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Africa Journal of Nursing and Midwifery https://doi.org/10.25159/2520-5293/6957
https://upjournals.co.za/index.php/AJNM/index ISSN 2520-5293 (Online) Volume 22 | Number 2 | 2020 | #6957 | 18 pages © Unisa Press 2020
Perceived Occurrence of Medication Administration Errors among Nursing Students at a Higher Education Institution in Western Cape, South Africa
Yousef A. Abusaksaka Hilda Vember
https://orcid.org/0000-0002-8242-8953 https://orcid.org/0000-0002-8006-6266
Cape Peninsula University of Technology, Cape Peninsula University of Technology,
South Africa South Africa
216152232@mycput.ac.za vemberH@cput.ac.za
Regis R. Marie Modeste
https://orcid.org/0000-0003-0329-3526
Cape Peninsula University of Technology,
South Africa
MARIEMODESTER@cput.ac.za
Abstract
The aim of the study was to determine awareness and perception of trends in the
occurrence of medication administration errors (MAEs) among nursing
students. A descriptive quantitative design was employed on two consecutive
days and a self-administrative questionnaire was used to collect data. The
validity and reliability of this instrument were tested and established by a pilot
study. Responses were collected from 291 nursing students at a higher education
institution (HEI) in Western Cape, South Africa. Non-probability proportional
quota sampling was used and the data was analysed with IBM SPSS® software.
The data was presented in graphs, percentages, means and standard deviation,
while inferential statistics was applied. The findings of the study revealed that
85.2% of the respondents were aware of MAE occurrence. There was no
significant difference between the respondents’ awareness of MAE occurrence
and their year of the study. The significant (p-value < 0.05) subscale for the
causes of MAE occurrence was the physician communication subscale (p-value
< 0.001). Moreover, the respondents perceived the top item to be using
abbreviations instead of writing out the prescription orders completely (p-value
< 0.001, mean = 4.85). The respondents disagreed that the pharmacy related
subscale and its items were causes of MAE occurrence. In conclusion, the
nursing students who participated in the study were aware of MAE occurrence
Abusaksaka, Vember and Marie Modeste
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during their practice time. The causes of these errors as indicated by the
respondents are mentioned in the article. Therefore, the healthcare institutions
as well as HEIs must focus on treating these causes in order to reduce MAE
occurrence and enhance patient safety.
Keywords: medication errors; medication administration errors; nursing students
Introduction and Background
According to the World Health Organization (WHO 2011), the risk of being harmed
during the rendering of healthcare is much greater than the risk of being harmed by air
travel or nuclear plants, which are sources usually perceived as being considerably
dangerous (Iliffe n.d.). Errors that occur during the delivering of healthcare lead to about
7 000 deaths annually in the United States (US) (WHO 2011, 243), while in the United
Kingdom these errors are the main cause of 712 deaths every year and are indicated as
a contributory factor in 1 700 to 22 300 deaths per year (Elliott et al. 2018, 4). The
number of deaths is an average based on the incidence of medication errors (MEs)
worldwide, but there are no clear statistics from the developed countries (Haw, Stubbs
and Dickens 2014, 798; WHO 2011, 243). However, it is important to stress that there
are differences between the developed and developing countries (Iliffe n.d.).
The medication administration process consists of five steps, namely: (1)
prescribing/ordering the medication; (2) transcribing and verifying the order; (3)
preparing the medication and delivering it; (4) administering the medication by the
healthcare workers; and (5) monitoring and documenting the medication. Medication
errors may occur at any time during one or more of these steps (Gordon 2014, 18) and
MEs are classified according to prescription, transcription, dispensing, and
administration errors (Radley et al. 2013, 471). An error at the administration phase is
very critical because it is directly harmful to the patient and the possibility to correct it,
is limited. Understanding how and why medication administration errors (MAEs) occur,
represents the key to the intervention that minimises MAEs (Keers et al. 2013a, 1046).
Wakefield, Uden-Holman and Wakefield (2005, 475–489) classify the causes of MAEs
into four main groups, namely, MAEs caused by factors related to pharmacies,
manufacturers, physicians, and nurses. Wakefield, Uden-Holman and Wakefield (2005,
475–489) developed a questionnaire based on the four main groups to investigate
nurses’ perceptions regarding MAEs. This questionnaire served as a baseline for further
research regarding the causes of MAEs.
Nurses are responsible for administering medications to various in- and outpatients
daily. Hence, the chance of committing errors during this process is probable (Jones and
Treiber 2010, 240). So, the prevention of MAEs and ensuring patient safety are
Abusaksaka, Vember and Marie Modeste
3
important roles of the nurse, as they are part of the medication administration process
(Weant, Bailey and Baker 2014, 47).
