CHAPTER ONE

INTRODUCTION

This chapter is the introductory chapter which presents the background of the study, the statement of the problem, the significance of the study, purpose of the study / broad objective, specific objectives of the study, research questions, hypothesis of the study, scope of the study and operational definition of terms.

Background of the Study

Nurses and all other health care professionals make mistakes in providing their care services regardless of the level of expertise, knowledge and precision (Crigger, 2014). Nursing errors can occur at any point during nursing activities and procedures, and the outcomes may be subtle or severe (Wagner, Damianakis & Pho, 2012). Such errors are more common in intensive care units (ICUs), due to the high-risk nature of the patients and the complex care they require; critically ill patients receive medications and interventions approximately twice as often as patients in other units (Camire´, Moyen, & Stelfox, 2009) and thus are exposed to greater opportunity for error. As frontline clinicians, nurses play an essential role in improving patient safety (Chipps, Wills & Tanda, 2011).

Compared with other members of the health care team, nurses spend more time with the patients and are much more engaged in giving continuous care to the patients. Such a relationship can expose nurses to a higher risk of making errors (Thomas, 2010). Statistics indicate that patients in ICUs experience an average of 1.7 errors per day and almost all of them suffer from a potentially life-threatening error at some point during their stay in the ICU (Moyen, Camire´, and Stelfox, 2014). In a study by Joolaee, Hajibabaee and Peyrovi, (2011), in Iran, the mean number of medication errors that nurses recalled was 19.5, and the mean error reporting was 1.3 cases in a 3-month period. Based on the code of ethics for nurses (Zahedi, Sanjari & Aala, 2013), a nurse is required to prevent possible injury to the client/patient by identifying and reporting professional errors of team colleagues. Any errors require an honest and open explanation to the client/ patient from the nurse involved (Sanjari, Zahedi & Aaelae, 2012). Overall, clinical errors are considered as important issues in society and concerns about such errors are increasing (Wiencek & Winkelman, 2010).

Reporting of human errors in health care agencies is often accompanied by embarrassment and fear of punishment; such errors can highlight lack of attention motivation and sufficient education and so there is a tendency to hide them (Beccaria & Pereira, 2009). Estimates suggest that 50–96% of adverse events are never reported (Kagan, & Barnoy, 2014), while about half of them are considered preventable (Zahedi, Sanjari & Aala, 2013). Understanding the type and causes of errors, and how to deal with and manage them are necessary for future prevention; all of which depends on a robust process of error reporting (Waters, 2010) any concealment or negligence in this process, in turn, can lead to consequences for the nurses, health care providers and the patients (Waters, 2010; Rathert, & May, 2017).

When a mistake is made, admitting and promptly reporting the error to an appropriate authority is the ‘right thing to do’. This is because hiding errors can have serious adverse consequences at both a practical and a moral level (Johnstone & Kanitsaki, 2016). Reporting of MAE is as important as intercepting them for providing valuable information about ‘near misses’ and errors to manage existing errors and prevent future errors (Kohn, Corrigan & Donaldson 2011). When hospitals identify medication error trends and problem areas, they can prevent future errors and, therefore, reduce patient harm and injuries (Association of Operating Room Nurses 2014). At the moral level, hiding errors (especially those that are clinically significant) may result in: besides, avoidable harm to patients, the nurse-patient fiduciary/trust relationship is being seriously undermined and, ipso facto, the good standing and reputation of the nursing profession as a whole (notably on account of the agreed ethical and professional practice standards of the profession concerning patient safety reporting requirements) being violated (Johnstone & Kanitsaki, 2016).

Reporting medication errors cause to improve patient safety and providing valuable information for prevention of medication errors in the future. Findings of Koohestani and Baghcheghi study (2008) indicated that 75.8% of medication errors committed by nurses (n=76) were reported to the instructor. Assessing nurses’ viewpoints about barriers to reporting of medical errors is a primary step to enhancing of reporting medication errors. Although, past studies have explored barriers in reporting medical errors among nurses, no attention has been paid by researchers to Aboh Mbasie General Hospital. This study was designed to address the need for understanding barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital.

Statement of the Problem

The most critical and crucial situation for patient is that when he\she received wrong medication or through wrong route. Providing safe medication administration is the primary and basic right of every patient to be treated safely without providing any harm to the patient by the negligence or incompetency of staff. The Institute of Medicine (IOM) issued a report, To Err is Human (Institute of Medicine (IOM), 2006): Building a Safer Health System. This is mentioned in the report of IOM that about 7,000 of death are occur annual because of the medication error which is going worse day by day. The effect of medication error is not good for patient, nurses, doctors and the health care system it reduce the efficiency of health care system.

