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International Journal of General Medicine
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ORIGINAL RESEARCH
Medication Administration Errors and Associated
Factors Among Nurses
This article was published in the following Dove Press journal:
International Journal of General Medicine
Dejene Tsegaye 1
Girma Alem 1
Zenaw Tessema 2
Wubet Alebachew
3
1
Department of Nursing, College of
Health Sciences, Debre Markos
University, Debre Markos, Ethiopia;
2
Department of Pharmacy, College of
Health Sciences, Debre Markos
University, Debre Markos, Ethiopia;
3
Department of Maternal and Neonatal
Health Nursing, College of Health
Sciences, Debre Tabor University, Debre
Tabor, Ethiopia
Introduction: Medication error has the potential to lead to harm to the patient. It is the leading
cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients’
hospitalization, produces extra costs and even death. This study aimed to assess medication
administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia.
Methods: Institutional-based, cross-sectional study design was used, and 422 study partici
pants were selected using a simple random sampling method. Data were collected using
a semi-structured and pre-tested self-administered questionnaire and observational checklist.
The collected data were analyzed using descriptive and analytical statistics and binary
logistic regression was done to identify factors associated with medication administration
errors. P-value ≤ 0.05 was considered statistically significant.
Results: Four hundred fourteen participants with a response rate of 98.1% were involved
and 54.3% were females. The median age was 30 with IQR (28–34) years and the majority of
them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was
57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong
assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated
medication administration errors. Significant association between medication administration
errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline
[AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31;
95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow
medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed.
Conclusion: MAE was high in the study area as compared to studies from Jimma
University Specialized Hospital, Adigrat and Mekelle University Hospital, and the
University of Gondar Referral Hospital and hence developing guidelines, providing training,
and develop strategies to minimize distracters are better to be undertaken.
Keywords: medication errors, medication administration, nurses, magnitude
Background
Correspondence: Zenaw Tessema
Department of Pharmacy, College of
Health Sciences, Debre Markos
University, P. O. Box, 269, Debre Markos,
Ethiopia
Email zenawlove21@gmail.com
MAE is any preventable act that contributes to the failure of proper medication use in the
treatment process resulting in harm for the patient to the extent of disability and death.1,2
It affects human relationships, threatens trust in the healthcare system as a whole, and can
also destroy life.3–5 Errors in medication administration can occur through failures in any
of the ten rights which are right patient, right medication, right time, right dose, right
route, right education/advice, rights to refuse, right assessment, right evaluation/
response, and documentation.6–9 Health workers committed medication administration
errors during the processes of ordering, prescribing, dispensing, preparing, or
administration.2,7
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http://doi.org/10.2147/IJGM.S289452
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Tsegaye et al
Globally, medication errors are leading causes of dif
ferent injuries and avoidable harms in the health care
system attributing to about 10% of the overall preventable
harm for hospitalized patients.10–12 In 2017, World Health
Organization reported that the annual global cost asso
ciated with medication errors has been estimated to reach
US ($) 42 billion accounting for 0.7% of the total health
expenditure.13 Moreover, in 2018, a British report on the
prevalence and burden of medication errors estimated the
occurrence of 237 million medication errors at all stages of
medication administration,14 and in Finland 700 to 1700
people died each year from medication-related errors.15
Similarly, in the USA, medication errors caused the
death of about 7000 patients and about 400,000 cases of
avoidable patient harm per year, which cost US ($)3.5
billion.2 In low and middle-income countries, the impact is
about twice as much in terms of the number of years of
healthy life lost.16
MAE is a global challenge and 18.7%-56% of hospi
talized patients face medication administration errors and
patients who faced this problem accounted for 60% to
80% in Australia and 64% in Nigeria.1
A study conducted in Tigray regional state of Ethiopia
revealed that wrong dose, administering at the wrong time,
medication omission, administering a wrong patient, admin
istering via a wrong route, administering un-prescribed
Figure 1 Schematic representation of the sampling procedure in the study area, 2019 (n=422).
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medication, and administering a wrong drug were the most
common types of MAE.17 As per the kinds of literature,
MAE can be prevented with consistent reporting systems
and by avoiding barriers to report the errors such as fear,
heavy workload, time constraints, and negative employees’
perceptions of error.18–20
Having a consistent reporting system and providing
care based on guidelines could prevent 75% of the occur
rence of harm to hospitalized patients.21 Medication
administration errors can also be prevented by the use of
technology like bar-coding for medications and patients,
smart infusion pumps for intravenous administration, sin
gle-use medication packages, and package design features,
and minimizing interruptions during the medication
administration process.7
Medication error, mainly the administration phase, is
accounted to be the most common cause of disability and
death throughout the world.22–24 It can also prolong
patients’ hospital stay resulting in increased healthcare
costs for patients, families, and health professionals.16
Clinical experience observations at different public health
hospitals revealed that nurses commit medication admin
istration error administration. Normally, there are limited
relevant findings concerning medication administration
error in sub-Saharan African countries, especially in
Ethiopia. It is the least researched and dumped health
problems where significant problems related to education,
economic, and trained labor is common, Besides, prior
studies were merely on the six rights of medication admin
istration and the magnitude of medication administration
error and contributing factors in the study hospitals is left
unknown. Therefore; the main aim of this study was to
assess medication administration errors and associated
factors among nurses in referral hospitals in Amhara
Ethiopia.
