Barriers of Medication Administration Error Reporting in Neonatal and Neonatal Intensive Care Units

Document Type: Original Article


1 Assistant Professor, Pediatric Nursing Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 PhD Candidate in Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 MSc in Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Assistant Professor in Biostatistics, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.



Medication administration error is the most common type of error in the field of medicine which is a risk factor for neonatal safety. These errors should be reported in order to prevent or mitigate their occurrence. In this regard, the present study aimed to determine the barriers of reporting medication administration errors from the point of view of nurses in neonatal and neonatal intensive care units.
Materials and Methods:
This descriptive cross-sectional study was performed on 157 nurses who were selected using the census sampling method. The participants were nurses of neonatal and neonatal intensive care units in the hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. Moreover, the required data were collected using the second part of the Medication Administration Error Reporting Survey whose psychometric properties (content validity, face validity, construct validity, and reliability) were determined beforehand.
Results of factor analysis indicated the fitness of the data of the Persian version of the scale with 16 items and four factors. Based on the findings, from the point of view of nurses, “fear” and “administrative response” were the most important barriers to reporting errors, in that order. The most and least common fears of nurses were the fear of negative perceptions and complaints of the family of patients (4.95±1.28) and the fear of reprimand by physicians (3.22±1.43), respectively. Moreover, the most important barrier in reporting the errors concerning the administrative response was the lack of positive feedback regarding the correct medication administration (4.22±1.62).
According to the results, it can be concluded that from the viewpoint of nurses, fear and administrative response are barriers to reporting medication administration errors.


1.             Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Therapeutic advances in drug safety. 2016;7(3):102-19.
2.             Baraki Z, Abay M, Tsegay L, Gerensea H, Kebede A, Teklay H. Medication administration error and contributing factors among pediatric inpatient in public hospitals of Tigray, northern Ethiopia. BMC pediatrics. 2018;18(1):321.
3.             Truter A, Schellack N, Meyer JC. Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa. South African Journal of Child Health. 2017;11(1):5-10.
4.             Clifton-Koeppel R. What nurses can do right now to reduce medication errors in the neonatal intensive care unit. Newborn and Infant Nursing Reviews. 2008;8(2):72-82.
5.             Stavroudis TA, Shore A, Morlock L, Hicks R, Bundy D, Miller M. NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit. Journal of Perinatology. 2010;30(7):459.
6.             Aboshaiqah AE. Barriers in reporting medication administration errors as perceived by nurses in Saudi Arabia. Middle-East J Sci Res. 2013;17(2):130-6.
7.             Taheri HabibAbadi E, Noorian M, Rassouli M, Kavousi A. Nurses' Perspectives on Factors Related to Medication Errors in Neonatal and Neonatal Intensive Care Units. Iran Journal of Nursing (2008-5923). 2013;25(80).
8.             Ni Y, Lingren T, Hall ES, Leonard M, Melton K, Kirkendall ES. Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit. Journal of the American Medical Informatics Association. 2018; 25(5): 555-63.
9.             Verklan MT, Walden M. Core Curriculum for Neonatal Intensive Care Nursing-E-Book: Elsevier Health Sciences; 2014.
10.          Wakefield BJ, Uden-Holman T, Wakefield DS. Development and validation of the medication administration error reporting survey. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY ROCKVILLE MD, 2005.
11.          Chiang H-Y, Lin S-Y, Hsu S-C, Ma S-C. Factors determining hospital nurses' failures in reporting medication errors in Taiwan. Nursing outlook. 2010;58(1):17-25.
12.          Hajibabaee F, Joolaee S, Peyravi H, Alijany‐Renany H, Bahrani N, Haghani H. Medication error reporting in Tehran: a survey. Journal of nursing management. 2014;22(3):304-10.
13.          Al-Youssif SA, Mohamed N. Nurses’ experiences toward perception of medication administration errors reporting. IOSR J Nurs Health Scienc. 2013;1(4):56-70.
14.          Ala’a Z, Aljasser IA, Sasidhar B. Barriers to reporting medication administration errors among nurses in an accredited hospital in Saudi Arabia. Br J Econ Manage Trade. 2016;11:1-13.
15.          Vrbnjak D, Pahor D, Štiglic G, Pajnkihar M. Content validity and internal reliability of Slovene version of Medication Administration Error Survey. Obzornik zdravstvene nege. 2016;50(1):20-40.
16.          You M-a, Choe M-H, Park G-O, Kim S-H, Son Y-J. Perceptions regarding medication administration errors among hospital staff nurses of South Korea. International journal for Quality in health care. 2015;27(4):276-83.
17.          DeVellis RF. Scale development: Theory and applications: Sage publications; 2016.
18.          WorldHealthOrganization. Process of translation and adaptation of instruments. Available from: https://www. substance _abuse/research_tools/translation/ en/ 2015.
19.          Yung HP, Yu S, Chu C, Hou IC, Tang FI. Nurses’ attitudes and perceived barriers to the reporting of medication administration errors. Journal of nursing management. 2016;24(5):580-8.
20.          Lee E. Reporting of medication administration errors by nurses in South Korean hospitals. International Journal for Quality in Health Care. 2017;29(5):728-34.
21.          Kim KS, KWON SH, KIM JA, Cho S. Nurses’ perceptions of medication errors and their contributing factors in South Korea. Journal of Nursing Management. 2011;19(3):346-53.
22.          Bifftu BB, Dachew BA, Tiruneh BT, Beshah DT. Medication administration error reporting and associated factors among nurses working at the University of Gondar referral hospital, Northwest Ethiopia, 2015. BMC nursing. 2016;15(1):43.
23.          Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse‐led medication monitoring. Journal of Nursing Management. 2011;19(3):377-92.
24.          Sarvadikar A, Prescott G, Williams D. Attitudes to reporting medication error among differing healthcare professionals. European journal of clinical pharmacology. 2010 ;66(8): 843-53.
25.          Lall S. The Lived Experience of Making a Medication Administration Error in Nursing Practice. International Journal of Nursing. 2017; 4(2):11-21.
26.          Erlen JA. Wanted—nurses: ethical issues and the nursing shortage. Orthopaedic Nursing. 2004;23(4):289-92.
27.          Witman   AB,  Park  DM,  Hardin  SB.  How do  patients want physicians to handle mistakes?: A survey of internal medicine patients in an academic setting. Archives of Internal Medicine. 1996;156(22):2565-9.
28.          Lan Y-H, Wang K-WK, Yu S, Chen I-J, Wu H-F, Tang F-I. Medication errors in pediatric nursing: Assessment of nurses' knowledge and analysis of the consequences of errors. Nurse Education Today. 2014;34(5):821-8.
29.          Sanghera I, Franklin B, Dhillon S. The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Anaesthesia. 2007; 62(1):53-61.
30.          Chiang HY, Pepper GA. Barriers to nurses' reporting of medication administration errors in Taiwan. Journal of nursing scholarship. 2006; 38(4):392-9.