Pryce-Miller and Emanuel (2010, 8) argue that nursing education institutions (NEIs)
should create a learning environment where experienced lecturers and professional
registered nurses conduct workshops for undergraduate nurses on the occurrence of
MAEs. Nursing students’ awareness of MAEs and patient safety is enhanced by early
exposure to the complex nature of the medication administration process. This should
be taught and practised in the clinical skills laboratory as continuous practice assists
nurses to improve patient outcomes (Ofosu and Jarrett 2015, 12). Practical training
should be fundamental for nursing students in order to facilitate a deeper understanding
of MAEs and their impact on patient safety (Hammoudi, Ismaile and Yahya 2017,
1038). Although lecturers spend time and effort on teaching students the protocols for
safe medication administration, students still commit MAEs (Valdez, De Guzman and
Escolar-Chua 2013, 222). In the literature, registered nurses are the focus of MAEs,
while nursing students’ MAEs remain unreported (Valdez, De Guzman and Escolar-
Chua 2013, 222). Therefore, the current study was conducted among the nursing
students at an HEI in Western Cape, South Africa to determine the main factors that
influence the occurrence of MAEs in order to enhance the patients’ safety and supress
the occurrence of these errors.
Problem Statement
Lack of the knowledge of MAEs has dire consequences for patients, nurses and
healthcare institutions. It severely compromises patient safety and may lead to disability
or even death. Therefore, it is imperative that nurses receive adequate training to
administer medication correctly to patients.
Aim and Objectives of the Study The aim of the study was to determine the awareness and perception of the occurrence
and reporting of MAEs among nursing students at an HEI in Western Cape, South
Africa.
The objectives of the study were to:
• determine the level of awareness of the occurrence and reporting of MAEs;
• determine the factors related to MAE occurrence as experienced by undergraduate nursing students at an HEI in Western Cape in the units at the
healthcare facilities where undergraduate students are placed.
Abusaksaka, Vember and Marie Modeste
4
Research Methodology
Research Design
A descriptive quantitative design was used in the study that was conducted among the
nursing students on 2 and 3 April 2017. Descriptive research is aimed at casting light
on current issues or problems through a process of data collection that enables
researchers to describe the situation more completely, in this case the occurrence and
reporting of MAEs as perceived by nursing students at an HEI in Western Cape.
Research Setting
The study was carried out at an HEI in Western Cape, South Africa. The nursing
department of the HEI has three sites where the basic undergraduate training programme
is offered. The campus included in the study for data collection has the largest number
of undergraduate students compared with the other two sites, which are situated in two
rural communities.
Population and Sampling
The target population for the study was approximately 563 second-, third- and fourth-
year undergraduate nursing students registered for the undergraduate nursing degree at
an HEI in Western Cape. All the students enrolled for the study programme were
approached to participate in the study.
Non-probability proportional quota sampling was used in the study. The purpose of
quota sampling is to draw a sample that has the same proportions or characteristics as
the whole population. With this sampling method, the researcher divided the population
group into three subgroups (strata) depending on their year of study (second-, third- and
fourth-year nursing students). Quota sampling with convenience technique was then
used to collect the data to achieve the desired sample size.
Sample Size
The researcher used the Sample Size Calculator (2016) to calculate the sample size, a
confidence level of 95%, and a confidence interval of 4. Moreover, the sample size was
calculated manually. Based on that, the sample size was estimated as 291, comprising
second-, third- and fourth-year undergraduate nursing students.
Data Collection
The present study used a self-administered questionnaire for the data collection.
Maintaining the quota distribution, the students were invited to participate in the study,
and 300 consent forms were distributed. The researcher and his supervisor met with all
Abusaksaka, Vember and Marie Modeste
5
the students, and the lecturer in each class introduced the researcher to the prospective
respondents. The data was collected from the population over two days on 2 and 3 April
2017. On the first day, data was collected from the second-year nursing students, then
on the following day, data was collected from the third- and fourth-year nursing
students. Three hundred consent forms were signed and 300 questionnaires distributed
to the respondents. Nine of the returned questionnaires were excluded because they were
incomplete. However, the sample size was achieved.
Before data collection commenced, the purpose and aims of the study were explained
to the respondents. A written information sheet was also given to all respondents and
attached to the consent form. The respondents were made aware that they had the right
to withdraw from the study, even after they had provided informed consent, without
being victimised or with any negative consequences. The respondents were given 15
minutes (as determined by the pilot study) to complete the questionnaire after reading it
and having it explained by the researcher and his supervisor. All of the respondents
returned their questionnaire before the end of 15 minutes.