Methods
Study Area and Period
The study was conducted among nurses working at referral
hospitals of Amhara regional state which are Debre
Birhan, Felegehiwot, Debre Markos, Gondar, and Dessie
referral hospitals from March 1–30, 2019.
Study Design
A multicenter hospital-based cross-sectional study design
triangulated with observation was conducted.
International Journal of General Medicine 2020:13
Tsegaye et al
Source Populations
All nurses who were working at referral hospitals of
Amhara region state.
Study Populations
Those nurses who were randomly selected from Amhara
referral hospitals during the study period.
Inclusion Criteria
Nurses with a minimum of six months of working experi
ence and involved in direct patient care were included in
the study.
Exclusion Criteria
Those nurses who were not involved in medication admin
istration practice and the ones serving in administrative
positions were excluded from the study.
Sample Size Determination
Using single population proportion formula, 95% confi
dence interval, 5% margin of error, a reasonable estimate
for the proportion of medication administration error from
Table 1 Socio-Demographic Characteristics of Participants,
2019
Variables
Frequency
Percentage
(n=414)
(100)
25 and less
26–30
34
193
8.2
46.6
31–35
98
23.7
36–40
64
15.5
Sex
41 and more
Female
25
225
6
54.3
Marital status
Male
Single
189
175
45.7
42.3
Married
232
56
Educational
Others
7
1.7
status
Diploma
61
14.7
nurse
BSc nurse
347
83.8
Educational
award
MSC nurse
Government
6
345
1.5
83.3
Work
experience
Private
4 and less
69
164
16.7
39.6
5–9
150
36.2
10–14
15 and more
69
31
16.7
7.5
Age (years)
Response
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Tsegaye et al
a prior study (51.8%),22 the required sample size (N) is
calculated as follows:
N¼
ðZα=2Þ 2�pð1
d2
pÞ
Where
N= Minimum sample size
P= Estimated proportion of medication administration
error (51.8%)
d= the margin of sampling error tolerated (5%)
Zα/2= is the standard normal distribution at 1-α%=
confidence level (95%=1.96), then
Sampling Procedure
To select 422 nurses from the total five referral hospitals in the
Amhara region, all hospitals were first listed down with their
respective nurse numbers after which the sample size was
proportionally allocated to each hospital. Then, the sampling
frame was prepared for each hospital by having lists of nurses
from the hospitals’ nursing director and human resource man
agement. Finally, eligible nurses of each hospital were selected
by simple random sampling technique (Figure 1).
Variables
Dependent Variable
Prevalence of medication administration error
ð1:96Þ 2 0:518 ð1
N¼
ð0:05Þ2
0:518Þ
;
N=384
Adding a 10% non-response rate, a sample of 422
nurses were included. For the observational part of the
study, since it is recommended to take a maximum of
10% of the sample size participating for cross-sectional
study, 42 nurses; proportionally, 5 from DBRH, 10 from
FHRH, 6 from DMRH, 15 from GUSH, and 6 from DRFH
were involved.
Independent variables
Socio-demographics characteristics, work-related factors,
professional related factors, and other error producing
conditions.
Data Collection Tools and Procedures
A semi-structured self-administered questionnaire was pre
pared and used to collect data on nurses’ socio-demographic
characteristics (salary, an institution where the nurse earned,
an educational award, year of experience, etc), work-related
Figure 2 Dose error types committed in the study area, 2019 (n =414).
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International Journal of General Medicine 2020:13
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factors (nurse to patient ratio, lack of written guideline for
medication administration, poor communication with other
nurses while facing problems, current working unit, lack of
reporting mechanism to medication errors and duration in
specific unit), professional related factors (lack of training
and inability to follow ten rights of medication administra
tion practice) and other factors contributing for MAE
(Unclear verbal order, illegible physicians handwriting,
wrong prescription and dispensing, look like drugs, nurses’
prescription in place of physicians, nurse administer medica
tion prepared by another nurse and physicians’ frequent
alteration of their orders). Moreover, the prevalence of
MAE, reporting trends of a medication error, and types of
MAE were considered. Ten trained diploma nurses were
involved in collecting data from the questionnaire.
A structured observational checklist that contained nine
direct observable medication administration rights was used
to gather data on a total of 42 nurses’ adherence to the
directly observable nine rights while medication administra
tion. Observational data collection was done by five Bsc
nurses working in different units of each hospital and after
observation, patients’ medical records were reviewed to tri
angulate with a record of ordered medications’ dose, route,
time, and other profiles.
Tsegaye et al
further analysis. Descriptive statistics like frequencies,
proportion, and summary statistics (mean, median, IQR,
and standard deviation) were used to describe the study
population with relevant variables and presented in tables
and graphs. Multi-collinearity between the study variables
was diagnosed using standard error and correlation matrix.
The assumptions for the binary logistic regression model
were first checked and then bivariable analysis was carried
out to identify candidate variables (p
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