A study on nurses’ perception on the medication error at one of the hospitals in East Malaysia 477
Clin Ter 2009; 160 (6):477-479
Original article
A study on nurses’ perception on the medication error at one
of the hospitals in East Malaysia
H. Hassan1, S. Das2, H. Se1, K. Damica3, S. Letchimi1, S. Mat1, R. Packiavathy1, S.Z.S. Zulkifli4
Department of 1Nursing, 2Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre; 3Ministry of Health, Ma-
laysia; 4Universiti Kebangsaan Malaysia Molecular Biology Institute (UMBI)
Abstract ‘right patient, right drugs, right dose, right route and right
time (1).
Background and Aims. Medication error is defined as any preven-
Error is defined as the use of the wrong plan to achieve
table event that might cause or lead to an inappropriate use or harming
an aim. Such event may be related to the long destination
of the patient. Such events could be due to compounding, dispensing,
of the processing of the drugs before it finally gets to the
distribution, administration and monitoring. The aim of the present
user. The National Coordinating Council for Medication
study was to determine the nurses’ perception on medication error
Error Reporting and Prevention in 2000, had listed types of
that were related directly or indirectly to the process of administration
medication error such as, incomplete patient information,
of drugs.
unavailable drug information, miscommunication of drug
Materials and Methods. This was a descriptive cross sectional
orders, inappropriate labeling and environmental factors (2).
study conducted on 92 staff nurses working in the selected wards
Hence, it is not impossible if medication error occurs along
in one of the hospitals in East Malaysia. Data was obtained through
the way because as people have administered medication
structured questionnaires.
with the constraints of time and resources.
Results. Analysis of data was done through SPSS program for
Medication error has been defined as any preventable
descriptive inferential statistics. Out of a total of 92 subjects, sixty-eight
event that might cause or lead to an inappropriate use or
(73.9%) indicated medication error occurred because the nurses were
harming the patient while the medication is in the control
tired and exhausted. Seventy nine subjects (85.9%) believed that any
of the health care professionals, patients or the consumers
medication error should be reported to the doctors; another 74 (80.2%)
(3). Such events could be related to the professional practi-
knew that their colleagues committed medication error and 52 (56.5%)
ces, health care products, the procedure itself or the system
did not report the case. Forty eight (52.17%) subjects committed me-
of prescribing, communicating, labeling, packaging or the
dication error at least once throughout their life. Of the 48 committed
nomenclature process such as compounding, dispensing,
medication, 45 (93.75%) nurses believed that the error committed was
distribution, administration and monitoring.
not serious; while 39 (81.25%) believed the error occurred during the
A past review report from the year 1993-1998 showed
1st 5 years of their working experience.
5366 medication errors (4). The same report depicted that
Conclusions. The findings showed that the incidence of medica-
68.2% resulted in serious patient outcomes and 9.8% were
tion error was due to the defect in the organizational system itself and
fatal (4). Another recent study showed that from July 1,
not solely due to the mistakes on the part of any individual. Clin Ter
2000, to June 30, 2005, 919,241 medication errors occur-
2009; 160(6):477-479
red (5). Such alarming figures underline the importance of
Key words: drugs, errors, hospitals, medication, nurses, percep-
medication errors.
tion The question is that if medication error had always
existed, why is it so difficult to identify and have errors
decreased in frequency or severity? As we could predict,
most of medication errors were silently buried and hidden
Introduction from the view and review. Nurses are the last group directly
involved with drug administration destination process and
Medication is defined as a licensed drug taken to cure they too without exception, would commit medication error.
or reduce symptoms of an illness or medical condition. To Therefore this study was performed on the nursing aspect,
ensure safe medication use, one should be aware of the basic to identify the prevalence of medication error and nurses
principle of 5r’s, i.e., ‘five rights’ of drugs administration- perception towards medication error.
Correspondence: Dr. Hamidah Hassan. Department of Nursing, Faculty of Medicine. Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras,
Luala Lumpur, Malaysia. Tel: 006-03-91456250. E-mail: [email protected]
478 F. Hassan et al.
Materials and Methods Table 1. Table showing summary of major findings from answers to
the six parts ot the instrument.
This was a descriptive cross sectional study, performed at Respondents Medication error
one of the hospitals in East Malaysia. It involved five multi-
48 (52.17%) out of 92 Committed at least once through-out
disciplinary wards such as male and female surgical wards, their working life.
female orthopedic, pediatric surgical and orthopedic and 48 (52.17%) out of 92 Believed it happened mainly during
first class general wards. Questionnaires were adopted from the night shift.