The questionnaires were collected after completion and coded anonymously by the
researcher as second year (2.000), third year (3.000) and fourth year (4.000). After
extraction of the data, the completed questionnaires were stored safely in a locked safe
in the nursing department at the HEI where the researcher is a registered student.
Research Instrument
The data collection instrument in the present study consisted of a self-administered
questionnaire. The questionnaire was used to determine the perceived occurrence of
MAEs among the nursing students.
The questionnaire for the study was divided into three sections in alphabetical order.
Parts A and B were developed by the researcher. Part C had been used in previous
studies and developed by Dr Bonnie Wakefield of the Sinclair School of Nursing at the
University of Missouri, US. Permission to use the questionnaire was obtained from the
developer.
Part A collected the respondents’ demographic characteristics (age, gender, marital
status and year of study) and comprised items 1, 2, 3 and 4. Part B outlined the
respondents’ awareness of the occurrence and reporting of MAEs and comprised Item
5. Part C outlined the causes of MAEs and comprised 20 items on MAE-related causes
with a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). This part of the
questionnaire was further classified into four subscales: physician communication
causes (6 items: questions 10, 11, 12, 13, 14 and 18); medication package causes (3
Abusaksaka, Vember and Marie Modeste
6
items: questions 7, 8 and 9); pharmacy related causes (3 items: questions 15, 16 and 17);
and nurse related causes (8 items: questions 19, 20, 21, 22, 23, 24, 25 and 26).
Pilot Study
A pilot study was employed in the study and conducted at one campus of the HEI under
study. The pilot study was used to test the various components of the questionnaire in
terms of the validity and reliability of the instruments to the nursing students. The pre-
testing questionnaire was conducted on one day during the data collection period. The
respondents in the pilot study included 15 second-, third- and fourth-year nursing
students who met the inclusion criteria for the study. The respondents of the pilot study
were not included in the sample size of the study.
Consent forms with the information sheet about the study were distributed to the
respondents prior to the questionnaire sheets. Agreement to participate in the pilot study
was obtained using the consent form. The researcher explained to the respondents the
purpose of the study and the contents of the informed consent. The researcher informed
the respondents that they were free to participate in the study or to withdraw at any time
even after completion of the consent form. A total of 15 questionnaires were distributed.
All the distributed questionnaires were returned. The respondents indicated that the
questionnaire was clear, easy to read and easily understood. The questionnaires took
approximately 10–15 minutes to complete. The results of the pilot study indicated that
no corrections or adjustments to the existing instrument were necessary. The
Cronbach’s alpha for the whole instrument was 0.83; 0.84 for the medication package
subscale; 0.85 for the physician communication subscale; 0.89 for the pharmacy related
subscale; and 0.81 for the nurse related subscale.
Data Analysis
The collected data was coded and tabulated. The Statistical Package for Social Sciences
(SPSS Version 24) was used to analyse the data. Microsoft Excel was utilised for
graphical presentation such as line and bar charts. The analysis was performed under
the supervision of, and with consultation and support from, the statistician at the HEI
where the research was done. In the study, descriptive and inferential statistics were
conducted to analyse the collected data.
Ethical Considerations
Permission for the study was obtained and renewed annually from the Research Ethics
Committee of the Faculty of Health and Wellness Sciences at the Cape Peninsula
University of Technology (CPUT) (reference number: CPUT/HW–REC 2016/H23). An
informed consent was obtained from each respondent. Anonymity and confidentiality
were assured. The respondents’ names were not recorded, and the data was numerically
Abusaksaka, Vember and Marie Modeste
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coded. Only the researcher, his supervisor, co-supervisor, and the statistician had access
to the data.
Results
Demographic Characteristics
In the current study, 290 respondents indicated their gender. Most of the respondents
(81.3%, n = 236) were female. The majority of the respondents (97.9%, n = 285)
responded to the age item and the mean of their ages was 23.49, with a minimum age
of 19 years and a maximum age of 43 years. Most of the respondents (81.7%, n = 233)
were 25 years or younger. The majority of the respondents (88.7%, n = 258) reported
their status as single. The distribution of the respondents was similar over the three years
of study, with 110 (37.8%) in second year, 93 (32.0%) in third year and 88 (30.2%) in
fourth year.
Respondents’ Awareness of MAE Occurrence across Each Year of Study
The respondents’ year of study was the only demographic variable that showed a
difference with the respondents’ awareness of MAE occurrence. As the study related to
the nursing students’ awareness of MAE occurrence, the researcher checked if there was
any relation between the students’ awareness and their year of study.
Table 1: Respondents’ awareness of MAE occurrence across each year of study
Are you aware of any medication administration errors in the health services where you are placed?
