REVIEW JURNAL

Disusun Oleh :
Kelompok 1
1.Lusiana Sahureka
2.Yona Putirulan
3.Elen Z. Taihutu
4.Seisye Manduapessy
5.Lusia Taihuttu
6. Yenny Loyono

PROGRAM STUDI SARJANA TERAPAN KEBIDANAN

POLITEKNIK BHAKTI ASIH PURWAKARTA

2023
 Review Jurnal
Judul REASONS FOR MEDICATION ADMINISTRATION ERRORS,
BARRIERS TO REPORTING THEM AND THE NUMBER OF
REPORTED MEDICATION ADMINISTRATION ERRORS
FROM THE PERSPECTIVE OF NURSES: A CROSS-
SECTIONAL SURVEY
Penulis
Iva Brabcov´a, Hana Hajduchova´, Val´erie To´ thova´ , Ivana
Chloubova´, Martin Cˇ ervený , Radka Prokeˇsova´ , Josef Malý ,
Jiˇrí Vl ˇcek, Martin Dosed ˇel, Kateˇrina Mala´-La´ dov ´a, Ondˇrej
Tesaˇr, Susan O’Hara
Tahun 2023
Jurnal Nurse Education in Practice
Pendahuluan Kejadian tidak diinginkan berarti suatu kejadian yang
menyebabkan kerugian bagi pasien dan "Kerugian" menyiratkan
kerusakan pada struktur atau gangguan fungsi tubuh dan/atau efek
merusak yang dihasilkan (The Council EU, 2009; WHO, 2021).
Kesalahan pengobatan adalah jenis kejadian tidak diharapkan yang
umum terjadi dalam perawatan kesehatan (Brabcova et al., 2022).
Kesalahan pengobatan dapat terjadi selama tenaga kesehatan
memesan, menyimpan, meresepkan, menyiapkan, atau memberikan
obat (Bis¸kin Çetin dan Cebeci, 2021). Kesalahan kepatuhan pasien
juga dapat dianggap sebagai jenis kesalahan pengobatan (Jain,
2017). Kesalahan pemberian obat berkaitan dengan kesalahan
dalam persiapan dan pemberian obat enteral dan parenteral
(Assunça˜o-Costa et al., 2022; Berdot et al., 2021).
Persyaratan dasar keperawatan kontemporer adalah memberikan
asuhan keperawatan yang aman dan berkualitas. Persyaratan untuk
memastikan kualitas dan keselamatan dalam layanan kesehatan
dirumuskan secara terperinci oleh Dewan Uni Eropa dalam
rekomendasi tentang Keselamatan Pasien dan Pencegahan Infeksi
Terkait Layanan Kesehatan dan WHO/Aliansi untuk Keselamatan
Pasien OECD (Dewan Uni Eropa, 2009). Penyediaan asuhan
 keperawatan yang berkualitas dikondisikan oleh kepatuhan
terhadap prosedur keperawatan yang baik dalam praktik. Namun,
penelitian dari banyak negara menunjukkan bahwa penyediaan
layanan kesehatan secara inheren terkait dengan risiko bahaya
(Liukka et al., 2020; Schwendimann et al., 2018; Bis¸kin Çetin dan
Cebeci, 2021).
Terjadinya efek samping (KTD) yang dilaporkan oleh sumber-
sumber asing cukup bervariasi. Organisasi Kesehatan Dunia
(WHO) menyatakan bahwa kemungkinan mencederai pasien
selama penyediaan layanan kesehatan adalah 1 banding 300
(WHO, 2019). Pendidikan dan pelatihan profesional kesehatan di
Republik Ceko di bidang keselamatan pasien merupakan bagian
integral dari kurikulum pendidikan (UU No. 96/2004 Kol.,
sebagaimana telah diubah, UU No. 372/2011 Kol., sebagaimana
telah diubah). Semua tenaga profesional kesehatan harus
memahami sepenuhnya bagaimana menerapkan dan menerapkan
prinsip dan konsep keselamatan pasien. Sebagai pemimpin masa
depan dalam asuhan keperawatan, mahasiswa keperawatan saat ini
harus dipersiapkan sepenuhnya oleh sistem pendidikan untuk
secara efektif mengurangi risiko pada pasien dan meminimalkan
kesalahan pemberian obat - MAE (Konsep Keperawatan, 2021,
Kesehatan, 2030).
Isi Menyediakan layanan kesehatan yang berkualitas dan aman adalah
prioritas utama bagi semua sistem kesehatan. Kesalahan pemberian obat
termasuk dalam kesalahan yang sering terjadi dalam praktik keperawatan.
Oleh karena itu, pencegahan kesalahan pemberian obat harus menjadi
bagian integral dari pendidikan keperawatan.
Metode Penelitian representatif sosiologis dilakukan dengan
menggunakan Survei Kesalahan Pemberian Obat yang
terstandarisasi. Studi penelitian ini melibatkan 1205 perawat yang
bekerja di rumah sakit di Republik Ceko. Survei lapangan
 dilakukan pada bulan September dan Oktober 2021. Statistik
deskriptif, deteksi interaksi otomatis Pearson dan Chi-square
digunakan untuk menganalisis data. Pedoman STROBE digunakan.
Hasil Penelitian Di antara penyebab kesalahan pemberian obat yang paling sering
terjadi adalah nama (4,1 ± 1,4) dan kemiripan kemasan antara obat yang
berbeda (3,7 ± 1,4), penggantian obat bermerek dengan obat generik yang
lebih murah (3,6 ± 1,5), seringnya terjadi gangguan selama persiapan dan
pemberian obat (3,6 ± 1,5), dan rekam medik yang tidak terbaca (3,5 ±
1,5).
Tidak semua kesalahan pemberian obat dilaporkan oleh perawat. Pada
saat yang sama, perawat dengan pengalaman klinis yang lebih banyak (≥
21 tahun) memberikan estimasi kesalahan pemberian obat yang lebih
rendah secara signifikan dibandingkan perawat dengan praktik klinis yang
lebih sedikit (p <0,001).
Keunggulan 1. Penulis memaparkan permasalahan dengan jelas pada latar belakang
terkait kesalahan dalam pemberian obat.
2. Penulis memaparkan hasil penelitian dengan jelas pada isi jurnal.
3. Penggunaan bahasa mudah dipahami oleh pembaca.
 Nurse Education in Practice 70 (2023) 103642

Contents lists available at ScienceDirect

Nurse Education in Practice

Reasons for medication administration errors, barriers to reporting

them and th
from the perspective of nurses: A cross-sectional survey
Iva Brabcov´a a,*,1, Hana Hajduchova´ a,2, Val´erie To´ thova´ a,3,
Ivana Chloubova´ a,4, Martin Cˇ ervený a,5, Radka Prokeˇsova´ b,6, Josef
Malý c,7, Jiˇrí Vl ˇcek c,8, Martin Dosed ˇel c,9,

