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Table 2 Summary of study findings

From: Improving patient safety through identifying barriers to reporting medication administration errors among nurses: an integrative review

First Author/year Country Aim of study Design participants Key findings (Barriers)
Alrabadi (2020) [33] Jordan To explore nurses’ understanding, perception, attitude, and prevalence of MEs and thereafter defining the main factors associated with its occurrence and needed for designing proper policies for its sufficient prevention. Cross-sectional study design 156 nurses Underreporting was related to fear of losing a job. Nurses not acknowledging the gravity of the MEs to necessitate reporting. Fear of colleague nurses’ actions. Nurses’ knowledge about what constitutes ME. The use of medication incident reporting was a barrier to underreporting of MEs.
Lee (2017) [34] South Korea To identify differences in what nurses, consider as MAEs, to examine their willingness to report these errors, and to identify barriers to reporting MEs by hospital type. Cross-sectional, study design 548 nurses Fear of negative consequences was a major barrier to ME reporting. Fear of legal actions against nurses by patients or their families. ME reporting consumed much time. Fear of criticism from colleagues or other professionals was also a barrier to ME reporting. Fear of managers’ reactions or punitive measures against nurses. No feedback is given after reporting MAEs.
Alamrani, (2020) [30] Saudi Arabia To investigate barriers to MAEs reporting and to identify the reasons for MEs among nurses in Saudi Arabia. Cross-sectional study design 321 nurses Nursing administration focuses on the individual rather than using the systems approach to solve the problems. Lack of feedback from authorities. Nurses felt they could be blamed if something negative happened to the patient. Much emphasis is placed on MEs as a measure of the quality of nursing care. Nurses feared negative consequences from reporting MAEs. ME is not clearly defined. Nurses did not think the error was important enough to report. Disagreement with the hospital’s definition of a ME. Nurses were unaware of the occurrence of MAEs.
Dyab et al. (2018) [32] Malaysia To explore nurses’ knowledge on ME reporting by determining their attitudes towards reporting and studying the implicated barriers and facilitators. Exploratory qualitative design 23 nurses Lack of time to report MEs. Tiredness and heavy workload. Nurses felt they would be embarrassed if they reported MAEs. Fear of being blamed. Fear of punitive actions/investigations. Fear of negative impact on job records. Lack of confidentiality in the reporting system. No feedback on previously reported MEs.
Yung et al. (2016) [35] Taiwan To explore the attitudes and perceived barriers to reporting MEs and to understand the characteristics of – and nurses’ feelings – about error reports. Cross-sectional study design 306 nurses Nurses with no reporting experience. MAE occurrence without patient harm. Nurses who could not identify errors did not report. Fear of blame from superiors. Fear of being labelled as incompetent and inadequate nurses.
Nourian et al. (2020) [27] Iran aimed to determine the barriers of reporting MAEs from the point of view of nurses in neonatal and neonatal intensive care units. Cross-sectional study design 157 nurses Fear of legal action by patient or relatives. Afraid of the adverse consequences of reporting MEs. No positive feedback is given for passing medications correctly. Nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error.
Bifftu et al. (2016) [37] Ethiopia This study aimed to assess the prevalence of ME reporting and associated factors among nurses working at The University of Gondar Referral Hospital, Northwest Ethiopia Cross-sectional study design 282 Nurses Level of education. Disagreement overtime error definition. Fear of consequence and for administrative reasons.
Shahzadi et al. (2017) [38] Pakistan To assess the barrier in reporting MAEs among nurses. Cross-sectional
study design
222 Nurses Nurses did not recognize ME. Nurses did not take MEs to be significant. Reporting takes much time. Negative response from the hospital administration. No proper ME reporting system.
Abdullah et al. (2017) [28] Iraq 1. To assess the causes of medication errors.
2. To assess the barriers that prevent nurses  from reporting MEs.
3. To find out the association between nurses’ demographic data and causes of MEs.
4. To find out the association between nurses’ demographic data and barriers to reporting MEs.
study design
150 Nurses Negative attitude toward the nurse by either patient or relatives. The fear of patients complaining that an error has occurred due to negligence. Nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error. Too much emphasis is placed on MEs as a measure of the quality of nursing care provided. There is no support for the nurse when an error occurs. The lack of an administrative system. Lack of instruction in the hospital on the definition of errors resulting from giving drugs.
Rutledge et al. (2018) [36] United States The study’s purpose was to report ME reporting barriers among hospital nurses and to determine the validity and reliability of an existing MERB questionnaire. Cross-sectional
study design
359 nurses Extra time involved in documenting ME. The system for forms used to report ME is long and time-consuming. Fear of liability or lawsuits. Fear of being blamed. Fear of disciplinary action.
Dirik et al. (2019) [39] Turkey To investigate hospital nurses’ involvement in the identification and reporting of MEs in Turkey. Cross-sectional study design 135 nurses Afraid/hesitant to be seen as incompetent by peers. Afraid/hesitant of being punished by managers. Unaware a mistake has been made. They believe that reporting is unnecessary if the patient was not harmed. Afraid/hesitant of a negative reaction from the patient or relatives. No positive feedback was given to the person who reports the error. Considering the error is not serious enough to report. Afraid/hesitant of physicians’ negative reactions. Fear of losing his/her job. Lack of a clear definition of ME in the institution. Lack of training for nurses about medication errors. Unaware of an error reporting form/process. Completion of error reporting form takes too long.
Hammoudi et al. (2018) [31] Saudi Arabia To assess the factors contributing to the occurrence and reporting of MEs from the nurse’s perspective. Cross-sectional study design 367 nurses. Nurses do not agree with the hospital’s definition of a ME. ME is not clearly defined. Nurses did not see the error to be important enough to report. Filling out an incident report for a medication error takes too much time. Too much emphasis is placed on MEs as a measure of the quality of nursing care. Nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error. Nurses fear adverse consequences from reporting MEs.
Amrollahi, et al. (2017) [29] Iran To determine nurses’ perspectives on the reasons behind MEs and the barriers to error reporting Cross-sectional study design 213 nurses Fear over the negative effects of error reporting on salaries. Unfair supervisory reactions are disproportionate to error seriousness. Forgetting to report MEs. Fear over the negative effects on annual staff evaluation. Fear of blame from the supervisor. Unclear definition of MEs.
Albukhodaah, et al. (2016) [13] Saudi Arabia To identify potential barriers or challenges that may influence reporting of MAEs among nurses in Saudi Arabia Mixed method design (qualitative and quantitative) 366 nurses Fear of punishment from the administration. The administration focuses on the individual, not the system. No feedback after reporting MEs. Nurses are concerned about patients or families developing a negative attitude towards them with a loss of confidence in their nursing abilities. Nurses are concerned about facing lawsuits or legal action by patients or family. Nurses felt they might be seen as criminals when they report MEs.