Year of study No Yes Total
Second year 16 (14.7%) 93 (85.3%) 109
Third year 18 (19.4%) 75 (80.6%) 93
Fourth year 9 (10.2%) 79 (89.8%) 88
Total 43 247 290
As presented in Table 1, the respondents’ awareness of MAE occurrence in each year
of their study is highlighted. The majority (n = 290) responded to the question, except
for one who did not answer this question.
A similar proportion of the respondents were aware of MAE occurrence during their
clinical placements in the three years of study. The highest percentage of awareness of
MAE occurrence among the respondents was noted among the fourth-year students
(89.8%, n = 79).
Abusaksaka, Vember and Marie Modeste
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Relationship between the Respondents’ Year of Study and Their Awareness of
MAE Occurrence
Table 2 shows the result of the chi-square test to determine if there was a significant
difference between the respondents’ year of study and their awareness of MAE
occurrence during their practice time.
Table 2: Results of chi-square tests for the respondents’ awareness of MAE
occurrence across years of study
Chi-square tests
Value Df Asymptotic significance (2–sided)
Pearson chi-square 2.986* 2 0.225
Likelihood ratio 3.027 2 0.220
Linear-by-linear
association
0.610 1 0.435
No. of valid cases 290
Note:
*0 cells (0.0%) have an expected count less than 5. The minimum expected count is 13.05.
There was no significant difference between the respondents’ year of study and their
awareness of MAE occurrence as indicated by the p-value in Table 2. In other words,
the respondents’ awareness of MAE occurrence was independent of their year of study.
Causes of MAE Occurrence
Subscales of Respondents’ Perceptions of the Causes of MAE Occurrence
Figure 1 shows the subscales of the respondents’ perceptions of the causes of MAE
occurrence.
Abusaksaka, Vember and Marie Modeste
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Figure 1: Subscales of the respondents’ perceptions of the causes of MAE occurrence
The physician communication subscale was ranked at the top subscale and was agreed
on by over two-thirds of the respondents. Moreover, the respondents indicated that the
medication package and nurse related subscales were at the same level of agreement.
Significant Subscales of the Causes of MAE Occurrence
Table 3 presents the results of one sample t–test for the four main subscales of the causes
of MAE occurrence. All the subscales were significantly different from the neutral level
of the 6-point Likert scale (3.5). The observed point was the pharmacy related subscale
which was significantly lower than the neutral level. This is an indication that this
subscale was not a significant cause of MAE occurrence among the respondents. The
other three subscales were significantly higher than the neutral level of the 6-point
Likert scale and thus reflected a significant cause of MAE occurrence.
Table 3: Significant subscales of the causes of MAE occurrence
One-sample t-test
Subscale
Test value = 3.5
t Df Sig. (2– tailed)
Mean difference
95% confidence interval of the difference
Lower Upper
0%
20%
40%
60%
80%
100%
Medication package Physician communication
Pharmacy related Nurse related
Agree Disagree
Abusaksaka, Vember and Marie Modeste
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Physician
communication
12.459 290 < 0.001 0.72125 0.6073 0.8352
Medication package 3.193 290 0.002 0.24914 0.0956 0.4027
Pharmacy related –28.445 290 < 0.001 –1.73654 –1.8567 –1.6164
Nurse related 6.537 290 < 0.001 0.35880 0.2508 0.4668
Significant Difference Items of the Causes of MAE Occurrence
Table 4 presents the results of the one-sample t-test for the items.
Table 4: The significant causes of MAE occurrence
One-sample t-test
Item
Test value = 3.5
Mean Std. deviation
Std. error mean t
95% confidence interval of the difference
Df Sig. (2– tailed)
The names of many
medications are similar.
3.50 1.611 0.095 –0.036 289 0.971
Different medications look
alike.
3.99 1.667 0.098 4.976 290 < 0.001
The packaging of many
medications is similar.
3.76 1.657 0.097 2.644 288 0.009
Physicians’ medication orders
are not legible.
4.65 1.650 0.097 11.819 288 < 0.001
Physicians’ medication orders
are not clear.
4.67 1.514 0.089 13.151 289 < 0.001
Physicians change orders
frequently.
3.88 1.448 0.085 4.501 289 < 0.001
Abbreviations are used instead
of writing the orders out
completely.
4.85 1.554 0.091 14.840 290 < 0.001
Verbal orders are used instead
of written orders.
2.97 1.733 0.102 –5.253 289 < 0.001
Pharmacy delivers incorrect
doses to this unit.
1.90 1.226 0.072 –22.232 289 < 0.001
Pharmacy does not prepare the
medication correctly.
1.72 1.116 0.065 –27.247 290 < 0.001
Pharmacy does not label the
medication correctly.
