Content analysis of nurses' reflections on medication errors in a regional hospital.

BACKGROUND: Medication errors [MEs] continue to be an area of concern both nationally and internationally. Medication administration is the final step in the process of medication management in hospitals and errors related to medication administration have been reported to be the most common type of medication errors. Although, there have been several attempts to reduce MEs, there is currently little evidence of their effectiveness across different settings.

METHODS: As part of incident reporting at a 290-bed Australian regional teaching hospital, nurses are required to complete a reflective summary detailing reasons or contributing factors as to why they believed a MEs occurred. 68 such summaries were completed by nurses during a five -year period. Anonymised summaries were analysed using content analysis underpinned by the Human Factors Framework.

RESULTS: Fifteen codes emerged from the data that aligned to three main categories of the Human Factors Framework. They were: Individual characteristics such as inexperience, stress and lack of knowledge (5 codes), Nature of the work such as prescription errors, time pressure, miscommunication, poor handover, and documentation errors (9 codes) and Physical environment such as distractions (1 code). Individual characteristics that included codes such as lack of attention, inexperience, stress, tiredness and fatigue were the most frequently reported (51.6%) reasons for the error.

CONCLUSIONS: MEs continue to be an intractable problem in hospitals. Nurses' reflections suggest that factors related to individual characteristics, physical environment and nature of the work are most frequently reported reasons for errors. Improving management of medication processes such as provision of medicine information resources and management of nurses' workload as well as enhancing graduate nurse education with simulation of 'real life' clinical settings appear to be the main targets for intervention.