Project – A survey into factors responsible for medication administration errors

CHAPTER ONE

INTRODUCTION

• Background to the Study

Medication administration errors (MAEs) are a persistent problem in healthcare settings, often leading to significant patient harm, increased hospital stays, and higher healthcare costs. The World Health Organization (WHO) highlights that medication errors are among the leading causes of avoidable harm in healthcare worldwide (WHO, 2017). MAEs occur at the point of administering medication to patients and can involve errors such as incorrect dosage, wrong time, wrong route, or giving medication to the wrong patient. A literature review of recent studies reveals that MAEs are multifactorial in origin, with human, organizational, and systemic factors all contributing.

Human factors, particularly those related to healthcare providers, are among the most commonly cited causes of MAEs. These include fatigue, stress, poor communication, and inadequate knowledge or training. Nurses, who are often responsible for medication administration, may suffer from cognitive overload due to long shifts and high patient-to-nurse ratios. According to Keers et al. (2013), cognitive slips and lapses caused by mental fatigue significantly increase the likelihood of medication errors. Moreover, insufficient understanding of drug properties or patient-specific contraindications can lead to serious adverse outcomes.

Organizational issues, such as staffing shortages, lack of standardized procedures, and insufficient support systems, further exacerbate the risk of errors. Studies have shown that when hospitals operate with inadequate staffing, nurses are forced to multitask and rush medication rounds, increasing the chances of error (Kim et al., 2021). Poor interprofessional communication and lack of a safety culture within organizations also contribute to the prevalence of MAEs. Institutions with robust reporting systems and non-punitive approaches to error disclosure tend to have fewer incidents due to proactive mitigation strategies (Brady et al., 2009).

Technological factors, while designed to reduce errors, can paradoxically introduce new risks. Electronic prescribing and automated medication dispensing systems are valuable tools, but improper use or design flaws can lead to critical mistakes. For instance, a study by Westbrook et al. (2010) found that while electronic systems reduced some types of errors, they also introduced new errors related to incorrect data entry or misinterpretation of digital alerts. Alarm fatigue, where clinicians become desensitized to frequent alerts, can also lead to overlooked warnings and incorrect medication administration.

Environmental and process-related disruptions—such as frequent interruptions during medication rounds—are consistently linked to MAEs. Interruptions may lead healthcare workers to lose focus or skip verification steps. A study by Flynn et al. (2016) found that nurses who were interrupted during drug administration were significantly more likely to commit an error. Additionally, poorly designed workspaces and lack of dedicated medication preparation areas contribute to distractions and procedural lapses.

1.2  Statement of the Problem

Medication administration errors (MAEs) continue to pose a significant threat to patient safety in healthcare systems globally. Despite advances in clinical practice, training, and healthcare technology, errors during the administration phase remain alarmingly common. These errors can result in a range of consequences, from minor health complications to severe morbidity and even mortality. The frequency and severity of MAEs underline the urgent need to understand the underlying causes and contributing factors to develop effective prevention strategies.

One of the primary issues contributing to MAEs is the human factor, which encompasses healthcare providers’ knowledge, experience, cognitive capacity, and emotional state. Nurses, who are most often responsible for medication administration, work in high-stress environments that require multitasking and constant attention to detail. Fatigue, stress, and inadequate training may impair their decision-making and lead to mistakes in dosage, timing, or medication selection. The lack of continuous professional development and the growing complexity of medication regimens further exacerbate these risks.

In addition to individual factors, organizational and systemic shortcomings significantly influence the occurrence of medication errors. Inadequate staffing, heavy workloads, poor supervision, and ineffective communication among healthcare professionals create an environment where mistakes are more likely to occur. When healthcare institutions operate under pressure without sufficient support structures, the quality of care diminishes, and patient safety becomes compromised. These systemic flaws indicate that addressing MAEs requires more than focusing solely on frontline workers.

Technology, while often implemented as a safeguard, has introduced its own set of challenges. Electronic health records, automated dispensing systems, and bar-code medication administration tools are designed to enhance accuracy and accountability. However, if these systems are poorly integrated, misused, or not accompanied by proper training, they may lead to new types of errors. Over-reliance on automated systems can also result in reduced vigilance and critical thinking among staff, which paradoxically undermines the intended safety benefits.

Environmental and workflow-related factors, such as frequent interruptions during medication rounds, unstandardized procedures, and poorly designed workspaces, also play a crucial role in causing MAEs. Distractions, noise, and inadequate access to medication references or patient information can disrupt nurses’ concentration and lead to avoidable mistakes. Furthermore, the lack of a blame-free reporting culture often discourages staff from disclosing errors, preventing institutions from identifying recurring patterns and implementing corrective actions.

In summary, the persistent problem of medication administration errors is multifaceted, involving human, organizational, technological, and environmental dimensions. Without a comprehensive and systemic approach to identifying and addressing these factors, MAEs will continue to jeopardize patient outcomes and erode trust in healthcare services. This study seeks to survey the root causes of medication administration errors with the aim of informing evidence-based interventions that enhance medication safety and promote a culture of continuous quality improvement.

