Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital


Jill Gladstone Clinical Audit Department, Royal Devon and Exeter Hospital Barrack Road Exeter Devon EX2 5DW England


Drug administration is one of the highest risk areas of nursing practice and a matter of considerable concern for both managers and practitioners The aim of this study, earned out in a district general hospital, was to identify any common themes that underlie the occurrence and reporting of drug administration errors Data were collected from a variety of sources drug error reports, questionnaires to nurses and nurse managers, and interviews with nurses who had been involved in drug errors Several areas of particular concern emerged, including the nurses’ confusion regarding the definition of drug errors and the appropriate actions to take when they occurred, their fear of disciplinary action, their loss of clinical confidence, the variation in managerial response, and a possible lack of nurses’ mathematical skills The results from the study demonstrated that it was likely that many drug errors were not reported, for a variety of reasons It is recommended that all of these issues are addressed as a matter of urgency, for the sake of both patients and nurse practitioners