Near misses: Nurses’ experiences with medication errors, power distance and error recover

Abstract

Background: Medication errors continue to be a major problem in health care settings in the United States. Research investigating factors contributing to medication errors continues in an attempt to reduce the incidence and save lives. Although electronic medical records and electronic prescribing technology have been reported to reduce the incidence, errors are continuing, some with significant impact on patient safety. A near miss is an incident that could potentially cause harm, was identified early and a mistake prevented. Little is known about near misses including the identification, intervention, prevention, and recovery. Nurses’ perceptions, what led up to the incident, and how they went about correcting these incidents (recovery) provides insight to understanding what near misses are, where they take place, and how. Poor communication is directly linked to medication errors and near misses. In nursing, one communication variable that relates to errors and near misses concerns the concept of Power Distance and how it affects communication between nurses, colleagues and families. Power distance is based on a perception of inequality existing between individuals. This perception of power inequality may contribute to errors associated with communication such as near misses, actual errors, poor adherence to treatment and poor compliance with medications.

Objectives: The aim of this study was to investigate nurse’s experiences of errors, recovery processes, the concept of Power Distance and poor communication that have led to near-miss incidents.

Methods: An on-line survey, developed for this mixed-methodological study, was completed by a total of 110 participants.

Results: Analysis of the descriptive data demonstrated three general themes of types of near misses experiences: wrong medication to wrong patients; error caught just before reaching patient; and recognition of error, correction made before implementation. Thematic analysis disclosed six themes related to actual examples of near misses: patient identified the near miss; medication was already administered by another nurse; a systems error occurred with the computerized dispending unit; the five rights were breeched; timing of administration was incorrect; and the wrong medication was dispensed directly from the pharmacy. Three themes emerged concerning miscommunication and near misses: between healthcare team members; between shifts; and pharmacy verifying and approving wrong med/wrong dose. Power distance was only minimally found to be of concern to the participants in relation to near misses.

Conclusions: Nurses’ experiences with near misses, recovery and Power Distance illuminate the need to further investigate what recovery behaviors and prevention practices are taking place. Further knowledge in this area may improve communication, reduce errors and ultimately increase patient safety.