Kateˇrina Mala´-La´ dov ´a c,10

, Ondˇrej Tesaˇr c,11, Susan O’Hara d,12
a
University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, J.
Boreck´eho 1167/27, 370 11 Cˇesk´e Budˇejovice, Czech Republic

b
University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Humanities in the Helping Professions, J.
Boreck´eho 1167/27, 370 11 Cˇesk´e Budˇejovice, Czech Republic

c
Charles University, Faculty of Pharmacy in Hradec Kra´lov´e, Department of Social and Clinical Pharmacy, Akademika Heyrovsk´eho 1203, 500 05 Hradec Kra´lov´e,

Czech Republic

d
The Ohio State University College of Nursing 238 Heminger Hall 1577 Neil Avenue Columbus, OH 43210, United States of America

A R T I C L E I N F O
A B S T R A C T

Keywords:
The aim of the study was to identify the reasons for medication administration errors, describe
Hospital incident the barriers in their reporting and estimate the number of reported medication administration
reporting Medication errors.
administration error
Medication error Background: Providing quality and safe healthcare is a key priority for all health systems.
Medication adminis- tration error belongs to the more common mistakes committed in
Nurses
nursing practice. Prevention of medication administration errors must therefore be an
integral part of nursing education.
Nurse practice patterns
Nursing research
Design: A descriptive and cross-sectional design was used for this study.

Methods: Sociological representative research was carried out using the standardized Medication
Administration Error Survey. The research study involved 1205 nurses working in hospitals in the
Czech Republic. Field surveys were carried out in September and October 2021. Descriptive
statistics, Pearson’s and Chi-square automatic interaction detection were used to analyze the
data. The STROBE guideline was used.

Results: Among the most frequent causes of medication administration errors belong name
(4.1 ± 1.4) and
packaging similarity the substitution of brand drugs by cheaper generics (3.6 ± 1.5), frequent interruptions during
between different the preparation and administration of drugs (3.6 ± 1.5) and illegible medical records (3.5 ±
drugs (3.7 ± 1.4), 1.5). Not all medication administration errors are reported by nurses. The reasons for

* Correspondence to: University of South Bohemia in Cˇesk´e Budˇejovice, Faculty of Health and Social Sciences, J. Boreck´eho 1167/27, 370 11
Cˇeske´ Budˇejovice, Czech Republic.

E-mail addresses: brabcova@zsf.jcu.cz (I. Brabcova´), hajducho@zsf.jcu.cz (H. Hajduchova´), tothova@zsf.jcu.cz (V. To´thov´a),
chloubo@zsf.jcu.cz (I. Chloubova´), cervenymartin@zsf.jcu.cz (M. Cˇervený), rprokes@zsf.jcu.cz (R. Prokeˇsova´), malyj@faf.cuni.cz (J. Malý),
vlcek@faf.cuni.cz (J. Vlˇcek), DOSEM0AA@faf.cuni.cz (M. Dosedˇel), ladovaka@faf.cuni.cz (K. Mala´-La´dov´a), tesao7aa@faf.cuni.cz (O. Tesaˇr),
ohara.168@osu.edu (S. O’Hara).

1
ORCID https://orcid.org/0000-0002-8707-8091.

2
ORCID https://orcid.org/0000-0002-6594-4585.

3
ORCID https://orcid.org/0000-0002-7119-8419.

4
ORCID https://orcid.org/0000-0002-6631-6265.

5
ORCID https://orcid.org/0000-0001-5612-158X.

6
ORCID https://orcid.org/0000-0002-8602-8463.

7
ORCID https://orcid.org/0000-0002-6538-1639.

8
ORCID https://orcid.org/0000-0002-8431-8897.

9
ORCID https://orcid.org/0000-0001-5253-7967.

10
ORCID https://orcid.org/0000-0001-6554-7339.

11
ORCID https://orcid.org/0000-0001-5180-1375.

12
ORCID https://orcid.org/0000-0003-0004-1307

https://doi.org/10.1016/j.nepr.2023.103642

Received 30 January 2023; Received in revised form 15 March 2023; Accepted 30 March 2023

Available online 11 April 2023

1471-5953/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by- nc-nd/4.0/).
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

non-reporting of such errors include fear of being blamed for a decline in patient health (3.5 ± 1.5), fear of
negative feelings from patients or family towards the nurse or legal liability (3.5 ± 1.6) and repressive responses
by hospital management (3.3 ± 1.5). Most nurses (two-thirds) stated that less than 20 % of medication
administration errors were reported. Older nurses reported statistically significantly fewer medication
admin-

istration errors concerning non-intravenous drugs than younger nurses (p < 0.001). At the same time,
nurses with more clinical experience (≥ 21 years) give significantly lower estimates of medication
administration errors than nurses with less clinical practice (p < 0.001).

Conclusion: Patient safety training should take place at all levels of nursing education. The standardized
Medi- cation Administration Error survey is useful for clinical practice managers. It allows for the
identification of medication administration error causes and offers preventive and corrective measures that
can be implemented. Measures to reduce medication administration errors include developing a non-
punitive adverse event reporting system, introducing electronic prescriptions of medicines, involving clinical
pharmacists in the pharmacotherapy process and providing nurses with regular comprehensive training.