1.68 1.112 0.065 –27.929 289 < 0.001
Abusaksaka, Vember and Marie Modeste
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The means of 12 of the 20 mentioned causes of MAE occurrence were significantly
higher than the neutral mean of the 6-point Likert scale (3.5). The means of these causes
ranged between 3.76 (+1.657) and 4.85 (+1.554). The top three significant causes with
the highest means were the use of abbreviations (4.85±1.554), unclear physician orders
(4.67±1.514), and illegible physician orders (4.65±1.619). Similar packaging of many
medications ranked at the bottom of the significant causes with a mean of (3.76±1.657).
Discussion
The current study aimed to determine nursing students’ awareness of MAE occurrence
and what they perceived to be the causes of MAE occurrence during their practice time.
The study found most of the respondents were aware of MAE occurrence during their
practice. This finding has been reported worldwide. In the emergency department of the
Imam Khomeini Hospital in Iran, less than half of the nurses had committed MEs
Poor communication between
nurses and physicians or
between the nursing student and
the supervisor.
4.32 1.464 0.086 9.589 290 < 0.001
Many patients are on the same
or similar medications.
4.51 1.446 0.085 11.936 290 < 0.001
On this unit, there is no easy
way to look up information on
medications.
3.40 1.758 0.103 –0.984 290 0.326
Nurses or the nursing students
get pulled between teams and
from other units.
3.84 1.688 0.099 3.432 288 0.001
Nurses or the nursing students
do not adhere to the approved
medication administration
procedure.
3.07 1.686 0.099 –4.319 289 < 0.001
Nurses or the nursing students
are interrupted while
administering medications to
perform other duties.
4.63 1.619 0.095 11.896 290 < 0.001
Unit staffing levels are
inadequate.
4.24 1.600 0.094 7.929 289 < 0.001
All medications for one team of
patients cannot be passed
within an accepted time frame.
3.99 1.651 0.097 5.014 289 < 0.001
Nurse or the nursing student is
unaware of a known allergy.
3.19 1.789 0.105 –2.999 290 0.003
Abusaksaka, Vember and Marie Modeste
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(Ehsani et al. 2013, 1). Another study conducted by Feleke, Mulatu and Yesmaw (2015)
indicated that MAEs occurred in about half of administered medication among nurses
in Ethiopia. According to Ojerinde and Adejumo (2014, 22), more than half of the
nurses in Nigeria were involved in ME occurrence. These errors occurred because of a
shortage of nurses, insufficient pharmacological information, nurses’ interruption
during medication administration, physician communication causes, nurse related
causes, pharmacy related causes, and medication package causes (Aboshaiqah 2014, 63;
Al-Youssif, Mohamed and Mohamed 2013, 61; Blignaut 2015, 162; Ehsani et al. 2013,
1; Hanna 2014, 41; Wakefield, Uden-Holman and Wakefield 2005, 484).
Four subscales for MAE occurrence were mentioned in the current study. Physician
communication represented the main subscale of the causes of MAE occurrence.
Moreover, the result of the one-sample t-test reflected the fact that this subscale was a
significant cause of MAEs as perceived by the respondents. This finding is supported
Aboshaiqah (2014, 63), who reported the physician communication subscale as the main
cause of MAE occurrence. Moreover, the physician communication subscale was
reported by other studies as the second cause (Hanna 2014, 41), or the fourth cause (Al-
Youssif, Mohamed and Mohamed 2013, 61) of MAE occurrence. Furthermore, other
studies noted some cases related to physician communication as a reason for MAE
occurrence. Blignaut (2015, 162–182) noted communication lapses between nurses and
physicians as a cause of MAE occurrence among the respondents in medical and
surgical units in Gauteng, South Africa. Likewise, there are other South African studies
that have noted the lack of communication between nurses and physicians as an
important cause of MAE occurrence (Du Preez 2016, 87; Hill 2016, 81–92). Nurse-
physician communication represented the baseline for patient safety. Hence,
communication between physician and nurse is of utmost importance, as it could have
detrimental effects on the patients’ safety (Holmström 2017, 96; Mohmmed and El-Said
Hassane El-sol 2017, 83).
The respondents indicated that the medication package subscale was the second cause
of MAE occurrence. The result of the one-sample t-test reflected the fact that the
respondents perceived that this subscale was a significant cause of MAE occurrence.
This finding concurs with that of Aboshaiqah (2014, 66), who reported that nurses in
Saudi Arabia agreed slightly with this subscale being a cause of MAE occurrence.