Mayo and Modified Gladstone (6). Prior ethical permission 23 (47.91%) out of 48 Did not report the incidence though
was taken for performing the study. As professional secrecy they had committed the error.
we chose not to disclose the name of the outside visiting 33 (68.75%) out of 48 Believed it happened in medical and
hospital which was considered for the study but we obtained surgical wards
all necessary ethical clearance to conduct such a study. 39 (81.25%) out of 48 Believed that it occurred during the
The instrument consisted of six parts, which focused on 1ST five years of their experience as
the six aspects of medication error: a staff nurse
Part A - Possible causes
Part B - Estimation of reported cases
Part C - Nurses’ perception Table 2. Table showing nurses’ perception on the causes of
Part D - Nurses’ view and practice on reporting medication error.
Part E - Nurses’ perception about self reporting
No N= (92) Ten Causes of Medication Error
Part F - Nurses’ working experience (open ended que-
1. 68 (73.91%) Nurses were too tired and exhausted
stions)
Part G - Questions regarding the demographic data of 2. 66 (71.7% ) Nurses were distracted by others whi-
le dispensing medication
respondents.
One hundred and fourteen sets of structured questionnai- 3. 61 (71.7%) Doctors writing difficult to read
res were given to 114 staff nurses from the selected wards. 4. 54 (58.7%) Doctors prescribed wrong drugs
Ninety two (80%) responded after one month in complete 5. 53 (57.6%) Nurses failed to check patients’ name
with drug charts
sets. Statistical Package for Social Science (SPSS) Version
6. 53 (57.6%) Nurses confused between two drugs
12.0 was used to analyze the data for descriptive and stati-
with similar names
stical inferentest and Chi Square 1 was used for the detailed
7. 46 (50.0%) Nurses miscalculated the dose
analysis.
8. 24 (26.1%) Nurses confused by the different
types of infusion devices
9. 19 (20.7%) Nurses set or adjusted infusion devi-
Results ces inaccurately
10. 18 (19.6%) Medication label/ packages were
Out of a total of ninety two subjects, sixty-eight (73.9%) damaged.
indicated medication error occurred because the nurses were
tired and exhausted. A total of 74 (80.2%) estimated that only
25% cases were reported. Seventy nine subjects (85.9%)
believed that any medication error should be reported to Table 3. Table showing the reasons why nurses failed to report
medication error.
the doctors; another 74 (80.2%) knew that their colleagues
committed medication error and 52 (56.5%) did not report N= (52) Reasons
the case. Forty eight (52.17%) subjects committed medica-
tion error at least once throughout their life. 45 (94.2%) Error was not serious enough to be reported
Of the 48 that committed medication, 45 (93.75%) 47 (90.2%) Fear of being subjected to disciplinary action
nurses believed that the error committed was not serious; 39 46 (88.5%) Reaction and pressure from nurse managers
(81.25%) believed the error occurred during the 1st 5 years of 40 (76.9 %) Reaction and pressure from peers
their working experience. The major findings were depicted 34 (65.4%) Fear of losing job
in Tables 1, 2 and 3.
Discussion increased bedside nursing, time to administer the drugs
would also be hampered. Nurses by nature, are conscientious
Perhaps there could be endless debate and discussion on and would not skip serving medication, but the real issue
the reasons for errors but we are sure that few dozens could is how do they go about serving the medication given that,
be easily recognized. As stated in this study, 68 (73.91%) time is limited? All of these factors could contribute to the
out of 92 respondents claimed that the error was committed medication errors.
because the nurses were exhausted and overworked, which There are ways to reduce the contributing factors. An
usually happened when the number of patients increased. earlier study described that long hours of work increased the
Such a situation would demand more time for patient care, likelihood of medical error three fold when nurses worked on
especially the demand for bedside nursing and more medi- shifts lasting 12.5 hours or more (7). All the factors seemed
cation to be processed. With limited number of nurses and to be related to shortage of staff or nurse patient–ratio. We
A study on nurses’ perception on the medication error at one of the hospitals in East Malaysia 479
opine that the administration may take proper steps to look safety standards. The alarming figures of 10-18% hospital
into these problems or make minimum efforts to improve injuries occurring as a result of medication errors under-
the system of working for nurses since the error is said to lines the urgent need of the hour to eliminate medication
be related to nurses’ overload. errors (14, 15). The present study was a humble attempt to
Another problem to be addressed on medication error highlight the causes for the medication errors and discuss
is the reporting of incident. Seventy (80.2%) out of 92 its implications.
respondents said that, only 25% cases were reported. If
medication error had always existed, why is it so difficult
to take action to reduce the error? Could the errors decrease References
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