1. Introduction fully prepared by the education system to

effectively reduce risk to pa- tients and
The basic requirement for contemporary minimize Medication administration errors -
nursing is providing safe, quality nursing care. MAEs (Concept
The requirements for ensuring quality and of Nursing, 2021, Health, 2030).
safety in health services were formulated in
1.1. Background
detail by the Council of the EU in the
recommendation on Patient Safety and the
Adverse event means an event that causes
Prevention of Healthcare- Associated
harm to the patient and “Harm” implies damage
Infections and the WHO/Alliance for Patient
to the structure or impairment of the body’s
Safety of the OECD (The Council EU, 2009).
function and/or any resulting deleterious effects
The provision of quality nursing care is
(The Council EU, 2009; WHO, 2021).
conditioned by adherence to good nursing
Medication errors are a common type of
procedures in practice. However, studies from
adverse event in healthcare (Brabcova´ et al.,
many countries show that healthcare provision
2022). Medication errors can occur during a
is inherently associated with the risk of harm
healthcare professional’s ordering, storing,
(Liukka et al., 2020; Schwendimann et al.,
prescribing, preparing, or administering
2018; Bis¸kin Çetin and Cebeci, 2021). The
medicine (Bis¸kin Çetin and Cebeci, 2021).
occurrence of adverse events (AE) reported by
Patient compliance errors can also be
foreign sources is quite variable. The World
considered a type of medication error (Jain,
Health Organization states that the probability
2017). Medication administration errors relate
of harming a patient during healthcare
to errors in the preparation and administration
provision is 1 in 300 (WHO, 2019). Education
of both enteral and parenteral drugs
and training of healthcare professionals in the
(Assunça˜o-Costa et al., 2022; Berdot et al.,
Czech Re- public in the area of patient safety is
2021).
an integral part of the educational curriculum
Nurses are responsible for administering the
(Act No. 96/2004 Coll., as amended, Act No.
right medication to the right patient, at the right
372/2011 Coll., as amended). It is necessary
time, in the right way and in the correct form
that all health professionals fully under- stand
(Brabcova´ et al., 2021). However, as Jessurun
how to implement and apply patient safety
et al. noted, MAEs have multiple causes
principles and con- cepts. As future leaders in
(Jessurun et al., 2022) and usually comprise a
nursing care, today’s nursing students must be
combi- nation of personal, organizational,
2
I. Brabcova´ et al.
material and/or technical failures that may
harm the patient (Neugebauer et al., 2021;
Prokeˇsova´ et al., 2022). For example, in
studies by Berdot et al. (2021), Ha¨rk¨anen et
al. (2015) and Cottney and Innes (2015), the
prevalence of MAEs ranged from 1.5 % to
31.9 %.
The most common MAEs include non-
administration, incorrect drug substitution,
incorrect dose, form and route of
administration, admin- istration of an
unprescribed drug, improper handling of drugs
or improper administration technique and
incorrect time of administration (Mekonen et
al., 2020; Brabcova´ et al., 2021; Alomari et
al., 2020; Berdot et al., 2021; Jessurun et al.,
2022; Owens et al., 2020).
Health service providers in the Czech
Republic are legally obliged to evaluate the
quality and safety of health services. The
general objectives of quality and safety
assessments are (1) to continuously improve
the quality and safety of health services and
strengthen public confidence in health service
providers and (2) to continuously improve the
risk man- agement system (Act No. 372/2011
Coll., health services, as amended). The
Ministry of Health of the Czech Republic, per
Act No. 372/2011 Coll., requires health
service providers to implement and use an
internal system for assessing the quality and
safety of provided care. As part of this
internal control system, the health service
provider records and monitors adverse events
and identifies and evaluates their causes;
additionally, corrective or preventive
measures are identified to avert future adverse
events (Ministry of Health of the Czech
Republic, 2021). Globally, the number of
adverse events reported by healthcare pro-
fessionals to various hospital information
systems is significantly lower than the number
of actual errors detected by healthcare
professionals (Lee, 2017). The main reason
for this failure to report errors appears to be
fear of punishment (Aljabari and Kadhim,
3
Nurse Education in Practice 70 (2023) 103642
2021). Therefore, hospital managers need to
be aware of the potential concerns of
healthcare professionals about reporting
medication errors and work to increase their
willingness to report errors through system-
wide support (Kim and
Kim, 2019).
In the Czech Republic, a nationwide Central
Adverse Event Report- ing System has been
established. It is a professional platform for
health service providers used to evaluate
anonymized aggregated data so that it can be
shared and compared with others. The Central
Adverse Event Reporting System is the first
system that monitors the reporting of adverse
events for all inpatient healthcare providers
(Ministry of Health of the Czech Republic,
2018). In 2020, 101,027 events were reported
to the central system, of which the largest
number related to pressure ul- cers (47,755,
i.e., 57.6 pressure ulcers per 1000 patients) and
falls (29,
635, i.e., 54.7 falls per 1000 patients). In the
same year, 777 medication errors (i.e., 4.7
medication errors per 1000 patients) were
reported. The reporting does not include the
causes of the errors (SHNU, 2021).
1.2. Aim(s) and objective
The present research study aimed to:
1. examine reasons for Medication Administration Errors (MAEs),
2. identify reasons for non-reported MAEs,
3. determine the estimated percentage of reported MAEs.
2. Methods
2.1. Study design
A sociological representative study was
conducted. A descriptive and cross-sectional
design was used in this study.
I. Brabcova´ et al.
2.2. Study setting
Evaluation of MAEs committed by Czech
nurses was carried out using the standardized
questionnaire, Medication Administration
Error Survey (MAE Survey), (Wakefield et al.,
2005).
Consent to use and translate the MAE
Survey was obtained from the authors of the
questionnaire. The authors of the MAE Survey
also required the use of the original wording of
the survey questions (ques- tionnaire items) for
this study.
The linguistic validation of the translation
and cultural adaptation of the standardized
MAE Survey tool into the Czech language took
place in four phases:
1. In the first validation phase, the original questionnaire was trans-
lated into Czech. Subsequently, another translator performed a
reverse translation of the Czech version of the questionnaire back
into English. The reverse translation aimed to verify whether the
Czech version of the questionnaire had the same content as the
original.
2. The questions that, based on the translation of two independent
translators, had to be clarified, related to the names of the de-
partments or job positions of the nurses (for example, practical
nurses/general nurses). In the second phase, an expert committee
compared the translations with the original English version of the
questionnaire. The expert panel consisted of members of the research
team (four general nurses and two clinical pharmacists).
3. In the third phase, pilot testing of the pre-final version of the ques-
tionnaires took place (30 general nurses).
4. In the fourth and last phase, final modifications of the Czech
version of the questionnaire "Průzkum medikaˇcního pochybení "
were made.
For this study, Medication Administration
Error (MAE) is defined as an error related to
ingestion, injection, or administration of
individual therapeutic doses (e.g., incorrect
drug administration, wrong patient, wrong
drugs, incorrect diluents).
The standardized MAE survey is divided into three parts:
A. Reasons for MAEs (29 items)
B. Reasons why MAEs are not reported (16 items)
C. Estimate the actual percentage of reported MAEs (20 items)
In sections A and B of the questionnaire,
respondents indicated their agreement with
each item (using the Likert scale), from 1 =
4
Nurse Education in Practice 70 (2023) 103642
strongly disagree to 6 = completely agree.
In section C of the questionnaire, respondents
were asked to estimate the actual percentage of
MAEs reported in their unit.
2.3. Sample size calculation
The sample consisted of 1205 nurses working
in inpatient wards of hospitals in the Czech
Republic. The primary source of sample partici-
pants was the National Register of Health Care
Workers (NRZP), as it stood on 19 August
2021. The Institute of Health Information and
Sta- tistics maintains the register at the Ministry
of Health of the Czech Re- public (UZIS). It
lists the number of nurses and their occupation,
region and age. According to the Institute, in
2021, 101,981 nurses were working in hospital
facilities in regions across the Czech Republic.
Our sample of nurses from hospitals in the
Czech Republic was designed to reflect the age
and regional distribution of the general CZ
nursing population. The sample size of general
nurses working in hos- pital inpatient wards
was set at 1200. The calculation was performed
using the Sample Size Calculator program,
which used the size of the general population
nurses working in inpatient facilities.
Confidence levels of 95 % and confidence
intervals or margins of error of 3 % were
determined (according to Raosoft).
The sample of nurses was constructed so
that its structure corresponds to the basic
composition of nurses in the Czech Republic
regarding age and region of the country where
they worked. These se- lection criteria ensured
that the sample set was representative of the
general nursing population in the CZ.
Compared with the age breakdown of the
overall population, the deviation does not
exceed 0.3 %; therefore, our sample is
representative of the overall age distribution of
nurses in the Czech Republic.
When constructing the sample, the second
representativeness indi- cator was the number
I. Brabcova´ et al.
of nurses in individual regions of the Czech
Re- public. The regions were defined based on
an administrative division valid since 1
January 2001. As part of the research, nurses
from all re- gions of the Czech Republic were
included and their representation corresponds
to the structure of the population. Since the
population deviation did not exceed 0.2 %, our
sample is representative of the workplace
distribution seen in nurses working in the
Czech Republic.
2.4. Inclusion and exclusion
criteria Inclusion criteria:
A. nurses working in inpatient wards in hospitals in the Czech Republic,
B. nurses working as general nurses, practical nurses, specialist
nurses, shift workers and head nurses (station nurses and head
nurses).
Exclusion criteria:
• nurses unwilling to participate in the study,
• nurses working in outpatient facilities.
2.5. Preliminary study sample and results
The preliminary study to verify the
“Medication Administration Error Survey
(MAE Survey), Wakefield et al. (2005).” was
conducted with 122 respondents from
5/09/2021–15/09/2021. The study evalu- ated
the process of selecting respondents, the
study’s organization, the wording of the
interviewers’ instructions and the length and
wording of the individual questions.
Nurse Education in Practice 70 (2023) 103642
management of these hospitals was requested
by letter, telephone, or in some cases, in-
person meetings to participate in the study.
After explaining the focus and importance of
the research, all hospitals agreed to participate.
In the second stage, the management of these
hospitals appointed a staff member who, in
cooperation with a research assistant, randomly
selected (considering quotas for age) a
specified number of nurses. This number was
increased by 20 % in anticipation of some
nurses refusing to participate. These nurses
were subsequently approached with a request
to participate in the study. If a nurse did not
want to participate, another nurse on the list
was approached.
Nurses who agreed to participate signed a
consent form and a face-to- face interview was
conducted. The interview took place at each
nurse’s workplace; all interviewers were from
a professional network of the INRES research
agency. The interviewers had no relationship
with any of the hospitals. Interviewers asked
respondents questions from a worksheet
containing the “Medication Administration
Error Survey (MAE Survey), Wakefield et al.
(2005)” questionnaire, as well as ques- tions
regarding respondents’ sociodemographic and
professional infor- mation. Sample
composition of nurses by age and region is
given in

