A Systematic Review of Knowledge, Attitude, Practice and the Associated Factors of Medication Error among Registered Nurses

Abstract

Medication errors happen all over the world and can cause people real harm. To solve this problem, it is important to know what healthcare workers know, how they feel about medication errors, and what they do about them. The goal of this systematic review of the literature is to find and summarize the current data about the KAP of healthcare workers toward medication errors and related factors. Electronic sources like PubMed, Scopus, and Web of Science were thoroughly searched for applicable studies released between January 2013 and December 2023. There were a total of 31 studies looked at in this study. The results showed that healthcare workers have a middling amount of knowledge about medication errors, but this varies from country to country and specialty to specialty. Most people did not like the idea of medication errors, and the biggest reason they didn't tell them was fear of being sued. Doctors and nurses not following safety rules and not communicating to each other well enough often cause medication errors. Too much work, stress, and not enough training also is affected by medication safety habits. The results of this study show that to reduce the number of medication errors there needs to be more education, better communication and teamwork among healthcare workers, and the creation of processes that put medication safety first.

Keywords

Systematic review; Nurses; Safety; Medication; Healthcare

Introduction

Patients' safety and the quality of treatment are both compromised by the prevalence of medication error. Medication errors are "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer," [1]. Prescription, distribution, administration, and tracking are all potential entry points for medication errors. A bad drug response, incarceration, or even mortality can result from medication errors [2]. Medication errors are relatively common, with some studies estimating that 10% of prescriptions in the industrialized world contain errors [3].

Medication errors can and should be avoided with the help of healthcare experts. Drug safety and patient results may be affected by healthcare providers' familiarity with and response to, the problem of medication errors. In order to better understand medication errors and the variables that contribute to them, numerous studies have analyzed the knowledge, beliefs, and behaviors of healthcare workers [4]. However, these investigations have yielded contradictory and unreliable results. The purpose of this systematic review was to assess healthcare providers' understanding, perspective, and response to medication errors and their contributing variables.

Materials and Methods

A comprehensive search was conducted using MEDLINE, Embase, and Cochrane databases from 2013 to 2023 as indicated by Table 1. The search terms included medication error, healthcare professionals, KAP, knowledge, attitude, and practice. The inclusion criteria were studies that investigated the KAP of healthcare professionals regarding medication errors and the associated factors. The exclusion criteria were studies that did not focus on medication errors or did not report KAP. Figure 1 shows the Prisma chart of the searches made.

Table 1. Table of searches using keyword.

Figure 1. Plasma chart: Knowledge, attitude and practice.

Selection criteria

Studies reporting the prevalence of medication errors, associated factors, and healthcare professionals' knowledge, attitude, and practice toward medication errors were included. The exclusion criteria were studies reporting medication errors in non-healthcare settings, and studies not reporting healthcare professionals' knowledge, attitude, or practice toward medication errors.

Results

218 studies were used for the study and 31 studies met the standards for inclusion, so they were all part of the systematic review. These studies were done in hospitals, clinics, and long-term care centers in many different countries and settings. The number of healthcare workers in the studies that were included went from 68 to 3,154. Most of the studies looked at what nurses and doctors knew, how they felt, and how they did their jobs. However, a few studies also looked at pharmacists and medical students. Table 2 shows summaries of the findings of the 31 studies.

Table 2. Summaries of the 31 studies included.

A total of 31 studies were included in this systematic review. The studies included a range of healthcare professionals, including physicians, nurses, pharmacists, and other allied health professionals.

Discussion

The current systematic literature review aimed to explore the knowledge, attitude, and practice of healthcare professionals towards medication errors and the associated factors. A total of 31 studies were included in the review, which analyzed data from healthcare professionals, including nurses, physicians, and pharmacists.

Knowledge

Out of 31 papers presented 22 researcher’s findings showed that nurses have a poor amount of knowledge about medication errors [17], but this varies from country to country and specialty to specialty and process of medication delivering [24,27,28]. For instance, a study done by Zahary et al. found that nurses knew more about medication errors than doctors did [5]. In the same way, a study done by Yee Wei et al. showed that pharmacists and nurses had sound knowledge regarding medication administration compare to other health care workers [15]. Meanwhile, Bravo et al., Cheraghi et al., Bucknall et al., and Parthasarathi et al., identified the most common form of medication error among nurses were wrong dose) [6,9,14,35]. Thus, Mahesh et al., Tsegaye et al., and Ehsani et al., identified that the nurses were confused with medications names such as (LASA) drugs because they look alike and sound alike [8,23,33]. In Abdel-Latif, Mulac et al., Zeeratchi et al., and Johari et al., had a contradicting idea that most error occur in the administration stage [12,13,16,26]. However on the other hand, Mulac et al and Parthasarathi et al., commented on the finding that medication error occurs during antibiotics transcription) [14,16]. Meanwhile, Pournamdar and Zare et al., argues that medication error among the nurses occurs due to poor computational skills [19].

Attitude

Out of 31 papers reviewed n=24 papers shows the nurses had poor attitude towards medication error reporting [11,26,36]. Main reason for this condition is due to lack of communication skills [8,29,31]. This include failure to reconfirm with doctor’s order [9]. According to Zeeratchi et al., one major negative attitude seen among the nurses is they tend to administer the drug twice [12]. However, Johari et al., claim that workload is contributing factor towards the negative attitude [13] Some other reasons for the attitude include physician illegible handwriting in patients file, unconducive working environment and interruptions during medication administration [19].

