compared to female nurses (17.4 ± 28.68). In addition, the most frequent medication errors are, respectively, several oral medications together, failure to comply with proper time of medicine (Before or after a meal), rapid injection of medicine that must be injected slowly, and giving medication later or earlier than the stipulated time.[12] Results of study of Halbach et al. (2003) showed that the most common medication errors have, respectively, been wrong time, not giving the medicine, wrong dose, and giving bogus medicines.[13] Because of this, the objective of this study was evolution of medication errors using self-reporting method and its relation with gender and work experience in nurses of one of the centers related with the university of medical science in Kermanshah in the second half of 2014.


   Research Methods Top


This is sectional descriptive single group and single-stage study. The study population included 540 nurses working in Imam Reza Hospital at the time of the study, and minimum required sample size was calculated to be n = 225 using Cochran formula based on pilot study and by considering the average incidence of errors observed P = 0.3, q = 0.7, d = 0.6. The two-parted researcher made questionnaire was data collection tool. The first part consisted of four questions about demographic information and the second part contained 16 questions about medication errors. The questionnaire was initially distributed in all sections and was then completed by nurses. Content validity was tested based on the evaluation of opinions of seven experts, and reliability was tested using retesting method in this way that questionnaire was given to twenty nurses in two steps with an interval of 2 weeks. Reliability was calculated to be averagely 0.69 for these questions using kappa coefficient. Data were analyzed by SPSS 20 software (IBM, London).


   Results Top


Based on the [Table 1], higher percentage of research sample was female, and their highest service experience range was 5–10 years.
Table 1: Distribution of respondents in terms of experience and gender

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Relation of questions with work experience: based on Chi-square test, there was no relation between experience and error in terms of giving medicine to the patient without a prescription (P = 0.81). Based on likelihood ratio test, there was no relation between experience and error of giving medicine to the patient earlier or later than planned (P = 0.221). Based on likelihood ratio test, there was no relation between experience and error of failure to dilute the drug that should be diluted (P = 0.49). Based on Pearson's Chi-square test, there was no relation between experience and error of failure to comply with prescribed time (before or after meals) to the patient (P = 0.26). Based on Pearson's Chi-square test, there was no relation between experience and error of failure to do necessary measures about medicines that require special attention (pulse, blood pressure) (P = 0.44). Based on likelihood ratio test, there was no relation between experience and error of mixing two or more medicines in micro set regardless of drug interactions (P = 0.99). Based on Pearson's Chi-square test, there was no relation between experience and error of rapid injection of medication that must be injected slowly (P = 0.065). Based on likelihood ratio test, there was no relation between experience and error of subcutaneous injections of medications that must be injected intravenously (P = 0.13). Based on likelihood ratio test, there was no relation between experience and error of intravenous injections of medications that must be injected subcutaneously (P = 0.35). Based on likelihood ratio test, there was no relation between experience and error of intramuscular injection of medications that must be injected intravenously (P = 0.18). Based on likelihood ratio test, there was no relation between experience and error of intravenous injection of medications that must be injected intramuscularly (P = 0.67). Based on likelihoo ratio test as presented in [Table 2], there was no relation between experience and error of giving chewable medication to patient in the form of swallowing (P = 0.23). Based on Chi-square test, there was no relation between experience and error of giving narcotics to patients after the operation without a prescription (P = 0.053). Based on likelihood ratio test, there was no relation between experience and error of giving the wrong medicine to the patient (P = 0.59). Based on likelihood ratio test, there was no relation between experience and error of giving medicine more or less than the prescribed dose to the patient (P = 0.79). Based on likelihood ratio test, there was no relation between experience and error of giving the medication to the patient without having a prescription method (P = 0.19). Based on likelihood ratio test, there was no relation between experience and error of failure to comply with appropriate patient status depending on the type of medicine (P = 0.95). Based on likelihood ratio test, there was no relation between experience and error of lack of medication prescribed by doctors to patients (P = 0.47) [Table 3].
Table 2: Various errors ratio based on self reporting of nurses

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Table 3: Evaluation of relation between type of medication errors and work experience

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Evaluation of relation of gender with evaluated medication errors