2.6. Selection of respondents and conduction of the survey

The field survey was conducted throughout

the Czech Republic from 26/09/2021–
15/10/2021. Respondent selection took place
in several stages using quota selection.
In the first stage, based on the number of
nurses in a given region, hospitals were
randomly selected from 234 hospitals listed
with the Institute of Health Information and
Statistics of the Czech Republic. The
5
 I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

Table 1
The reliability of the Czech version of the MAE
Sample composition of nurses by age and region. Survey questionnaire was tested by calculating
Cronbach’s Alpha coefficient. The lower value
Age ranges Nurses (N) % Deviation

up to 34 years 294 24.4 +0.1

for an acceptable reliability level value is 0.6
35–44 years 306 25.4 +0.1 and the upper value is 0.9. A Cronbach’s Alpha
45–54 years 363 30.1 0.0
55–64 years 201 16.7 —0.3 value higher than 0.9 means that there are
65 and more years 41 3.4 +0.1
Total number of nurses 1.205 100.0 0.0 redun- dant or repetitive items in the
Regions of the Czech Republic Nurses (N) % Deviation questionnaire.
Capital City of Prague
Central Bohemia Region
206
102
17.1
8.5
—0.2
—0.1
Area A “Reasons for Medication
South Bohemian Region 66 5.5 +0.1 Administration Errors (29 items)” achieved
Pilsen Region 66 5.5 +0.1
Karlovy Vary Region 30 2.5 0.0 Cronbach´s Alpha value of 0.873, while area B
Usti Region 72 6.0 —0.1
Liberec Region 48 4.0 +0.1 “Reasons for not reporting Medication
Hradec Kra´love´ Region 68 5.6 0.0
Pardubice Region 54 4.5 +0.2 Administration Errors (16 items)” obtained
Vysoˇcina Region
South Moravian Region
64
145
5.3
12.0
+0.1
—0.1
Cronbach´s Alpha value of 0.896. The level of
Olomouc Region
Zlin Region
77
63
6.4
5.1
0.0
—0.1
reliability in both areas
Moravian-Silesian Region 144 12.0 0.0
Total number of nurses 1.205 100.0 0.0 3. Results

Table 1. The summary of variables used in this study

The collection of the interviewers’ and termed sample characteristics are given
worksheets, visual inspections (for below and in Table 2.
Sample characteristics of nurses:
completeness) and data conversion into a
digital format was completed by 30 October
2021. Basic mathematical-statistical analysis, ▪ age (≤ 34 years – 24.4 %; 35–44 years – 25.4 %; 45–54 years –

processing of frequency and contingency tables
and basic data inter- pretation, including
processing nurse comments, were completed
by 15 November 2021.
2.7. Data analyses
Each completed interview sheet underwent
logical and visual in- spection. Interview sheets
with non-functional logical links or incom-
pletely filled-in were discarded. Subsequently,
a mathematical- statistical analysis of the data
was carried out. Measures of central tendency
(mean, variance and standard deviation),
frequency and pivot tables were determined.
The Pearson Chi-Square test and Cronbach’s
alpha were used in the context analysis. The
significance level was set at 5 % (p = 0.05).
30.1 %; 55–64 years – 16.7 %; ≥ 65 years and
over – 3.4 %),
▪ the highest level of education attained (secondary education –
37.1 %; tertiary professional 29.2 %;
university Bc. – 27.8 %; university Mgr. –
5.9 %),
▪ hospitals (university hospitals – 20.2 %; regional hospitals –
28.9 %; district hospitals – 38.7 %; other
– 12.2 %),
▪ department (surgery – 35.9 %; internal medicine – 49.8 %;
long-term care units – 14.3 %),
▪ number of patients per nurse/shift (≤ 20 patients – 58.8 %;
21–30 patients – 31.5 %; ≥ 31 patients – 9.7 %)),
▪ length of experience of nurses (≤ 5 years – 16.9 %; 6–10 years –
13.8 %; 11–15 years – 14.2 %; 16–20 years – 12.4
%; ≥ 21 years
– 42.7 %).
3.1. Reasons for Medication Administration Errors