1.3  Aim and Objectives of the Study

The aim of the study is to examine a survey into factors responsible for medication administration errors. The specific of objectives are:

1. Identify the common types of medication administration errors that occur in healthcare settings.
2. Determine the root causes of medication administration errors, including factors such as human error, system failures, and communication breakdowns.
3. Assess the impact of medication administration errors on patient safety and healthcare outcomes.
4. Explore the role of healthcare professionals, including nurses, pharmacists, and physicians, in preventing medication administration errors.

1.4  Research Questions

The research questions are buttressed below:

1. What are the common types of medication administration errors that occur in healthcare settings?
2. What are the root causes of medication administration errors, including factors such as human error, system failures, and communication breakdowns?
3. How do medication administration errors impact patient safety and healthcare outcomes?
4. What is the role of healthcare professionals, including nurses, pharmacists, and physicians, in preventing medication administration errors?

1.5  Research Hypothesis

The hypothetical statement of the study is buttressed below:

Ho: Medication administration errors will not affect patient safety and healthcare outcomes.

H1: Medication administration errors will affect patient safety and healthcare outcomes.

1.6  Significance of the Study

Understanding the factors responsible for medication administration errors (MAEs) is critically important for improving patient safety and enhancing the quality of healthcare delivery. This study holds significant value as it seeks to identify the root causes of these errors from multiple dimensions—human, organizational, technological, and environmental. By exploring these contributing factors in-depth, the study provides essential insights that can inform interventions aimed at reducing the prevalence of MAEs and minimizing the harm they cause.

One of the primary beneficiaries of this study will be healthcare practitioners, particularly nurses and other frontline staff involved in medication administration. By highlighting the specific errors and conditions under which they occur, the findings can inform targeted training programs, skill enhancement initiatives, and changes in workflow processes. Improved awareness of the factors leading to MAEs will empower healthcare workers to adopt safer practices and better manage high-pressure situations that often contribute to mistakes.

Healthcare administrators and policymakers also stand to benefit significantly from this research. With a clearer understanding of the organizational and systemic issues that lead to medication errors—such as inadequate staffing, poor communication systems, and ineffective use of technology—hospital leaders and decision-makers can implement more strategic policies. These may include restructuring medication delivery systems, improving reporting and feedback mechanisms, and fostering a culture of safety within healthcare institutions.

Furthermore, this study is significant for the advancement of healthcare technologies. By identifying the unintended consequences of systems like electronic health records (EHRs), automated dispensing units, and bar-code scanning tools, the study can contribute to the redesign and optimization of these systems. Technology developers and healthcare IT professionals can use these insights to make systems more user-friendly, reliable, and compatible with clinical workflows, reducing the likelihood of error.

On a broader level, the research contributes to the body of academic knowledge surrounding patient safety and medication management. It supports ongoing scholarly efforts to understand the complexity of MAEs and provides empirical data that can be used in future research. This may include comparative studies, development of new safety protocols, or evaluation of intervention strategies across different healthcare settings and populations.

In conclusion, this study is highly significant for its potential to drive systemic change in the prevention of medication administration errors. By addressing the issue from a holistic perspective, it not only supports the improvement of clinical practices and policies but also promotes a culture of safety, accountability, and continuous learning in healthcare. Ultimately, the study aims to contribute to better patient outcomes, reduced healthcare costs, and increased trust in the healthcare system.

1.7  Scope of the Study

The study examines a survey into factors responsible for medication administration errors. A case study of Benue state University Teaching Hospital Makurdi. The study is limited to Benue state University Teaching Hospital Makurdi.

1.8  Operational Definition of Terms

Factors: Factors are elements, conditions, or circumstances that contribute to a particular result or outcome. In the context of medication administration errors, factors refer to the various causes or influences—such as human behavior, organizational structure, or environmental conditions—that increase the likelihood of an error occurring.

Responsible: Responsible refers to being the cause or source of something, or being accountable for an outcome. When discussing errors, it implies the person, process, or condition that directly or indirectly leads to a particular event, such as a medication error.

Medication: Medication is any substance used to diagnose, treat, cure, or prevent disease or medical conditions in humans. It includes prescription drugs, over-the-counter medicines, and other pharmaceutical products administered to patients.

Administration: Administration, in a healthcare context, refers to the process of giving a medication to a patient. This includes selecting the correct medication, determining the appropriate dosage, timing, and route (e.g., oral, intravenous), and ensuring it reaches the right patient as prescribed.

Errors: Errors are unintentional mistakes or failures in carrying out a planned action as intended or using the wrong plan to achieve an aim. In medication administration, errors may involve giving the wrong drug, incorrect dose, wrong patient, or incorrect timing or route.

Medication Administration Errors (MAEs) (combined concept): Medication Administration Errors are mistakes that occur during the process of delivering a prescribed medication to a patient. These errors can include giving the wrong drug, incorrect dosage, administering it at the wrong time, by the wrong route, or to the wrong patient. MAEs are a major concern in clinical practice due to their potential to cause harm.

Project – A survey into factors responsible for medication administration errors