Nurses' perception of medication administration errors and factors associated with its reporting in the neonatal intensive care unit.

BACKGROUND: Medication administration is a complex process and nurses play a central role in this process. Errors during administration are associated with severe patient harm and significant economic burden. However, the prevalence of underreporting makes it challenging when analysing the current landscape of medication administration error (MAE) and hinders the implementation of improvements to the existing system. The aim of this study is to describe the reasons for the occurrence of MAEs and the reasons behind the underreporting of MAEs, to determine the estimated percentage of MAE reporting and to identify factors associated with them from the nurses' perspective.

METHODS: This cross-sectional study was conducted using a validated self-administered questionnaire. The questionnaire contained 65 questions which were divided into three sections: (1) reasons for the occurrence of MAEs which consisted of 29 items; (2) reasons for not reporting MAEs which consisted of 16 items; and (3) percentage of MAEs actually reported which consisted of 20 items. It was distributed to 143 nurses in the Neonatal Intensive Care Units of five public hospitals in XXX. Multivariable logistic regression was used to identify factors associated with MAE reporting.

RESULTS: The estimated percentage of MAE reporting was 30.6%. The most common reasons for MAEs were inadequate nursing staff (5.14 (SD 1.25)), followed by drugs which look alike (4.65 (SD 1.06)) and similar drug packaging (4.41 (SD 1.18)). While the most common reasons for not reporting MAEs were that nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.56 (SD 1.32)) and that too much emphasis is placed on MAEs as a measure of the quality of nursing care (4.31 (SD 1.23)). Factors statistically significant with MAE reporting were administration response (AOR = 6.90; 95% CI = 2.01-23.67; p=0.002), reporting effort (AOR = 3.67; 95% CI = 1.68-8.01; p=0.001) and nurses with advanced diploma (AOR = 0.29; 95% CI = 0.13-0.65; p=0.003).

CONCLUSION: Our findings shows that underreporting of MAEs is still common and less than a third of the respondents reported MAEs. Therefore, to encourage error reporting, emphasis should be placed on the benefits of reporting, adopting a non-punitive approach, and creating a blame-free culture.