Yates correction was applied in case of an

insufficient number of observations. Statistical The nurses indicated agreement with each
data processing was carried out using the SPSS item using the Likert scale, where responses
statistical program. ranged from 1 = strongly disagree (the
6
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

weakest reason for an MAE) to 6 = strongly

agree (MAE). The higher the value of the
arithmetic means, the stronger the overall
agreement that the item leads to MAEs.
In the opinion of nurses, the most common
reason for MAE was similarity in the appearance
of drugs (4.1 ± 1.4, data are rounded). This
was followed by name similarity (3.9 ± 1.4)
and packaging similarity

Table 2

Composition of nurses in CR according to selected socio-demographic indicators.

7
 I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642
Age N % Education N %
Up to 34 294 24.4 School of Nursing 447 37.1
35–44 306 25.4 Higher Nursing 352 29.2
school
45–54 363 30.1 Bachelor’s degree 335 27.8
55–64 201 16.7 Master’s degree 71 5.9
65 and above 41 3.4 In total 1205 100.0
In total 1205 100.0

Gender N % Achieved N %
specialization
Men 44 3.7 Yes 209 17.3
Women 1161 96.3 No 996 82.7
In total 1205 100.0 In total 1205 100.0

Hospital type N % Years of work N %

experience
University Hospital 244 20.2 Up to 5 years 204 16.9
Regional (regional) 348 28.9 6–10 years 166 13.8
hospital
was very high. District (regional) 466 38.7 11–15 years 171 14.2

The value of Cronbach’s alpha was in area C hospital

Other 147 12.2 16–20 years 150 12.4

"Estimated percentage of medication errors In total 1205 100.0 21 years and above
In total
514
1205
42.7
100.0
reported" 0.977 for intravenous drugs (11 items) Ward type N % Average number N %
and 0.964 for non-intravenous drugs (9 items). of patients
Surgical disciplines 433 35.9 Up to 20 patients 709 58.8
There were redundant or repetitive items in this Internal disciplines 600 49.8 21–30 patients 379 31.5
Department of follow- 172 14.3 31 patients and 117 9.7
part of the questionnaire. However, the up and long-term above

reliability is still satisfactory. care

In total 1205 100.0 In total 1205 100.0

2.8. Ethical approval

The study was approved by the Ethics

Committee of the Faculty of Health and Social
Sciences of the University of South Bohemia
Note: N = absolute frequency; % - relative frequency.
in Ceske Budejovice on 18 June 2019 by the
Declaration of Helsinki (WMA, 2022)

8
I. Brabcova´ et al.
(3.7 ± 1.4). Other causes of MAEs included
frequent substitution of branded original with
less expensive generics (3.6 ± 1.5), frequent in-
terruptions during the preparation and
administration of medicines (3.6
± 1.5), prescription of the same medicines to
multiple patients (3.6 ± 1.4), communication
problems with physicians, e.g., frequent changes
in instructions (3.3 ± 1.3) and illegibility of
medical records (3.5 ± 1.5). MAEs caused by
pharmacies (1.7 ± 1.0) were considered rare.
In other words, nurses mostly believed that
pharmacies prepared and labelled medication
correctly. Nurses also did not associate MAEs
with patient allergies (1.9 ± 1.0), failures to
follow the approved medication administration
procedures (1.9 ± 1.1), or the inability to find
informa- tion on medicines (2.0 ± 1.1), see
Table 3 and the appendix for more
information pp. 1–2.
3.2. Reasons for not reporting Medication Administration Errors
Agreement with each item on the Likert
scale was recorded; possible responses ranged
from 1 = strongly disagree (the weakest
reason for a reluctance to report an MAE) to 6
= strongly agree (the strongest reason for a
reluctance to report an MAE).
For interpretation, the higher the arithmetic
mean value, the stron- ger the reason for not
reporting MAEs to the hospital information system
and vice versa.
The weakest reasons (Table 4) for not
reporting MAEs by nurses included not
recognizing that a medication error had occurred
(2.2 ± 1.2), disagreement with the definition of
a medication error (2.3 ± 1.1, data in rounded),
expectations that medications be administered
exactly as prescribed were unrealistic (2.4 ±
1.3), contacting a doctor in the case of a
medication error is too time-consuming (2.5 ±
1.3) and medication errors are not clearly defined
(2.5 ± 1.2).
The strongest reasons (Table 4) for not
reporting MAEs included being blamed if
something happens to the patient because of a
9
Nurse Education in Practice 70 (2023) 103642
medi- cation error (3.8 ± 1.5), fear of negative
attitudes towards the nurse by the patient or their
family, or the potential for legal action against the
nurse (3.5 ± 1.6), nursing management focuses
on the individual instead of the system as a
possible cause of medication error (3.4 ± 1.5),
excessive emphasis on medication errors as a
measure of the quality of nursing care (3.3 ±
1.5) and the overall concern of nurses about the
adverse consequences of reporting medication
errors (3.3 ± 1.5), see appendix for more
information p. 3.
3.3. Estimated percentage of medication errors reported
For both intravenous (68.4 %) and non-
intravenous (63.6 %) drugs, approximately
two-thirds of nurses reported that only 0–20 %
of MAE were reported, according to their
estimates, see appendix for more in- formation
p. 4.
Our results, see Table 5, show that nurses
report a significantly higher number of MAEs
involving the administration of non-intravenous
drugs in district hospitals (p < 0.001) than
nurses in internal medicine
departments (p < 0.05). Younger nurses (< 35
years), p < 0.05 and
nurses with the least experience (< 5 years), p
< 0.001, reported significantly higher
estimates for the number of medication
errors
involving the administration of intravenous
drugs. A statistically sig- nificant association
between the number of reported intravenous
medication errors and nurse education was also
demonstrated; higher estimates of reported
medication errors in the administration of
intra- venous drugs were reported by nurses
with higher levels of education (p
< 0.05).
A significantly higher number of reported
errors in intravenous administration were
reported by nurses in regional hospitals than
by
nurses working in “other” hospitals (p <
0.001) and nurses working in internal medicine
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

departments (p < 0.01). determine what percentage of all medication

errors are reported and describe the reasons for
4. Discussion failure to report MAEs.
According to the research, the strongest
The present study focused on the issue of reasons given for MAEs are the similarity
MAEs in hospital settings. The analysis aimed between drugs (4.1 ± 1.4), between names
to identify the reasons for medication errors, (3.9 ± 1.4)
Table 3

Reasons for MAEs – comparison of mean values.

