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      Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia

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          Abstract

          Background

          Unsafe medication practices are the leading causes of avoidable patient harm in healthcare systems across the world. The largest proportion of which occurs during medication administration. Nurses play a significant role in the occurrence as well as preventions of medication administration errors. However, only a few relevant studies explored the problem in Ethiopia. Therefore, this study aimed to assess the magnitude and contributing factors of medication administration error among nurses in tertiary care hospitals, Addis Ababa, Ethiopia, 2018.

          Methods

          We conducted a hospital-based, cross-sectional study in Addis Ababa, Ethiopia. The study involved 298 randomly selected nurses. We used adopted, self-administered survey questionnaire and checklist to collect data via self-reporting and direct observation of nurses while administering medications. The tools were expert reviewed and tested on 5% of the study participants. We analyzed the data descriptively and analytically using SPSS version 24. We included those factors with significant p-values ( p ≤ 0.25) in the multivariate logistic regression model. We considered those factors, in the final multivariate model, with p < 0.05 at 95%Cl as significant predictors of medication administration errors as defined by nurse self-report.

          Result

          Two hundred and ninety eight (98.3%) nurses completed the survey questionnaire. Of these, 203 (68.1%) reported committing medication administration errors in the previous 12 months. Factors such as the lack of adequate training [AOR = 3.16; 95% CI (1.67,6)], unavailability of a guideline for medication administration [AOR = 2.07; 95% CI (1.06,4.06)], inadequate work experience [AOR = 6.48; 95% CI (1.32,31.78)], interruption during medication administration [AOR = 2.42, 95% CI (1.3,4.49)] and night duty shift [AOR = 5, 95% CI (1.82, 13.78)] were significant predictors of medication administration errors at p-value < 0.05.

          Conclusion and recommendation

          Medication administration error prevention is complex but critical to ensure the safety of patients. Based on our study, providing a continuous training on safe administration of medications, making a medication administration guideline available for nurses to apply, creating an enabling environment for nurses to safely administer medications, and retaining more experienced nurses may be critical steps to improve the quality and safety of medication administration.

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          Most cited references21

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          Medication errors in the Middle East countries: A systematic review of the literature

          Background Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. Results Forty-five studies from 10 of the 15 Middle Eastern countries met the inclusion criteria. Nine (20 %) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1 % to 90.5 % for prescribing and from 9.4 % to 80 % for administration. The most common types of prescribing errors reported were incorrect dose (with an incidence rate from 0.15 % to 34.8 % of prescriptions), wrong frequency and wrong strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs). Most studies did not assess the clinical severity of the medication errors. Conclusion Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed.
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            Medication administration error: magnitude and associated factors among nurses in Ethiopia

            Background The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay. It also increases costs for clinicians and healthcare systems. Due to this, assessing the magnitude and associated factors of medication administration error has a significant contribution for improving the quality of patient care. The aim of this study was to assess the magnitude and associated factors of medication administration errors among nurses at the Felege Hiwot Referral Hospital inpatient department. Methods A prospective, observation-based, cross-sectional study was conducted from March 24–April 7, 2014 at the Felege Hiwot Referral Hospital inpatient department. A total of 82 nurses were interviewed using a pre-tested structured questionnaire, and observed while administering 360 medications by using a checklist supplemented with a review of medication charts. Data were analyzed by using SPSS version 20 software package and logistic regression was done to identify possible factors associated with medication administration error. Result The incidence of medication administration error was 199 (56.4 %). The majority (87.5 %) of the medications have documentation error, followed by technique error 263 (73.1 %) and time error 193 (53.6 %). Variables which were significantly associated with medication administration error include nurses between the ages of 18–25 years [Adjusted Odds Ratio (AOR) = 2.9, 95 % CI (1.65,6.38)], 26–30 years [AOR = 2.3, 95 % CI (1.55, 7.26)] and 31–40 years [AOR = 2.1, 95 % CI (1.07, 4.12)], work experience of less than or equal to 10 years [AOR = 1.7, 95 % CI (1.33, 4.99)], nurse to patient ratio of 7–10 [AOR = 1.6, 95 % CI (1.44, 3.19)] and greater than 10 [AOR = 1.5, 95 % CI (1.38, 3.89)], interruption of the respondent at the time of medication administration [AOR = 1.5, 95 % CI (1.14, 3.21)], night shift of medication administration [AOR = 3.1, 95 % CI (1.38, 9.66)] and age of the patients with less than 18 years [AOR = 2.3, 95 % CI (1.17, 4.62)]. Conclusion In general, medication errors at the administration phase were highly prevalent in Felege Hiwot Referral Hospital. Documentation error is the most dominant type of error observed during the study. Increasing nurses’ staffing levels, minimizing distraction and interruptions during medication administration by using no interruptions zones and “No-Talk” signage are recommended to overcome medication administration errors. Retaining experienced nurses from leaving to train and supervise inexperienced nurses with the focus on medication safety, in addition providing convenient sleep hours for nurses would be helpful in ensuring that medication errors don’t occur as frequently as observed in this study. Electronic supplementary material The online version of this article (doi:10.1186/s12912-015-0099-1) contains supplementary material, which is available to authorized users.
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              Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review

              Background Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. Objective The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. Methods We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Results Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5–20.1%), while adverse drug events causing admission were reported in 2.8% (0.7–6.4%) of patients but it was reported that a median of 43.5% (20.0–47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0–0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8–72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5–50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload. Conclusion Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors. Electronic supplementary material The online version of this article (10.1007/s40801-017-0125-6) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                wondmienehadam@gmail.com
                wudma.alemu@yahoo.com
                niguse99@gmail.com
                asmamawdemis@gmail.com
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                13 January 2020
                13 January 2020
                2020
                : 19
                : 4
                Affiliations
                [1 ]Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
                [2 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, School of Nursing and Midwifery, College of Health Sciences, , Addis Ababa University, ; Addis Ababa, Ethiopia
                Author information
                http://orcid.org/0000-0002-3986-8072
                Article
                397
                10.1186/s12912-020-0397-0
                6958590
                31956293
                8c0577eb-5dac-4764-a07f-6b69cd0aef01
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 January 2019
                : 8 January 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100007941, Addis Ababa University;
                Award ID: AAU/R/354/2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Nursing
                medication administration errors,factors,nurses
                Nursing
                medication administration errors, factors, nurses

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