However, Hanna (2014, 41) and Al-Youssif, Mohamed and Mohamed (2013, 65)
reported this subscale as the main cause of MAE occurrence in their studies. It is
important that all medication should be clearly designed and marked in order to
distinguish between the various medication packages. Applying the barcode technique
to mark all medication differently could play an important role in facilitating the
selection and administration of the correct medicine (Alotaibi and Federico 2017; 1177;
Blignaut 2015, 251; Keers et al. 2013b, 253). Furthermore, the nurse should take the
Abusaksaka, Vember and Marie Modeste
13
medication package to the patient’s bedside and open it just before administering the
medication (Al-Youssif, Mohamed and Mohamed 2013, 65).
The nurse related subscale was cited as the third cause of MAE occurrence. Moreover,
the result of the one-sample t-test confirmed that this subscale was a significant cause
of MAEs as perceived by the respondents. This finding is supported by Aboshaiqah
(2014, 66), who indicated that nurses in Saudi Arabia agreed slightly with the nurse
related subscale being a cause of MAE occurrence. Other studies reported the nurse
related subscale as the fourth (Al-Youssif, Mohamed and Mohamed 2013, 61) or last
(Hanna 2014, 41) cause of MAE occurrence. In South Africa, the patient-nurse ratio,
work overload, inadequate staffing levels, and nurses being interrupted while
administering medication were noted as contributing factors by professional nurses and
medication administrators (Blignaut 2015, 162; Du Preez 2016, 46–57; Hill 2016, 71–
75). These issues could be minimised by increasing staffing levels and providing a safe
medication preparation area with a “No-Talk” sign (Feleke, Mulatu and Yesmaw 2015,
1; Mohmmed and El-Said Hassane El-sol 2017, 84). A continuous educational
development programme should be provided for nurses to raise their awareness of the
effects of interruption during medication administration on patient safety (Feil 2013, 6–
8).
The respondents disagreed that the pharmacy related subscale was a cause of MAE
occurrence. Furthermore, the result of the one-sample t-test confirmed that this subscale
was not a significant cause of MAE occurrence. This finding is supported by Al-
Youssif, Mohamed and Mohamed (2013, 57) and Aboshaiqah (2014, 66) who noted this
subscale as the least cause of MAE occurrence. Moreover, Aboshaiqah (2014, 66) and
Hanna (2014, 41) indicated that the nurses disagreed slightly with this subscale as a
cause of MAE occurrence. Likewise, Hill (2016, 70) reported that 58.05% of South
African nurses indicated that MAEs rarely occurred owing to incorrect dispensing of
medication by the pharmacy. Regular courses for nurses, physicians and pharmacists
with regard to medication management and calculation play an important role in
mitigating MAE occurrence and enhancing patient safety (Du Preez 2016, 99; Feleke,
Mulatu and Yesmaw 2015, 7).
The use of abbreviations was perceived as the main cause contributing to the occurrence
of MAEs. This reason was cited as the first significant cause of MAE occurrence in the
current study. This finding is supported by Blignaut (2015, 161), who reported that
83.2% of South Africa medication administrators mentioned this as a risk for MAE
occurrence. Al-Youssif, Mohamed and Mohamed (2013, 66) noted the use of
abbreviations as the second reason for MAE occurrence as indicated by nurses in Saudi
Arabia. Moreover, many international studies have confirmed the use of abbreviations
as an important cause of MAE occurrence (Aboshaiqah 2014, 65; Hanna 2014, 41;
Abusaksaka, Vember and Marie Modeste
14
Valdez, De Guzman and Escolar-Chua 2013, 222). This information is useful to
healthcare institutions in avoiding the use of abbreviations and encouraging physicians
to write orders clearly and legibly (Al-Youssif, Mohamed and Mohamed 2013, 66; Du
Preez 2016, 98).
The result of the one-sample t-test showed that unclear physician orders were the second
significant cause of MAE occurrence. Similarly, Hanna (2014, 41) mentioned unclear
physician orders as the second cause of MAE occurrence as indicated by nurses in the
US. However, according to Abaoshaiqah (2014, 65), only 25% of nurses in Saudi Arabia
mentioned it as a cause of MAE occurrence. When an order is not clear, it could lead to
misinterpretation which could compromise patient safety. This information could
facilitate the development of new techniques, such as electronic orders and the use of
barcodes for prescribing orders, to avoid or mitigate the occurrence of MAEs (Alotaibi
and Federico 2017, 1177; Blignaut 2015, 251).
Recommendations
Based on the findings, it is recommended that interpersonal skills and communication
among nurses and physicians be enhanced in order to discuss the causes of MAE
occurrence openly; that interruption during medication administration should be
eliminated with a no-distraction area and use no-talk signs to alert others during the
medication administration time; that the staff level should be increased and the nurse
educator/supervisor should be available to nursing students during their practice time,
so they will not depend on the nurses; and that students should be exposed to more
simulation practice in this regard in the onsite clinical laboratories at NEIs under the
supervision of well-trained clinical mentors/supervisors.