Reasons for MAE No Mode Median AVG s2 s

1. The names of many drugs are similar 1205 4 4 3.847 1.924 1.387
2. Different drugs look similar 1205 4 4 4.059 1.943 1.394
3. The packaging of many drugs is similar 1205 4 4 3.743 1.931 1.389
4. Doctor instructions are not readable 1205 4 4 3.467 2.164 1.471
5. Doctor instructions are not clear 1205 2 3 2.834 1.715 1.310
6. Doctors frequently change instructions 1205 4 3 3.303 1.803 1.343
7. Abbreviations are used instead of the name of drugs 1205 1 2 2.662 2.086 1.444
8. Instead of written instructions, only verbal instructions are given 1205 2 3 2.928 2.025 1.423
9. The pharmacy delivers the wrong strength of the drug 1205 1 2 2.080 1.399 1.183
10. The pharmacy does not prepare medicines correctly 1205 1 0 1.656 0.929 0.964
11. The pharmacy does not label the drugs correctly 1205 1 0 1.641 0.947 0.973
12. Pharmacists are not available 24 h 1205 2 3 3.181 2.910 1.706
13. Frequent substitution of branded drugs with generics 1205 4 4 3.591 2.172 1.474
14. Poor communication between nurses and doctors 1205 2 2 2.628 1.626 1.275
15. Multiple patients taking the same or similar drugs 1205 4 4 3.626 1.833 1.354
16. Lack of training for new medicines 1205 2 2 2.734 1.795 1.340
17. Difficult to find information about medicines 1205 1 2 1.980 1.128 1.062
18. Limited information for nurses on medications 1205 2 2 2.054 1.110 1.054
19. Nurses move between workplaces 1205 2 2 2.331 1.679 1.296
20. Missing information on late submission 1205 1 2 2.181 1.627 1.276
21. Non-compliance with drug administration procedures 1205 1 2 1.928 1.280 1.131
22. Frequent interruptions during medication administration 1205 4 4 3.607 2.172 1.474
23. Insufficient staffing levels 1205 2 3 2.954 2.309 1.520
24. Medication cannot be administered at the scheduled times 1205 2 2 2.676 1.593 1.262
25. Incorrect recording of medication instructions 1205 2 2 2.384 1.347 1.161
26. Documentation mistakes are often made 1205 2 2 2.484 1.505 1.227
27. Equipment malfunctions or is not set correctly (e.g., IV pumps). 1205 2 2 2.092 1.159 1.077
28. Nurses are not fully informed about patient allergies 1205 1 2 1.912 1.191 1.091
29. Patients off the ward for other procedures 1205 2 2 2.717 1.707 1.306

Note: Mo = mode; Me = median; AVG = average s2 = variance; s = standard deviation (data from tables are rounded in the text).

10
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

Table 4
Reasons for not reporting MAEs by nurses – comparison of mean values.

Reasons for unreported medication errors N Mo Me Average s2 s

1. Nurse disagrees with the hospital definition of MAE 1205 2 2 2.247 1.147 1.071
2. After a mistake it is not recognized by the nurse 1205 2 2 2.202 1.499 1.224
3. Time-consuming MAE form completion 1205 2 3 2.914 1.916 1.384
4. Contacting a doctor in the case of MAE is time-consuming 1205 2 2 2.455 1.672 1.293
5. MAEs are not clearly defined 1205 2 2 2.461 1.482 1.217
6. The error is not serious enough to be reported 1205 1 2 2.602 1.879 1.371
7. Fear of being seen as incompetent 1205 2 3 2.925 2.472 1.572
8. Fear of negative attitudes or lawsuits from the patient or their family 1205 4 4 3.473 2.412 1.555
9. Unrealistic medication administration requirements 1205 2 2 2.408 1.764 1.328
10. Fear of being reprimanded by a doctor for the mistake 1205 2 3 3.113 2.235 1.495
11. Concerns about the adverse consequences of MAE reporting 1205 4 3 3.258 2.206 1.485
12. Management responses do not match the severity of the errors 1205 2 3 2.847 1.693 1.301
13. Fears of accusations due to medication error 1205 4 4 3.749 2.367 1.539
14. Inadequate positive feedback on the correct administration of the drug 1205 1 3 2.954 2.665 1.633
15. Too much emphasis on MAEs as a measure of the quality of care 1205 3 3 3.300 2.305 1.518
16. Focusing too much on individuals in medication errors 1205 4 3 3.381 2.279 1.510

Note: Mo = mode; Me = median; s 2 = variance; s = standard deviation, (data from tables are rounded in the text).