The most prevalent reason given for not disclosing medication errors was concern and fear over potential legal repercussions [18]. Those working in the healthcare industry also voiced concerns about legal liability, censure action, and harm to professional standing [36-38]. Some people may not disclose medication errors because they do not believe the reporting system or because they do not think it is essential if the patient is not hurt. Healthcare workers have an unfavorable outlook on drug mishaps, but they also want a culture of safety that promotes sharing and learning from mistakes. Alsulami et al., found that medical workers recognized medication errors as a reality of healthcare but viewed them as teachable moments rather than causes for reprimand. Hence, more open and clear contact between various healthcare practitioners was also mentioned, as was the need for improved instruction for healthcare workers on drug safety and medication error reporting. There was also a distinction on how community felt about medication errors based on the severity of the damage that could have resulted from each category of error [37] according to research by Seys et al. [39].

Practice

The practice of medication errors are commonly the result of healthcare providers failing to follow established protocols and failing to effectively communicate with one another. Out of 31 paper reviewed, 24 paper paper suggest that the nurses lack of practices [12,13,16]. Thus, non-compliance to medication safety practices was due to improper medication technique [27] and communication [18,25,31], together with no proper guidelines [21,26,29]. The study by Tsegaye et al. [8]. In a study conducted by Cheraghi et al., quotes that lack of training lead to poor practice [6].

Factors associated with KAP of medication error among nurses

There are several factors that were associated with KAP on medication error among the nurses. The study identified staff factors such as lack of pharmacological knowledge, unfamiliarity with the abbreviated names tend to be the factor associated with medication [5,13,15,23]. Medication errors were found to be more common among healthcare workers working in high-stress settings like critical care units due to factors like unpleasant working environment, increase workload, poor staffing [6,8,16,22,25]. As a result of under staffing, healthcare providers may be asked to perform duties outside their area of specialization or may not have enough time to dedicate to medication safety practices, both of which can increase the likelihood of prescription mistakes occurring. Finally, a major contributor to medication errors was found to be insufficient instruction on medication safety. It was discovered that healthcare workers who said they had received little to no instruction on drug safety were more likely to make mistakes [40]. This emphasizes the need for healthcare groups to focus and engage in training programs, as well as the significance of continuous training and instruction on drug safety practices. Several studies have examined how administrative and environmental factors affects nurses' ability to follow safe prescription procedures. The study carried out by Pournamdar and Zare et al., O’Hara et al., and Joolaee et al., identified that factors of medication error is due to poor nurse to patient ratio, poor supervision, noisy and crowded environment, technical failures, inappropriate planning, poor facilities [19,20,22].

Conclusion

The current review shows how healthcare workers have different levels of understanding, attitude, and practice when it comes to medication errors and related factors. To make patients safer, health care workers should learn how to define and categorize drug errors, as well as what happens to patients when these mistakes happen. In addition, health care workers should be directed appropriately to report medication errors without worrying about jeopardizing their career, and safety methods should be practice as often as possible. More study is needed to find out what healthcare workers know, how they feel, and what they do about Medication errors in different healthcare situations.

Limitations

Firstly, most of the studies included in this analysis were cross-sectional in design, which limits the ability to establish causality between the factors and knowledge, attitude, and practice levels. Secondly, the studies included in this review were conducted in different countries, which may affect the generalizability of the findings. Thirdly, most of the studies included in this literature used self-report measures to assess knowledge, attitude, and practice levels, which may be subject to bias. Fourthly, the studies included in this analysis varied in the tools and criteria used to assess medication errors, which may affect the comparability of the findings. Lastly, the heterogeneity of the included studies was high, which may affect the validity of the results.

Practical implications

The results of this comprehensive literature analysis have numerous practical consequences. Educating healthcare workers on the description and categorization of Medication errors, as well as the application of safety strategies to avoid errors, should be a top priority for the hospital concerned with patient safety. Medication errors should be reported and healthcare providers should have access to a secure reporting system that will safeguard their privacy and prevent them from facing repercussions for doing so.

Healthcare groups should implement prescription delivery procedures and standards, and healthcare workers should be encouraged to double-check medicines on a regular basis to decrease prescription mistakes. Safe drug delivery and the avoidance of errors depend on the effective dialogue and collaboration of healthcare workers.

Healthcare facilities should routinely evaluate and analyze medication error rates in order to spot problem areas and develop corrective measures. Healthcare organizations can enhance patient results and foster a culture of safety by making safety a top priority and employing methods supported by evidence to reduce medication errors.

Future research implications

The understanding, mindset, and practice of healthcare workers in various contexts, such as general care, long-term care, and community settings, regarding Medication errors should be investigated in future studies. To further facilitate the similarity of study results, studies should work to create and verify uniform criteria and classes of Medication errors

Furthermore, initiatives targeted at enhancing healthcare workers' understanding, perspective, and behavior with regard to Medication errors should be studied to determine their efficacy. Education and training, the introduction of safety strategies, and the application of technology are all examples of potential initiatives that could help cut down on medication errors.

Finally, research should investigate how medication errors affect patients' results and quality of life from the patients' points of view. Healthcare groups can enhance patient-centered care and patient safety by engaging patients in the creation of strategies to avoid medication errors.

Ethics Approval and Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Availability of Data and Materials

Data are derived from previous studies.

Competing Interests

The Authors declare no competing interests.

Funding

Self Sponsored.

Authos Contributions

Author A: Priscila Anesha Visvalingam researched and prepared the manuscripts.

Author B: Shidqiyyah Binti Abdul Hamid has read the systematic review and suggested some corrections to be carried out.

Author C: Muzaitul Akma Binti Mustapha Kamal Basha has approved the systematic review upon reading.

Acknowledgements

The Authors would like to thank International University of Malaysia (IIUM) for the support for this study.