Limitations of the Study
The HEI where the study took place is one of three HEIs that offer undergraduate
nursing training in Western Cape, with four campuses. Since the study was only
conducted on one of its campuses, the results are not generalisable. Also, a self-reporting
method was used in the study that might introduce some bias. However, the research
was conducted at the largest campus with the most students enrolled at that institution.
Furthermore, the HEI has a large number of students similar to its counterparts.
Moreover, the target sample for the study was achieved. Furthermore, both the
researcher and his supervisor were available during questionnaire distribution to clarify
any questions from the respondents.
Abusaksaka, Vember and Marie Modeste
15
Conclusion
In conclusion, the study findings revealed that most of the respondents were aware of
MAE occurrence during their practice time. There was no significant difference
between the respondents’ awareness of MAE occurrence and their year of study. Four
main subscales for the causes of MAE occurrence were mentioned in the study;
however, the respondents agreed with the medication package, physician
communication and nurse related subscales as causes of MAE occurrence, while they
disagreed with the pharmacy related subscale as a cause of MAE occurrence. The top
items for MAE occurrence as perceived by the respondents in the current study were
using abbreviations instead of writing out the prescription orders completely and unclear
physician orders. The respondents perceived incorrect medication preparation by the
pharmacy to be the most disagreed item as a cause of MAE occurrence.
MAEs are a problem worldwide and it are a threat to the patients’ lives. Therefore, the
causes of these errors must be discovered and treated among the nursing students, as
well as the graduated nurses, to reduce the occurrence of these errors. This requires
cooperation between the education institutions, healthcare institutions, and the
healthcare workers along with a commitment to keep the patients safe.
Acknowledgements
The authors wish to thank the Libyan Embassy in South Africa for financial support and
Dr Bonnie Wakefield for supporting this work and granting permission to use the
instruments for data collection.
References
Aboshaiqah, A. E. 2014. “Nurses’ Perception of Medication Administration Errors.” American
Journal of Nursing Research 2 (4): 63–67. https://doi.org/10.12691/ajnr-2-4-2
Al-Youssif, S. A., L. K. Mohamed, and N. S. Mohamed. 2013. “Nurses’ Experiences toward
Perception of Medication Administration Errors Reporting.” Journal of Nursing and
Health Science 1 (4): 56–70. https://doi.org/10.9790/1959-0145670
Alotaibi, Y. K., and F. Federico. 2017. “The Impact of Health Information Technology on
Patient Safety.” Saudi Medical Journal 38 (12): 1173–1180.
https://doi.org/10.15537/smj.2017.12.20631
Blignaut, A. J. 2015. “Medication Administration Safety in Medical and Surgical Units of the
Gauteng Province.” Doctoral diss., North-West University, Potchefstroom.
Abusaksaka, Vember and Marie Modeste
16
Du Preez, E. R. 2016. “Human Factors Causing Medication Administration Errors as Self–
Reported by Registered Professional.” Master’s diss., Stellenbosch University.
Ehsani, S. R., M. A. Cheraghi, A. Nejati, A. Salari, A. H. Esmaeilpoor, and E. M. Nejad. 2013.
“Medication Errors of Nurses in the Emergency Department.” Journal of Medical Ethics
and History of Medicine 6: 11.
Elliott, R., E. Camacho, F. Campbell, D. Jankovic, M. Martyn St James, E. Kaltenthaler, R.
Wong, M. Sculpher, and R. Faria. 2018. “Prevalence and Economic Burden of Medication
Errors in the NHS England.” Rapid Evidence Synthesis and Economic Analysis of the
Prevalence and Burden of Medication Error in the UK. Policy Research Unit in Economic
Evaluation of Health and Care Interventions. Accessed March 20, 2020.
https://psnet.ahrq.gov/issue/prevalence-and-economic-burden-medication-errors-nhs-
england
Feil, M. 2013. “Distractions and Their Impact on Patient Safety.” Pennsylvania Patient Safety
Advisory 10 (1): 1–10.
Feleke, S. A., M. A. Mulatu, and Y. S. Yesmaw. 2015. “Medication Administration Error:
Magnitude and Associated Factors among Nurses in Ethiopia.” BMC Nursing 14 (53): 1–8.
https://doi.org/10.1186/s12912-015-0099-1
Gordon, M. G. 2014. “Improving the Process of Medication Administration.” The
Pennsylvania Nurse 69 (1): 17–22.