The occurrence of medical errors can compromise patient confidence in the health care system by exposing them to risk of adverse drug reactions, increase the costs of care, and even death (Demehin, Babalola, & Erhun, 2012). The suffering is not only confined to patients, families, and health care agencies, even nurses, and pharmacists as well as other health care providers who are involved blame themselves for drug misadventures. They are worried and guilty, and the memory of the error stays with them for many years (Esi, & While, 2011). The Institute of Medicine report implicates (Institute of Medicine. 2011) medical errors (MEs), at least in part as a direct cause between 44,000 and 98,000 patient deaths annually in the United States. The global burden of MEs results from all types of adverse events which includes prolong hospital stay, financial burden, disability, morbidity and mortality.

It is also evident from the report of IOM that about 1.5 million of people are injured because of the medication administration error and annual expense for treating those patient take more than 3.5 billion dollar annually which is a great expense. This all happen just because of the medication administration error. Now a days it’s a very great concern for the stake holders of health care system that how to prevent medication error and reduce the death rate and the expenses (Institute of Medicine (IOM), 2006). In spite of the critical role of the nurse in identifying and reporting Medication errors when they occur, there has been little research attempting to assess their perception of these responsibilities. In fact, every step in patient care for a nursing professional involves a potential for error and some degree of risk to patient safety. This is especially true in regards to medication errors. Really, proper understanding of the contributing reasons for why medical errors occur, why medical errors not reporting and the extent to which errors are actually reported is the first step toward preventing errors.

Objectives of the Study

The purpose of the study is to assess the barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital. Specifically the objectives of the study are:

1. To identify the perceived barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital.

2. To identify the causes of the barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital.

3. To identify the strategies for reporting and preventing medical errors among nurses, in Aboh Mbasie general hospital.

Research Questions

The research questions are formulated based on the objectives and statement of problem to include;

1. What are the perceived barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital?

2. What are the causes of the barriers in reporting medical errors among nurses, in Aboh Mbasie general hospital?

3. What are the strategies for reporting and preventing medical errors among nurses in Aboh mbaise general hospital?

Research Hypothesis

The study attempted to test the following hypothesis:

There is no relationship between nurses’ years of experience and number of barriers in reporting medical errors in Aboh Mbasie general hospital.

Significance of the Study

In everyday nursing care there is a lot of medication error occurred which are not reporting properly due to multiple reasons. This study will help in identifying some of the main barriers which play a vital role in underreporting of medication error. This study will help the hospital administration to build systematic and effective strategies to prevent medication administration error and also help the staff nurses to know about their perception of underreporting medication error. The reporting of medication error will help the organization to develop measures to reduce the error therefore, cost effective health can be deliver to public.

The results of this survey will provide information on factors influencing medical errors (MEs) in this environment and the development of standards to reduce the incidence of MEs. The knowledge also would assist with system redesign to reduce or eliminate barriers to reporting MEs ultimately ensuring highest quality patient care. Though the issue of MEs has attracted attention from several quarters of the world, there are some countries which do not have the essential ME monitoring systems and are oblivious to the problems created by them. However, efforts are now being taken in these countries, especially Nigeria and India through pharmaco-vigilance system, to gather information on adverse drug reactions. Stakeholders (health workers, patients, caregivers, hospital management) will be aware of the factors associated with MEs, why medication administration/ dispensing errors are not reported and how they can be reduced. Future researchers may also use this study as a reference and guide for future studies on medication administration (MAEs)/ dispensing errors (DEs) as there is paucity of local data in this area

Scope of the Study and Delimitation

The coverage of this study is nurses, in Aboh Mbasie general hospital. The study is concerned with the assessment of barriers in reporting medical errors among nurses in Aboh Mbasie General Hospital. The study variables include barriers, causes, prevention and management of medical errors. The study covers the socio-demographic factors of age, gender, level of education and level of experience and the relationship between nurses’ years of experience and number of barriers in reporting medical errors will also be explored. Limitations of the study include its cross-sectional design and use of sample from only one general hospital; therefore, results cannot be generalized to all nurses.

Operational Definition of Terms

For the purpose of this study, the key terms have been defined as follows:

Medication Error: Any preventable event that may cause the handling and administrating of medication in an inappropriate way which may cause serious health problem to patient and may lead to severe consequences even the prevention of this are the responsibility of health care delivery person.

Barrier: Any situation or obstacles which prevent normal movements or being hurdle in doing something.

Nurse: The definition of a nurse is someone who cares for sick, old or young people, or someone who provides medical assistance. For the sake of this study, it refers to those working in Aboh Mbasie General Hospital.