Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital

Authors

  • C. Haw MRCP MRCPsych,

    Professor of Mental Health and Consultant Psychiatrist
    1. University of Northampton School of Health, St Andrew's Academic Centre, King's College London Institute of Psychiatry
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  • J. Stubbs MPharmS MSc,

    Professor of Psychiatric Nursing and Research Manager
    1. University of Northampton School of Health, St Andrew's Academic Centre, King's College London Institute of Psychiatry
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  • G. L. Dickens RMN BSc (Hons) MA PhD

    Research Assistant, Corresponding author
    1. St Andrew's Healthcare, Northampton, UK
    • Correspondence:

      G. L. Dickens

      St Andrew's Academic Centre

      King's College London Institute of Psychiatry

      St Andrew's Healthcare

      Billing Road

      Northampton

      Northants NN1 5DG

      UK

      E-mail: gdickens@standrew.co.uk

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Abstract

Accessible summary

  • Medication administration errors and near misses are common including in mental health settings. Nurses should report all errors and near misses so that lessons can be learned and future mistakes avoided. We interviewed 50 nurses to find out if they would report an error that a colleague had made or if they would report a near-miss that they had.
  • Less than half of nurses said they would report an error made by a colleague or a near-miss involving themselves. Nurses commonly said they would not report the errors or near misses because there was a good excuse for the error/near miss, because they lacked knowledge about whether it was an error/near miss or how to report it, because they feared the consequences of reporting it, or because reporting it was too much work.
  • Mental health nurses mostly report similar reasons for not reporting errors and near misses as nurses working in general medical settings. We have not seen another study where nurses would not report an error or near miss because they thought there was a good excuse for it.
  • Training programmes and policies should address all the reasons that prevent reporting of errors and near misses.

Abstract

Medication errors are a common and preventable cause of patient harm. Guidance for nurses indicates that all errors and near misses should be immediately reported in order to facilitate the development of a learning culture. However, medication errors and near misses have been under-researched in mental health settings. This study explored the reasons given by psychiatric nurses for not reporting a medication error made by a colleague, and the perceived barriers to near-miss reporting. We presented 50 nurses with clinical vignettes about error and near-miss reporting and interviewed them about their likely actions and about their views and perceptions. Less than half of participants would report an error made by a colleague (48%) or a near-miss involving themselves (40%). Thematic analysis revealed common themes for both not reporting an error or a near-miss were knowledge, fear, burden of work, and excusing the error. The first three themes are similar to results obtained from research in general medical settings, but the fourth appears to be novel. Many mental health nurses are not yet fully convinced of the need to report all errors and near misses, and that improvements could be made by increasing knowledge while reducing fear, burden of work, and excusing of errors.

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