Medication Safety In Nursing Practice: Assessing The Impact Of Workload, Fatigue, And Staffing Ratios On Medication Errors Among Registered Nurses
Keywords:
Medication safety, Nurse workload, Fatigue, Staffing ratio, Patient safetyAbstract
Background:Medication errors remain a critical challenge to patient safety, particularly in resource-constrained healthcare settings. Registered nurses (RNs) play a central role in medication administration, and factors such as workload, fatigue, and staffing ratios may significantly influence the occurrence of such errors. This study aimed to assess the association between these occupational factors and medication errors among RNs in hospital settings in Pakistan.
Methods:A cross-sectional study was conducted among 80 registered nurses working in tertiary care hospitals. Data were collected using a structured, pretested questionnaire assessing workload, fatigue, staffing ratios, and self-reported medication errors in the past three months. Logistic regression was used to examine associations between independent variables and medication errors, adjusting for age, gender, and work experience.
Results:Medication errors were reported by 38.7% of participants. Higher workload (AOR = 2.41; 95% CI: 1.12–5.19; p = 0.024) and fatigue levels (AOR = 3.05; 95% CI: 1.32–7.05; p = 0.009) were significantly associated with increased odds of medication errors. Nurses reporting unfavorable staffing ratios (≥6 patients per nurse) were twice as likely to commit errors (AOR = 2.18; 95% CI: 1.04–4.58; p = 0.041).
Conclusion:The findings highlight the strong influence of workload, fatigue, and staffing adequacy on medication safety among nurses. Interventions aimed at optimizing nurse-to-patient ratios, managing fatigue, and balancing workload are essential to improve patient safety and healthcare quality in hospital settings..
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References
Bell, L., Gibbins, J., & Stone, P. W. (2023). Nurse fatigue and its association with medication errors: A scoping review. Journal of Nursing Management, 31(4), 845–858. https://doi.org/10.1111/jonm.13855
Hong, J., Kim, J. H., & Lee, Y. (2022). Perceived staffing adequacy, nurse fatigue, and quality of care in acute care hospitals: A cross-sectional study. International Journal of Environmental Research and Public Health, 19(12), 7220. https://doi.org/10.3390/ijerph19127220
Moradi, M., Rakhshan, M., & Joolaee, S. (2023). Medication errors and associated factors during COVID-19 pandemic among nurses in Iranian teaching hospitals. BMC Nursing, 22, 125. https://doi.org/10.1186/s12912-023-01251-9
Uysal, N., Şahin, S., & Akpınar, R. B. (2021). Nursing workload, staffing ratios, and patient safety outcomes in low- and middle-income countries: A systematic review. International Nursing Review, 68(4), 495–507. https://doi.org/10.1111/inr.12695
Yamamoto, A., Igarashi, T., & Watanabe, K. (2023). The relationship between nursing time, workload, and medication administration errors: Evidence from 10 Japanese hospitals. International Journal for Quality in Health Care, 35(1), mzad004. https://doi.org/10.1093/intqhc/mzad004
Zhang, L., Liu, X., & Sun, T. (2022). Workload and medication administration errors among nurses: A quantitative analysis across medical institutions. BMC Health Services Research, 22, 143. https://doi.org/10.1186/s12913-022-07564-1
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987–1993.
Alquraan, H., Al-Quraan, A., Al-Momani, M., & Qudah, A. (2020). Workload and time pressure as risk factors for medication errors among nurses in Jordanian hospitals. Journal of Nursing Management, 28(4), 948–956.
Asefa, T., Getachew, Y., & Tesfaye, H. (2021). Prevalence and factors associated with medication errors among nurses: A cross-sectional study. BMC Nursing, 20, 95.
Bae, S. H., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and adverse events: Systematic literature review. Nursing Outlook, 62(2), 138–156.
Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2018). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 74(7), 1534–1544.
Carayon, P., & Gurses, A. P. (2008). Nursing workload and patient safety — A human factors engineering perspective. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US).
Elden, N. M. K., & Ismail, A. (2016). The relationship between nurses’ work environment and medication errors: A systematic review. Journal of Nursing Care Quality, 31(3), 291–298. Geiger-Brown, J., & Trinkoff, A. M. (2010).
Is it time to pull the plug on 12-hour shifts? Journal of Nursing Administration, 40(3), 100–102. Holden, R. J., Scanlon, M. C., Patel, N. R., Kaushal, R., Escoto, K. H., Brown, R. L., ... & Karsh, B. T. (2011).
A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Quality & Safety, 20(1), 15–24. Johnson, A. L., Jung, L., Brown, K. C., Weaver, M. T., & Richards, K. C. (2017).
Sleep deprivation and fatigue in hospital nurses: Relationship to perceived error and safety culture. Journal of Nursing Care Quality, 32(4), 362–369. Kim, J., & Bates, D. W. (2013).
Medication errors associated with adverse drug events in hospitals: A systematic review. Pharmacotherapy, 33(9), 894–905. Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004).
The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202–212. Tiwary, A., Rani, N., & Kumar, S. (2019).
Incidence and causes of medication errors among nurses: A cross-sectional survey. International Journal of Nursing Studies, 98, 76–82. Zarea, K., Mohammadi, A., Beiranvand, S., Hassani, F., & Baraz, S. (2018).
The prevalence of medication errors among nurses: A systematic review and meta-analysis. International Journal of Clinical Practice, 72(10), e13201
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