Hannah Fitzpatrick, Kayla Kilfeather, Jessica Chan, Madyson Carrie, Rachel Keithley
Abstract
was gathered to answer the question: In nurses in the hospital setting, does inadequate sleep
increase the frequency of medication errors compared to nurses who are not sleep deprived?
Various commonalities and inconsistencies exist among the articles. The most significant
commonality is the finding of a significant correlation between sleep deprivation and increased
frequency in medication errors. Limitations of the studies are acknowledged and include small
sample sizes, single studies, use of subjective data, and the need for further research.
Recommendations for further practice include shortening the number of nurses’ shift hours and
reducing nurse-patient ratios. Finally, there are several potential improvements for further
research. Use of larger sample sizes and a clear definition of “sleep deprivation” can enhance
the validity of research. A potential topic for further research is one that studies the prevalence
in medication errors in eight-hour shifts versus twelve-hour shifts. Additionally, future studies
could compare the number of medication errors in places with smaller nurse-patient ratios
Introduction
career particularly, the importance of meticulous critical thinking as well as a clear and
concentrated mind are pertinent to successful practice. Although medication administration may
become a monotonous task for nurses, it requires careful thought and technique. The effects of
incorrect medication administration may be costly to patient outcomes. This poses the question:
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 3
In nurses in the hospital setting, does inadequate sleep increase the frequency of medication
Commonalities
studies focused specifically on the occurrence of medication errors within nursing practice. A
prevalent theme in these studies showed that as hours of sleep among nurses decreased, the
occurrence of medical errors significantly increased (Ferris, 2015; Saleh, Aswadalla, El-masri, &
Sleem, 2014; Ramadan & Al-Saleh, 2014). Data in multiple articles also confirmed that long
hours and night shifts resulted in decreased cognitive function and nursing fatigue, leading to
medication errors (Ferris, 2015; Scott, Arslanian-Engoren & Engoren, 2014; Seelye, Mattek,
Howieson, Riley, Wild, & Kaye, 2014; Shohani & Tavan, 2018; Soletti, Bailey, Smith &
Hirvela, 2014). These findings are indicative of the cognitive effects that sleep deprivation may
have on the brain. Findings also conveyed that error occurred during medication administration,
and accuracy was heavily influenced by outside distractions (Hayes, Jackson, Davidson, &
Power, 2015; Saleh et al., 2014). Multiple studies concluded that inadequate sleep does not
allow the brain to restore to its full potential, as it causes memory loss, mind wandering, and
limited information-processing abilities (Angel, Cortez, Juarez, Guerrero, Garcia, Ramirez, &
Valdez, 2015; Ramadan & Al-Saleh, 2014; Schwarz, Gerhardsson, Lekander, Fischer, Axelsson,
Inconsistencies
One of the main inconsistencies among the studies was that the definition of sleep
deprivation is not made clear, there were inconsistencies between studies in the method they
used to define sleep deprivation. For example, in one study participants had four hours of sleep
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 4
each night for five nights (Angel et al., 2015), and in another study, sleep deprivation was
defined as less than five hours of sleep the previous night (Ramadan & Al-Saleh, 2014). Another
inconsistency found was the types of tools used to gather data. Some of the tools used include
questionnaires, self-report inventories, scales, demographic data sheets, and exams such as the
Mini Mental Status Exam. Finally, inconsistencies were found among the populations used in
the studies. Participants ranged from members of the American Association of Critical Care
Limitations
The most prevalent limitation seen throughout each study was small sample sizes. This
poses a threat to validity because it allows large generalizations to be made about the effects of
sleep deprivation for all nurses. Furthermore, multiple studies were confined to a single setting
or population (Ferris, 2015; Ramadan & Al-Saleh, 2014; Shohani & Tavan, 2018). This
threatens validity as well by making the generalization that data restricted to few
areas/specialties can be applied to all nurses. Certain studies solely relied on questionnaires and
sleep diaries to gather data, limits objective measurements of sleep (Angel et al., 2015; Saleh et
al, 2014; Shohani & Tavan, 2018). This threatens validity due to the fact that questionnaires are
based on opinion and may be swayed by personal experience rather than objective sleep studies.
In two studies, further research is necessary to produce more accurate conclusions because the
current studies are not enough to prove its legitimacy and cannot yet be applied to all populations
There are several recommended changes for nursing practice. First, one study showed
that nurses who do not get enough sleep, experience fatigue, or do not have enough time to
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 5
recover in between shifts also reported more decision regret (Scott et al., 2014). A solution
would be to shorten work shifts to eight to ten hours, instead of twelve. This would enable
nurses to get adequate sleep so that they are rested and alert for their next shift. Second, one of
the main causes of medication errors is due to an interruption while the nurse is administering
medications. Eighty-five percent of these interruptions result in error (Hayes et al., 2015).
Reducing the nurse-patient ratio would allow the nurse to focus on giving the medication
correctly without several other patients needing their assistance. Third, in order to avoid the
same medication error from occurring again, each hospital should support a positive learning
Many improvements to further research can be made. First, using larger sample sizes
would enhance the studies’ validity. Second, samples from a variety of population settings could
be used to decrease bias. Furthermore, strict monitoring of sleep schedules along with a clear,
quantitative definition of “sleep deprivation” rather than the use of sleep diaries, questionnaires,
and self-report inventories would enhance the validity of the studies. A topic for further research
could compare the number of medication errors made by nurses who work an eight-hour shift
versus the number of errors made by nurses working a twelve-hour shift. Additionally, future
studies could compare the number of medication errors in places with smaller nurse-patient
References
Angel, J., Cortez, J., Juarez, D., Guerrero, M., Garcia, A., Ramirez, C., & Valdez, P. (2015).
https://doi.org/10.1016/j.slsci.2015.06.001
Ferris, J. (2015). Nursing Fatigue: An evidence-based practice review for oncology nurses.
https://doi.org/10.1188/15.CJON.662-664
Hayes, C., Jackson, D., Davidson, P.M., Power, T. (2015). Medication errors in hospitals: a
Ramadan, M., Al-Saleh, K. (2014). The association of sleep deprivation on the occurrence of
errors by nurses who work the night shift. Current Health Sciences Journal. 40(2),
97-103. https://doi.org/10.12865/CHSJ.40.02.03
Saleh, Abdelbaset M., Awadalla, Nabil J., El-masri, Yosr M., Sleem, Wafaa F. (2014). Impacts
of
145-163. https://doi.org/10.1016/j.ejcdt.2013.10.001.
Schawrz, J., Gerhardsson, A., Lekander, M., Fischer, H., Axelsson, J., Kecklund, G. & T.
Scott, L. D., Arslanian-Engoren, C., & Engoren, M. C. (2014). Association of sleep and fatigue
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 7
with decision regret among critical care nurses. American Journal of Critical Care,
Seelye, A., Mattek, N., Howieson, D., Riley, T., Wild, K., Kaye, J. (2014). The impact of sleep
Shohani, M., & Tavan, H. (2018). Factors affecting medication errors from the perspective of
https://doi.org/10.7860/JCDR/2018/28447.11336
Soletti, L., Bailey, A., Smith, M., & Hirvela, M. (2014). Novice nurses, night shifts, and
https://eds.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&sid=5494af56-6d18-
4776-ac99-a7dba6b5307e%40sdc-v-sessmgr02(ISSN)0273-4117.