Perceived factors contributing to medication administration errors and barriers to reporting

among nurses in Cardiac Emergency Departments of Punjab, Pakistan

Shazia Saleem¹, Samina Kausar², Yasmeen Saleem¹, Arooj Fatima¹, Shahida Parveen¹

¹MS Nursing Scholar, University of Health Sciences, Lahore, Pakistan

²Professor of Nursing & Head of Department, Institute of Nursing, University of Health Sciences,

Lahore, Pakistan

Correspondence: Shazia Saleem, Institute of Nursing, University of Health Sciences, Lahore

ABSTRACT

Objective: To determine the factors contributing to medication administration errors (MAEs),

identify barriers to reporting medication errors (MEs), and assess the association of identified factors

with practice-related characteristics among nurses working in emergency departments of cardiac

hospitals in Punjab, Pakistan.

Methodology: A cross-sectional analytical study was conducted at Multan Institute of Cardiology

(MIC) and Rawalpindi Institute of Cardiology (RIC) from 2023-2024. A total of 181 registered nurses

working in cardiac emergency departments were included using universal sampling. Data were

collected using a modified and validated questionnaire consisting of three sections: demographic

profile, factors contributing to MAEs (31 items across four categories), and barriers to reporting MEs

(10 items). Statistical analysis was performed using SPSS version 25. Chi-square test was used to

determine associations, with p-value ≤0.05 considered significant.Results: Nurse-related factors emerged as the most significant contributors to MAEs (Mean=35.14,

SD=8.4), followed by patient and workplace challenges (Mean=20.41, SD=7.3), administrative

factors (Mean=14.12, SD=1.9), and medicine/physician order factors (Mean=12.45, SD=4.6). The

most prevalent barrier to reporting MEs was fear of disciplinary punishment/lawsuits (Mean=4.41,

SD=1.95). All practice-related characteristics showed statistically significant associations with MAE

factors (p<0.05). Years of experience (p=0.002), working in multiple hospitals (p=0.001), nurse-to

patient ratio (p=0.001), availability of guidelines (p=0.001), and shift type (p=0.031) were

significantly associated with MAE factors.

Conclusions: Nurse-related factors and fear of punishment represent critical challenges in cardiac

emergency departments. The significant association between practice characteristics and MAEs

underscores the need for targeted interventions addressing staffing ratios, guideline implementation,

and non-punitive reporting cultures to enhance patient safety.

Keywords: Medication administration errors, barriers to reporting, cardiac emergency department,

nurses, patient safety, Pakistan.