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      Evaluation of medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals: a cross-sectional study in Iran

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          Abstract

          Introduction

          Medication errors in nursing negatively affect the quality of the provided health-treatment services and society’s mentality about the health system, threatening the patient’s life. Therefore, this study evaluates medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals.

          Materials and methods

          All the nurses working at teaching hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences (southwest of Iran) comprised the statistical population of this research (260 participants). Data were collected using three questionnaires: a demographic characteristics questionnaire, a medication error questionnaire, and the standard Circadian Type Inventory (CTI) for a normal physiological cycle.

          Results

          At least one medication error was observed in 83.1% of nurses during their work span. A medication error was found in 36.2% of nurses during the COVID-19 pandemic (over the past year). Most medication errors (65.8%) occurred during the night shift. A significant relationship was detected between medication errors and shift work. Medicating one patient’s drug to another (28.84%) and giving the wrong dose of drugs (27.69) were the most common types of medication errors. The utmost medication error was reported in emergency wards. The fear of reporting (with an average of 33.06) was the most important reason for not reporting medication errors ( p < 0.01).

          Discussion and conclusion

          Most nurses experienced a history of medication errors, which were increased by shift work and the COVID-19 pandemic. Necessary plans are recommended to reduce the fatigue and anxiety of nurses and prevent their burnout, particularly in critical situations. Efforts to identify risky areas, setting up reporting systems and error reduction strategies can help to develop preventive medicine. On the other hand, since the quality of people’s lives is considered the standard of countries’ superiority, by clarifying medical errors, a higher level of health, satisfaction and safety of patients will be provided.

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          Most cited references35

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          Impacts of shift work on sleep and circadian rhythms.

          Shift work comprises work schedules that extend beyond the typical "nine-to-five" workday, wherein schedules often comprise early work start, compressed work weeks with 12-hour shifts, and night work. According to recent American and European surveys, between 15 and 30% of adult workers are engaged in some type of shift work, with 19% of the European population reportedly working at least 2 hours between 22:00 and 05:00. The 2005 International Classification of Sleep Disorders estimates that a shift work sleep disorder can be found in 2-5% of workers. This disorder is characterized by excessive sleepiness and/or sleep disruption for at least one month in relation with the atypical work schedule. Individual tolerance to shift work remains a complex problem that is affected by the number of consecutive work hours and shifts, the rest periods, and the predictability of work schedules. Sleepiness usually occurs during night shifts and is maximal at the end of the night. Impaired vigilance and performance occur around times of increased sleepiness and can seriously compromise workers' health and safety. Indeed, workers suffering from a shift work sleep-wake disorder can fall asleep involuntarily at work or while driving back home after a night shift. Working on atypical shifts has important socioeconomic impacts as it leads to an increased risk of accidents, workers' impairment and danger to public safety, especially at night. The aim of the present review is to review the circadian and sleep-wake disturbances associated with shift work as well as their medical impacts.
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            Shift Work: Disrupted Circadian Rhythms and Sleep—Implications for Health and Well-being

            Purpose of review Our 24/7 society is dependent on shift work, despite mounting evidence for negative health outcomes from sleep displacement due to shift work. This paper reviews short- and long-term health consequences of sleep displacement and circadian misalignment due to shift work. Recent findings We focus on four broad health domains: metabolic health; risk of cancer; cardiovascular health; and mental health. Circadian misalignment affects these domains by inducing sleep deficiency, sympathovagal and hormonal imbalance, inflammation, impaired glucose metabolism, and dysregulated cell cycles. This leads to a range of medical conditions, including obesity, metabolic syndrome, type II diabetes, gastrointestinal dysfunction, compromised immune function, cardiovascular disease, excessive sleepiness, mood and social disorders, and increased cancer risk. Summary Interactions of biological disturbances with behavioral and societal factors shape the effects of shift work on health and well-being. Research is needed to better understand the underlying mechanisms and drive the development of countermeasures.
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              Medication Without Harm: WHO's Third Global Patient Safety Challenge.

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                Author and article information

                Contributors
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                21 September 2023
                2023
                21 September 2023
                : 10
                : 1200686
                Affiliations
                [1] 1Department of Medical Education, School of Medicine, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
                [2] 2Department of Community Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
                [3] 3Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
                Author notes

                Edited by: Tambone Vittoradolfo, Campus Bio-Medico University, Italy

                Reviewed by: Francesco De Micco, Campus Bio-Medico University, Italy; Leili Tapak, Hamadan University of Medical Sciences, Iran

                *Correspondence: Abdolreza Gilavand, gilavanda@ 123456gmail.com ; gilavand_a@ 123456ajums.ac.ir
                Article
                10.3389/fmed.2023.1200686
                10552141
                37809343
                7ea95d0d-841b-46eb-b8c2-b3f6076b2bfb
                Copyright © 2023 Gilavand, Jafarian and Zarea.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 05 April 2023
                : 07 September 2023
                Page count
                Figures: 0, Tables: 7, Equations: 0, References: 35, Pages: 6, Words: 4676
                Categories
                Medicine
                Original Research
                Custom metadata
                Regulatory Science

                medication errors,shift work,nursing,teaching hospitals,covid-19

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