Based on Chi-square test, there was no relation between gender and error of giving medication to patients without a prescription (P = 0.27). Based on Fisher's exact test, there was a relation between gender and error of giving the medication to the patient earlier or later than planned regulations in a way that we can say error of giving the medication to the patient earlier or later than planned regulations has been more common in females (50.6%) compared to males (28.6%) (P = 0.013). Based on Fisher's exact test, the error of failure to dilute the medication that should be diluted was females (8.3%) and males (2.9%) had no statistically significant difference (P = 0.476). Based on Fisher's exact test, the error of failure to adhere to prescribed time (before or after meals) to the patient has been reported to be more common in females (27.4%) than males (8.6%) (P = 0.011). Based on Chi-square test, there was no significant difference in males and females in failure to do necessary measures about medicines that require special attention (pulse, blood pressure) (P = 0.507). Based on Fisher's exact test, there was a significant difference between females (7.1%) and males (2.9%) in error of mixing two or more medicines in micro set regardless of drug interactions (P = 0.07). Based on Pearson's Chi-square test, there was no significant difference in females (11.4%) and males (14.9%) in rapid injection of medication that must be injected slowly (P = 0.595). Based on Fisher's exact test, there was no significant difference in females (4.8%) and males (0%) in subcutaneous injections of medications that must be injected intravenously (P = 0.356). Based on Fisher's exact test, there was no significant difference in females (6.5%) and males (2.9%) in intravenous injections of medications that must be injected subcutaneously (P = 0.69). Based on Fisher's exact test, there was no significant difference in females (2.4%) and males (5.7%) in intravenous injections of medications that must be injected subcutaneously (P = 0.276). Based on Fisher's exact test, there was no significant difference in females (3%) and males (0%) in intramuscular injection of medications that must be injected intravenously (P = 0.59). Based on Fisher's exact test, there was no significant difference in females (12.5%) and males (11.4%) in giving chewable medication to patient in the form of swallowing (P = 0.99). Based on Chi-square test, there was no significant difference in females (25%) and males (11.4%) in giving narcotics to patients after operation without a prescription (P = 0.081). Based on Fisher's exact test, there was no significant difference in females (14.9%) and males (18.6%) in giving the wrong medicine to the patient (P = 0.42). Based on Fisher's exact test, there was no significant difference in females (14.3%) and males (2.9%) in giving medicine more or less than the prescribed dose to the patient (P = 0.044). Based on Fisher's exact test, there was no significant difference in females (8.9%) and males (0%) in giving the medication to the patient without having a prescription method (P = 0.079). Based on Fisher's exact test, there was no significant difference in females (8.3%) and males (5.7%) in failure to comply with appropriate patient status depending on the type of medicine (P = 0.99). Based on Fisher's exact test, there was no significant difference in females (4.2%) and males (2.9%) in the lack of medication prescribed by doctors to patients (P = 0.99) [Table 4].
Table 4: Evaluation of relation between gender and type of medication errors

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   Discussion and Conclusion Top


Based on the obtained results, there was no significant relation among 18 cases of medication errors evaluated using self-reporting method and work experience. From all evaluated errors, there was a significant relation between the error of lack of compliance with the time of prescription of medicine and gender which means that the error of failure to adhere to prescribed time (before or after meals) to the patient was reported to be more in females (27.4%) than males (8.6%) (P = 0.011). There was also a significant relation between the error of giving medicine more or less than the prescribed dose to the patient and gender which means that the error of giving medicine more or less than the prescribed dose to the patient was reported to be more in females (14.3%) than males (2.9%) (P = 0.011). Results of study of Mohammed et al. showed that medication errors have occurred in 17.9% of students among whom 42.30 were responsible for medication error. The most common types of medication errors were amount of medicine, wrong dose, and infusion rate. The highest medication errors have occurred in the emergency ward, and majority of medication errors have been intravenous injections (51.35%).[11] Results of study of Soudabeh et al. showed that creation of an effective system for reporting and recording error will reduce medication errors.[12] Results of study of Soudabeh et al. (2009) showed that the average of medication errors was higher in male nurses (40.85 ± 37.4) compared to female nurses (17.4 ± 28.68). In addition, the most frequent medication errors are, respectively, several oral medications together, failure to comply with proper time of medicine (Before or after a meal), rapid injection of medicine that must be injected slowly, and giving medication later or earlier than the stipulated time.[13] Results of study of Halbach et al. (2003) showed that the most common medication errors have, respectively, been wrong time, not giving the medicine, wrong dose, and giving bogus medicines.[13] Several reasons have been provided about medication errors, these reasons generally are (1) Insufficient knowledge and skills of personnel: Lack of knowledge about patient, diagnosis, patient name, purpose of the medication, lack of knowledge and method of operating with medicine infusion pumps, confusing intravenous line with gastric tube, failure to properly prepare the medicine before administering it, and not knowing side effects of medicine. (2) Failure to follow the prescribed medicine's policy: lack of familiarity with the special rules of prescribing medications such as chemotherapy, antiarrhythmia, and respiratory muscle relaxants and not checking allergic diseases of patient and bracelets of special disease before prescribing medication. (3) Failure in communication between personnel: bad handwriting in pharmaceutical prescriptions, use of medical abbreviations, and verbal commands. (4) Failure in cases involving individuals and health system: Nurses' work experience, number of hours worked in tandem, rotating shifts, heavy workload, distraction, and work interruptions during medication administration, nurses being in unfamiliar wards ant, etc. Drug companies are involved in errors which is trough identical packaging and similar names for Medicines. Four types of medication errors are reported in different articles as follows: (1) Wrong dose, (2) wrong drug prescription, (3) wrong dug, (4) wrong time which has also been evaluated in this study, and following factors are mentioned in occurrence of error: Lack of familiarity with Medicines, providing advanced medications without rechecking them, heavy workload, misunderstanding when taking oral medication orders, and finally distraction when checking prescription. Since medical errors may not be reported due to fear of worsening the issue, not knowing that reporting medication errors is extremely important, covering the work of colleagues and fear of blame and condemnation of director of ward and others, we suggest that parallelism and extensive studies be carried out in all hospitals in the province for identified of the highest cases of errors and providing suggestions for reducing those. On the other hand, the possible causes fear or negligence of nurses about reporting of errors is essential, and use of training, control, and close monitoring is necessary in the field of medication errors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Stratton KM, Blegen MA, Pepper G, Vaughn T. Reporting of medication errors by pediatric nurses. J Pediatr Nurs 2004;19:385-92.  Back to cited text no. 9
    
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Correspondence Address:
Farideh Moradi
Department of Health Services Management, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_256_17

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