BJSTR MS Id 001533
BJSTR MS Id 001533
BJSTR MS Id 001533
DOI: 10.26717/BJSTR.2018.07.001533
RSH Eldesouky. Biomed J Sci & Tech Res
Abstract
Background: Medical Errors (ME) are inevitable part of any health care system and pose a threat to patient safety.
Objectives: To determine the prevalence, forms, consequences and the underlying factors of ME among nurses in the University Hospital of
Benha and to detect the prevalence of reporting ME and causes of un-reporting.
Material and Methods: This cross-sectional study was conducted up on 257 nurses. Data were collected during December 2017, using an
English self-administered, anonymous questionnaire sheet.
Results: 36.2% of the studied nurses committed ME, 48.4% of them committed errors more than once. The most frequent form was giving
wrong dose of medications (35.5%). Tiredness due to excessive overtime work and inadequate training of the nurses were the mostly reported
underlying factors (62.6% and 39.3% respectively). The prevalence of ME was significantly higher among junior nurses (P=0.029), those graduated
from nursing school and technical institute of nursing than faculty of nursing (41.6%, 29.6% and 16.7% respectively) (P=0.017), among single,
widowed and divorced nurses than married ones (81.2%, 60%, 50% and 32.5% respectively) (P<0.001). Also, it was higher among Nurses of work
experience <10 years (51.9%) compared with those of 20-30 or more years (33.3% and 30.2% respectively) (P=0.024). One third (33.3%) of nurses
who committed ME did not report it. Fear of legal issues was the most common cause of un- reporting (80%).
Conclusion: ME is a serious problem that threatens patient safety. Staff training, non-punitive work environment and properly working
reporting system are the best solutions to prevent ME.
Keywords: Medical errors; Nurses; Forms; Reporting; Administering Treatment; Un-Reporting; Fisher’s Exact Test
Introduction
to Institute of Medicine (IOM) approach, ME comprise a wide
Medical Errors (ME) represent a serious public health problem
range of events. It may be diagnostic; “error or delay in diagnosis”,
and pose a threat to patient safety [1]. It is extremely important
failure to employ indicated tests ,use of outmoded tests or therapy,
to adopt a standard definition for ME throughout the world,
failure to act on results of monitoring or testing, treatment error;
because lack of agreement on standard definition makes it difficult
“wrong performance of an operation , procedure, or test”, error in
for researchers to obtain valid and reliable data, and to assess
administering treatment; “error in the dose or method of using a
the impact of specific organizational interventions [2]. The most
drug, avoidable delay in treatment or in responding to an abnormal
common definition for ME is that it is an unintended act (either of
test and inappropriate care”, preventive error; “failure to provide
omission or commission) or one that does not achieve its intended
prophylactic treatment or inadequate monitoring or follow-up of
outcome, [3] the failure of a planned action to be completed as
treatment “ and finally, failure of communication ,equipment and
intended (an error of execution), the use of a wrong plan to achieve
other system failure [1]. Although medical errors can be caused by
an aim (an error of planning), [4] or a deviation from the process of
all members of health care team, nursing medical errors are the
care that may or may not cause harm to the patient [5]. According
most common [6].
Biomedical Journal of
Scientific & Technical Research (BJSTR)
6020
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6021
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6022
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
Shortage of time characters of the studied nurses where (Table 4) illustrates that
Using abbreviations of names 75 29.2 the prevalence of medical errors significantly (P<0.05) decreased
Taken oral orders instead of writing 74 28.8 by age (45.6% of nurses of 20- year age group, 40% of those
orders of 30- years, 29% of 40- years and only 14.3% of those of ≥50
years age group. Prevalence was significantly (P<0.05) higher
Tiredness due to excessive overtime work and inadequate
among the nurses graduated from nursing school and technical
training of the nurses were the mostly reported factors (62.6% and
institute of nursing than faculty of nursing (41.6%, 29.6% and
39.3% respectively) by the studied nurses. Noisy ward environment
16.7% respectively. Also, medical errors were higher among
and large variety of drugs in medication cabinet were the most
single, widowed and divorced nurses than married ones (81.2%,
common (42.8% and 30.4%) among the environmental factors.
60%, 50% and 32.5% respectively), P<0.001. The prevalence was
Regarding managerial factors, inadequate staffs in each working
significantly higher among nurses of work experience less than 10
shift and working in night shift were the mostly reported (52.1%
years (51.9%) compared with those of 20-30 or more years of work
and 31.1% respectively) (Table 3). The study also investigated the
experience (33.3% and 30.2% respectively), P<0.0.5.
association between committing errors and socio-demographic
Table 4: Association between committing MEs and socio-demographic characters of the studied nurses.
