Medication Error Reporting and the Work Environment in a Military Setting

Following the Institute of Medicine's report on medical errors and recommendations to curb them, the Department of Defense (DoD) set a goal of reducing medical errors by 50% over the next five years. Prevention strategies to reduce medical errors overall and medication errors in particular require accurate information on the occurrence of these errors. Civilian sources report underestimations in institutional (incident) reports, at least in part due to the fear of negative consequences associated with error disclosure. A change in focus from individual blame to systems failures is often advocated to reduce errors. Recent studies have demonstrated an association between organizational factors and reasons for not reporting medication errors (Wakefield, Wakefield, & Uden-Holman, 2000). Previous research suggests certain contextual features of the inpatient work environment enhance patient outcomes. It is possible that these same features minimize error rates and/or enhance error disclosure. This study will focus on error reporting and the work environment of nurses. It seeks to: 1) assess the differences in medication error reporting between an anonymous report method and the current formal incident report system; 2) examine the relationship of the nursing work environment and medication error reporting; 3) assess civilian and military nurses' perceptions of the reasons for medication errors, reasons for non-report and extent of non-report; and 4) assess the relationships of unit-based and shift-specific organizational factors with the likelihood of medication error and/or error report. Cross-sectional and longitudinal data will be collected from military, civilian, and contract registered nurses. Nurses' perceptions of the reasons for medication errors, reasons for non-report and extent of non-report will be assessed using Medication Administration Error Survey. The Revised Nursing Work Index will provide the organizational attribute data. The Workload Management System for Nursing will serve as the source for staffing information. Formal incident report medication errors rates will be obtained from the institution's performance improvement database. Anonymous medication error reports and shift-based workload information will be collected at the end of each nurse's shift via a coupon over a 30-day period. Data will be analyzed using descriptive, correlational, and multivariate statistics. This study will employ multiple units of analysis: individual reports, shift-based reports and unit-specific aggregates. Only by investigating medication error reporting and the context that supports or deters such reporting can we begin to develop reasonable strategies for increasing error reporting and ultimately measuring error reduction.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2014101776.xhtml