Hammoudi, B. M., S. Ismaile, and O. A. Yahya. 2017. “Factors Associated with Medication
Administration Errors and Why Nurses Fail to Report Them.” Scandinavian Journal of
Caring Sciences 9: 1–9. https://doi.org/10.1111/scs.12546
Hanna, E. J. 2014. “Exploring the Relationship between Reporting Medication Errors and
Nurse Fear of Retribution.” Master’s diss., Gardner-Webb University, Boiling Springs.
Haw, C., J. Stubbs, and G. L. Dickens. 2014. “Barriers to the Reporting of Medication
Administration Errors and Near Misses: An Interview Study of Nurses at a Psychiatric
Hospital.” Journal of Psychiatric and Mental Health Nursing 21 (9): 797–805.
https://doi.org/10.1111/jpm.12143
Hill, K. J. 2016. “Prevalent Elements Related to Human Factors Associated with Medication
Administration Errors in Private Healthcare Institutions within the Western Cape, South
Africa: A Nursing Perspective.” Master’s diss., Stellenbosch University.
Holmström, A. R. 2017. “Learning from Medication Errors in Healthcare – How to Make
Medication Error Reporting Systems Work?” Doctoral diss., University of Helsinki.
Abusaksaka, Vember and Marie Modeste
17
Iliffe, J. n.d. “10 Facts on Patient Safety”. Accessed March 20, 2020.
http://commonwealthnurses.org/Documents/Tenfactsonpatientsafety_001.pdf
Jones, J., and L. Treiber. 2010. “When the 5 Rights Go Wrong: Medication Errors from the
Nursing Perspective.” Journal of Nursing Care Quality 25 (3): 240–247.
https://doi.org/10.1097/NCQ.0b013e3181d5b948
Keers, R. N., S. D. Williams, J. Cooke, and D. M. Ashcroft. 2013a. “Causes of Medication
Administration Errors in Hospitals: A Systematic Review of Quantitative and Qualitative
Evidence.” Drug Safety 36 (11): 1045–1067. https://doi.org/10.1007/s40264-013-0090-2
Keers, R. N., S. D. Williams, J. Cooke, and D. M. Ashcroft. 2013b. “Prevalence and Nature of
Medication Administration Errors in Health Care Settings: A Systematic Review of Direct
Observational Evidence.” Annals of Pharmacotherapy 47 (2): 237–256.
https://doi.org/10.1345/aph.1R147
Mohmmed, R. G. A., and A. El-Said Hassane El-sol. 2017. “Nursing Innovations: Medication
Administration Errors and Safety.” IOSR Journal of Nursing and Health Science 6 (3): 75–
85. https://doi.org/10.9790/1959-0603047585
Ofosu, R., and P. Jarrett. 2015. “Reducing Nurse Medicine Administration Errors.” Nursing
Times 111 (20): 12–14.
Ojerinde, C. A., and O. P. Adejumo. 2014. “Factors Associated With Medication Errors
Among Health Workers In University College Hospital, Nigeria.” Journal of Nursing and
Health Science 3 (3): 22–33. https://doi.org/10.9790/1959-03342233
Pryce-Miller, M., and V. Emanuel. 2010. “Ongoing Education Would Boost Competency in
Drug Calculations.” Nursing Times 106 (34): 8.
Radley, D. C., M. R. Wasserman, L. E. W. Olsho, S. J. Shoemaker, M. D. Spranca, and B.
Bradshaw. 2013. “Reduction in Medication Errors in Hospitals Due to Adoption of
Computerized Provider Order Entry Systems.” Journal of the American Medical
Informatics Association 20 (3): 470–476. https://doi.org/10.1136/amiajnl-2012-001241
Valdez, L. P., A. de Guzman, and R. Escolar-Chua. 2013. “A Structural Equation Modeling of
the Factors Affecting Student Nurses’ Medication Errors.” Nurse Education Today 33 (3):
222–228. https://doi.org/10.1016/j.nedt.2012.01.001
Wakefield, B. J., T. Uden-Holman, and D. S. Wakefield. 2005. “Development and Validation
of the Medication Administration Error Reporting Survey.” In Advances in Patient Safety:
From Research to Implementation, edited by K. Henriksen, J. B. Battles and E. S.
Marks,475–489. Rockville: Agency for Healthcare Research and Quality.
Abusaksaka, Vember and Marie Modeste
18
Weant, K. A., A. M. Bailey, and S. N. Baker. 2014. “Strategies for Reducing Medication
Errors in the Emergency Department.” Open Access Emergency Medicine 6: 45–55.
https://doi.org/10.2147/OAEM.S64174
WHO (World Health Organization). 2011. “WHO Multi-Professional Patient Safety
Curriculum Guide.” Accessed March 210, 2020.
https://www.who.int/patientsafety/education/mp_curriculum_guide/en/
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