Not committed errors (n=164) Committed errors (n=93) X2
Variable
No. % No. % (P)
Age (in years)
37 54.4 31 45.6
20-
54 60.0 36 40.0 9.05
30-
55 70.5 23 29.5 (0.029)
40-
18 85.7 3 14.3
≥ 50
Sex
9 60.0 6 40.0 0.1
Male
155 64.0 87 36.0 (0.75)
Female
Residence
117 63.9 66 36.1 0.004
Rural
47 63.5 27 36.5 (0.95)
Urban
Graduation
25 83.3 5 16.7
Faculty of nursing 8.16
101 58.4 72 41.6
Nursing school (0.017)
38 70.4 16 29.6
Technical institute of nursing
Marital status
158 67.5 76 32.5
Married FET=
1 50.0 1 50.0
Divorced 16.4
2 40.0 3 60.0
Widowed (<0.001)
3 18.8 13 81.2
Single
Years of work experience
26 48.1 28 51.9
< 10 7.47
78 66.7 39 33.3
10-20 (0.024)
60 69.8 26 30.2
>20
Work hours per week
82 65.6 43 34.4 0.34
≤ 50
82 62.1 50 37.9 (0.56)
> 50
Tobacco (n=15 males)
7 77.8 2 22.2 FET
No
2 33.3 4 66.7 (0.13)
Yes
Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6023
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6024
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
Our results were consistent with Ehsani et al. [12] who was confirmed by other studies [35-38] as they found that young
found that shortage of nursing staff, inadequate pharmacological nurses were reluctant to report, perceived more reporting barriers
knowledge and fatigue resulting from high workload were among and had more negative attitude to error reporting than senior
human and managerial factors as well as usage of abbreviated nurses. This could be explained that young nurses are the front-line
names and similarities in drug names were among the medical personnel involved in administering drugs and the prevalence of
factors associated with medication errors. The same findings were committing MEs are higher among them than senior nurses. When
reported by other studies such as Al-Shara [13], Hosseinzadeh et al. they commit errors which are common, any negative consequences
[20] and the systematic review by Alsulami et al. which mentioned are likely to impact them directly and make them unwilling to
that poor knowledge of prescribed or administered medications was report them.
the most common reported contributory factor for MEs in Middle
Another important finding of our study was that the number of
Eastern countries [21] Also, hesitated that shortage of workforce
medication errors reported by the nurses was less than occurred
[20-25], heavy workload [23-27], poor physical or mental health
in real practice. This can be explained by fear of legal issues.
[24-28], are also common factors contributing to MEs in different
Among those who reported the error (62 out of 93, 66.7% of
studies and literature reviews.
nurses committing ME), (75.8%) of reporting nurses informed the
Pape et al. [29] reported that, inadequacy of job training and physician in duty, (24.2%) told the head nurse to take the suitable
insufficient knowledge of the graduates are causes of medication actions. This was the opposite to the situation of Yung et al. who
errors. Cheragi et al. [17] reported that low nurse to patient ratio demonstrates that (88.9%) of nurses had reported the error orally
among the managerial factors causing medication errors. Dibbi et and that most had done to the head nurse (67.6%) and physicians
al. [30] agree with our results as he showed that human factors (44.4%) [37]. The principle causes of un-reporting were fear of
were the most common cause (46.5%) of medication errors among legal issues, followed by unknown error reporting mechanism and
patients in Saudi Arabia`s hospital .Various studies have reported finally lack of clear definition of ME. Another study done by Yung et
that crowded and noisy environment, tiredness, lack of adequate al. [37] declared that fear (fear of blaming, labeled as incompetent
support, carelessness, increased workload as the most important nurses, a fear of judicial issues, a fear of being dis-trusted by
factors causing medication errors, mostly in intensive care units doctors; patients and families, and a fear of being exposed to the
[31]. On assessment of the association between committing MR and public by the media).
some sociodemographic factors of participating nurses ,we found
Also, our finding come in agreement with other several studies
that the prevalence of ME was significantly higher among young age
which found that personal fears were the major perceived barriers
nurses (45.6% of nurses of 20- year and only 14.3% of those of ≥50
of ME reporting [38-41]. However, most of nurses declared that
years age group). The prevalence was significantly higher among
if they committed an error, they would report it on condition
nurses of work experience less than 10 years (51.9%) compared
that the reporting system characterized by confidentiality, being
with those of 20-30 or more years of work experience (33.3% and
non-punitive, well known and transparent. Similar finding was
30.2% respectively).
demonstrated by Yung et al. who reported that (73.5%) of nurses
These results were not supported by Sozani et al. and Ghasemi considered that all medication errors should be reported, whether
et al. as they found that there was no significant association the patient is harmed or not [37]. There are many studies which
between the effective factors in causing the medicine-related errors emphasize on non-punitive [26,39], blame free [22,27,42] and
and variables of age and work experience [32,33]. This may be due supportive [22] work environment for ME reporting; being familiar
to difference in demographic characteristics among Egyptian and with clinical terminology, training and experience, regular feedback,
Iranian populations. Prevalence was significantly higher among mandatory and optional reporting are important requirements for
the nurses graduated from nursing school and technical institute good error reporting system [43].
of nursing than faculty of nursing (41.6%, 29.6% and 16.7%
respectively), and the possible explanation for this finding is that
Limitation of the study
faculty graduated nurses are knowledgably and more qualified. The participants were the nursing staff only of a university
We also noticed that ME were higher among single, widowed and hospital; future studies should include physicians and other para
divorced nurses than married ones (81.2%, 60%, 50% and 32.5% medical staff from university, private and teaching hospitals.
respectively), and this could be attributed to the psychological Moreover, self-reported data were collected, and this may be
problems facing single, divorced & widowed nurses. subjected to recall bias. However, bias is a part of any study.
Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6025
Biomedical Journal of Scientific & Technical Research Volume 7- Issue 4: 2018
working in night shift and inadequate staffs in each working shift. 13. Al Shara M (2011) Factors contributing to medication errors in Jordan: a
The prevalence of errors was higher among junior nurses than nursing perspective. Iran J Nurs Midwifery Res 16(2): 158-161.
senior ones. The most frequently committed errors were giving 14. Nikpeyma N, Gholamnejad H (2009) Reasons for medication errors in
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Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6026
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Cite this article: EM Araby, RSH Eldesouky, HA Abed. Medical Errors Among Nurses in The University Hospital of Benha, Egypt: Forms,
Underlying Factors and Reporting. Biomed J Sci&Tech Res 7(4)- 2018. BJSTR. MS.ID.001533. DOI: 10.26717/ BJSTR.2018.07.001533. 6027