and between drug packaging (3.7 ± 1.4), Table
3. Drugs that are more likely to be confused due
to the similarity of trade names or packaging are
called LASA (Look-A like Sound-A like) drugs,
Wakefield et al. (2005). Examples include
celecoxib (NSAID), phenytoin (antiepileptic) and
citalopram (antidepressant). The above drugs
have very similar
brand names (Celebrex, Cerebyx and Celexa),
MZCˇ R, 2016. Managers
establish logical procedures to prevent
confusion between LASA drugs. Other
considerations include the need to purchase
medicines with similar names, separate storage
of LASA drugs, highlighting the drug’s name
or strength on the drug’s packaging and so on.
Computerized or- ders or bar-coded medication
administration are a technological mea- sure
that further helps eliminate drug confusion
regarding strength and form.
Another problem area is frequently replacing
original branded drugs with cheaper generics (3.6
± 1.5), Table 3. In the Czech Republic, the
prices of medicines are not fixed, so to reduce
costs, hospitals respond to changes in medicine
prices and buy cheaper generic drugs. At the
same time, doctors may fail to notice drug
changes and prescribe drugs that are no longer
available in the hospital pharmacy. As a result,
nurses do not have the prescribed medication
available and are forced to ask the doctor to
change the prescription in the documentation.
11
An effective solution for the prevention of
MAEs is the use of elec- tronic prescriptions of
medicines via the hospital information system,
which is connected to the institutional
pharmacy and does not allow the attending
physician to prescribe an unavailable drug.
Another possible solution is to increase the
competencies of nurses. A necessary condition
for such a change is an update of the nursing
school pharmacology curriculum so that nurses
are adequately prepared to administer drugs
without an indication from a doctor in clinical
practice.
Another factor that increases the risk of MAEs
is communication problems with doctors
(frequent changes to instructions (3.3 ± 1.3),
illegibility of records (3.5 ± 1.5) and unclear
medical records (2.8 ± 1.3), Table 3. Timely,
accurate and comprehensible transmission of
written and oral information between doctors and
nurses is a prereq- uisite for minimizing the risk
of MAEs. Additionally, there is a cold and
distrustful relationship between doctors and
nurses, which should be seen as a significant
problem. Team members are often unwilling or
unable to cooperate and are often not interested in
providing and receiving information from each
other. It is a great challenge for man- agers to
support and build mature professional teams that
incorporates a sense of belonging and harmony in
formal and informal relationships, as well as a
I. Brabcova´ et al.
Table 4
team with the ability of self-reflection and self-
management.
Pharmacists are essential members of
medical teams. As primary drug experts,
pharmacists can significantly contribute at all
levels to minimizing MAEs (Malý, 2020). This is
recognized by nurses who cited the
unavailability of clinical pharmacists 24 h a
day (3.1 ± 1.7) as a strong risk factor
associated with MAEs. At present, the role of
clinical pharmacists in Czech hospitals is
growing. Clinical pharmacists pri- marily
cooperate with physicians to determine the best
medications for hospitalized patients. In
addition, they cooperate with other medical
staff, including nurses, where they can
contribute to minimizing medi- cation errors
(European Statements, 2014).
Other reasons for MAEs by nurses include
frequent interruptions of nurses during drug
preparation and administration (3.6 ± 1.5) and
staff shortages (2.9 ± 1.5), Table 3. Staff
shortages are the second most common reason
for MAEs (Elasrag and Abu-Snieneh, 2020),
although it was not one of the top issues in our
study. Insufficient staff causes overload, fatigue
and lack of concentration, all of which are risk
factors for AE/MAEs and reduce the safety of
care (El-Jardali et al., 2011). One potential
consequence of undersized nursing staff in the
Czech health service is failing to maintain
recommended drug administration times (2.6
± 1.2), Table 3. Plevova et al. (2020) also
noted that failure to comply with drug
administration times is one of the most
frequently neglected nursing duties.
Improper nursing procedures may also have
an impact on the pa- tient’s behavior at home. To
minimize this type of MAE, it is advisable to
introduce into clinical practice electronic
prescription of individual drugs by selection
from a database with default settings for
adminis- tration relative to food. It is also
necessary to strengthen the education of
nurses. Pharmacists play an essential role
12
Nurse Education in Practice 70 (2023) 103642
here, contributing to mini- mizing MAEs by
educating nurses about appropriate strategies
for drug administration relative to food and
drink.
In the opinion of nurses, the top four reasons
MAEs are not reported are (1) fear of accusations
over MAEs (3.8 ± 1.5), (2) due to fear of
adverse reactions from the patient or their family
(3.5 ± 1.6), (3) fear of management reactions
(3.3 ± 1.5) and (4) fear of physician reactions
(3.1 ± 1.5), Table 4. These results indicate that
a “traditional” health- care system persists in
Czech hospitals, dominated by a culture of in-
dividual guilt and employees are punished for
mistakes. Therefore, we are not surprised by the
concerns of the nurses in our study, i.e., when
MAEs occur, nursing management focuses on the
individual rather than the system as a possible
cause of the error (3.4 ± 1.5), Table 4. This
management approach is based on the mistaken
assumption that pun- ishment will improve the
quality of care and will also act as a warning to
others. However, we believe the opposite is true.
An authoritative and restrictive management
approach toward employees leads to staff
reluctance to report mistakes and misconduct. At
the same time, authoritatively managed systems
contribute to most errors (Brabcova´ et al.,
2021). That is why managers must change their
way of thinking by abandoning the traditional
approach to MAEs and issues of staff
misconduct. A fair system leaves employees
individually accountable for their actions but
protects them at the same time. They looked for
the real
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

Table 5

Estimated percentage of medication errors actually reported (%).

Type of error for non-intravenous medication Reported percentage (%)

0–20 21–30 31–40 41–50 51–60 61–70 71–80 81–90 91–99 100

1. Incorrect method of administration. 69.1 11.0 6.0 4.5 3.2 1.1 1.0 0.6 0.6 2.9
2. Incorrect filing time. 51.0 21.2 10.1 5.1 5.4 1.0 1.7 0.9 1.5 2.1
3. The wrong patient. 73.0 9.8 3.5 3.7 1.2 1.1 0.5 0.8 1.0 5.4
4. Incorrect dose. 63.2 16.0 5.0 2.5 3.1 2.7 0.9 1.2 1.1 4.3
5. Incorrect medicine. 68.5 12.5 3.2 3.1 3.9 1.0 1.1 0.9 1.0 4.8
6. The drug is not administered. 53.1 21.7 7.4 5.7 2.6 2.3 1.1 1.3 1.9 2.9
7. The drug is administered but not prescribed by a doctor. 59.2 17.2 8.8 3.5 3.0 1.7 0.8 0.9 1.2 3.7
8. The drug was administered after the instruction to discontinue treatment. 63.2 19.1 5.1 2.5 2.8 1.2 0.7 0.7 1.9 2.8
9. The drug was given to a patient with a proven allergy to the drug. 72.9 11.1 2.8 1.4 0.7 0.7 2.3 0.8 0.9 6.4
Average 63.6 15.5 5.8 3.6 2.9 1.5 1.1 0.9 1.2 3.9

Type of intravenous medication misconduct Reported percentage (%)

0–20 21–30 31–40 41–50 51–60 61–70 71–80 81–90 91–99 100
1. Incorrect method of administration. 75.9 9.0 3.6 1.7 1.2 2.4 0.6 1.2 1.0 3.4
2. Incorrect filing time. 56.8 19.2 9.4 5.1 3.2 0.9 0.9 0.9 1.2 2.4
3. The wrong patient. 76.4 9.0 1.8 1.1 0.7 2.7 0.7 0.2 1.4 6.0
4. Incorrect dose. 68.7 14.0 3.2 1.7 1.3 0.6 1.0 2.7 1.7 5.1
5. Incorrect drug. 76.2 7.7 2.7 1.3 2.7 0.7 0.9 0.6 1.2 6.0
6. The drug is not administered. 64.5 17.3 3.6 2.7 2.7 1.6 1.2 0.8 1.9 3.7
7. The drug is administered but not prescribed by a doctor. 67.0 13.8 4.4 2.7 1.6 1.1 0.3 2.7 2.1 4.3
8. The drug was administered after the instruction to discontinue treatment. 68.5 12.7 4.6 2.2 1.4 3.3 0.8 0.8 1.9 3.8
9. The drug was given to a patient with a proven allergy to the drug. 76.4 8.1 1.5 1.7 0.9 0.6 2.6 0.6 0.9 6.7
10. Incorrect solution. 69.9 13.9 2.9 3.8 1.3 0.6 0.3 0.6 1.6 5.1
11. Incorrect rate of administration. 52.4 19.8 10.0 4.8 2.3 1.8 1.3 3.4 1.2 3.0
Average 68.4 13.1 4.3 2.6 1.6 1.5 1.1 1.4 1.5 4.5

roots of the mistakes and try to address these The limitations of our study include the
issues. They introduced a non-punishing disadvantage of using a questionnaire since it
system for reporting adverse events and can sometimes distort the opinions of
encouraged open team communication and respondents. The nurses in our study expressed
feedback regarding AEs, MAEs and staff their attitudes, opinions and experi- ences.
misconduct (Ministry of Health of the Czech Another limitation is that the standardized
Republic, 2016; WHO, 2021). MAE survey does not consider the full
In the third part of our study, nurses were spectrum of causes of medication errors. The
asked to estimate the percentage of MAEs that ques- tionnaire does not address risk factors
are reported. An analysis of answers shows that associated with the work envi- ronment
two-thirds think that no more than 20 % of (inoperable equipment, lighting, noise), nursing
MAEs are reported, i.e., about 80 % are interventions (insufficient methods of patient
unreported, Table 5. In a study by Lee (2017), identification, failure to comply with the
MAE reporting rates were also very low (6.3– recommended spacing between medication and
29.9 %), as well as in a Turkish study (23.5 %) meals), or the patient (unwillingness of the
by Günes¸ et al. (2020). In contrast, high rates patient to follow the recommended instructions
of MAE reporting were observed in studies for the use of the drug and the nature of patient
from Taiwan 67.8 % (Yung et al., 2016) and illnesses, etc.). The MAE questionnaire is
Ethiopia 57.4 % (Jember et al., 2018). Higher focused on the opinion of nurses and does not
estimates of reported medication errors in the include the views of other healthcare
administration of intravenous drugs were professionals, such as pharmacists and doctors.
reported by nurses with higher levels of The strength of the study is its
education. representativeness. The study presents a unique
view of MAE in Central Europe. A strength of the
4.1. Strengths and limitations MAE survey is that it not only aims to identify
reasons for MAEs but also attempts to track the
13
I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642
number of MAEs reported relative to the total critical for inpatient safety, prevention of
number of MAEs and determine why nurses increased complications and subsequent read-
fail to report MAEs. The results of our study missions due to the long-lasting effects of errors. If
will hopefully highly motivate nursing care nurses can be part of a culture that teaches how
managers to move away from “traditional” to report errors without fear of repudiation and
approaches to AEs, MAEs and staff dismissal, then error reduction is predicted. It
misconduct that focus on individual failure and will prevent nurses from fear and anxiety in
toward a more progressive system that their jobs.
examines all factors that contribute to AEs, Additional key points of this research
MAEs and staff misconduct and assigns include the impactful role of education early on
responsibility and accountability appropriately. in nursing schools. If nurses are taught to
practice thoughtful medication administration,
5.Conclusions and relevance to clinical have the time to do so and have the ability to
practice and nurse education recognize an impending error or near-miss -
then patient care safety and quality are
Research has pointed out that risks of MAEs are potentiated.
present in the clinical practice of nurses and Curriculum programs using virtual and
MAE reporting continues to be inadequate. mixed reality can add to the growing
Therefore, it is essential for healthcare innovation movement in nursing and allied
managers to support educational processes in health education.
target groups of employees in the area of
monitoring, reporting and analysis of adverse
events, to increase the safety of medication
prescription and administration (shared
learning) through proactive and retroactive
interventions and to strengthen non-punitive
reporting and reporting systems. Patient safety
cannot be enhanced without educated
healthcare professionals.
As representatives of higher education
institutions, our role is to include and
continuously update drug safety in nursing
care curricu- lums. Graduates of nursing study
programs (1) must know the risks associated
with drug administration and
pharmacotherapy, (2) develop in-practice
control mechanisms for MAE prevention, (3)
understand the need to encourage patients to
actively participate in the medication process,
(4) understand the need to fully report MAEs
and learn from previous mistakes, (5) be able
to identify potential or actual drug-food
interactions and (6) understand the benefits of
a multidisciplinary approach to drug delivery
safety.
Patient safety as described in this research is
14
 I. Brabcova´ et al. Nurse Education in Practice 70 (2023) 103642

Further, teams of providers can get together in Declaration of Competing

the virtual world and practice each point of care Interest
in the complex system of medication
administration. The authors declare that they have no known
Additionally, hospital unit design has to competing financial interests or personal
adapt. Medication admin- istration errors have relationships that could have appeared to
been detailed in this research as related to the influence the work reported in this paper.
right time and right dose. If medication
dispensing units are not accessible, not equally
Acknowledgements
stocked and too far from a nurse’s assignment,
or the login process takes too long, errors will
We would like to thank all nurses who
continue. MAE measures within the hospital
graciously and willingly participated in the
will add to the growing role of the change in
study. We are grateful for the collaboration and
the design of the environment.
cooperation of hospital institutions in
In conclusion, the standardized MAE survey
supporting this study.
is an effective tool that helps to identify risks
in the prescription, preparation and administra-
Appendix A. Supporting
tion of drugs. Analysing the causes of
information
medication errors enables health service
providers to introduce preventive and Supplementary data associated with this
corrective mechanisms into practice in a article can be found in the online version at
targeted manner, thus increasing the quality doi:10.1016/j.nepr.2023.103642.
and safety of the care provided.

5.1. Further research References

Follow-up research focuses on direct drug Act No. 372/2011 Coll., on Health Services and Conditions for their Provision, as
Amended, Ministry of the Interior of the Czech Republic (Online). Retrieved from:
administration monitoring by the nurse during file:///C:/Users/majitel/Downloads/sb0131–2011-372–2011.pdf. (Accessed 2 April
2022).
morning, noon and evening drug
Act No. 96/2004 Coll., on Conditions for Obtaining and Recognizing Qualifications for
administration. Data collection took place in Non-medical Health Professions and for Performing Activities Related to the
Provision of Health Care, as Amended, Ministry of the Interior of the Czech Republic
the second half of 2022 in four hospitals in the (Online). file:///C:/Users/majitel/Downloads/sb030–04.pdf. (Accessed 2 April

South Bohemian Region. The number of 2022).

monitored medication ad- ministrations was Aljabari, S., Kadhim, Z., 2021. Common barriers to reporting medical errors. Sci. World

6536. Analyses of the monitored MAEs are J. 10 (2021), 6494889 https://doi.org/10.1155/2021/6494889.

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Health of the Czech Republic (grant number:
NU20-09-00257). All rights reserved.

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