PERCEPTION AND CULTURE OF

MEDICATION ERROR REPORTING (MER)

AMONG DOCTORS, PHARMACISTS AND
NURSES IN HOSPITAL TUANKU FAUZIAH
(HTF) KANGAR, PERLIS

MUHAMMAD NURHALIMI BIN AHMAD AZMIL

PUTERI NURUL FATIHAH BINTI DATU BANDIRA

PRECEPTOR:

CIK JURISMA CHE LAH

INTRODUCTION

– MEDICATION ERROR (ME)

– A medication error is any preventable event that may cause or lead to inappropriate
medication use or patient harm while the medication is in the control of the
healthcare professional, patient or consumer (Guideline on Medication Error
Reporting, Ministry of Health Malaysia).
– Samsiah et al (2016) stated in their study that medication errors are among of the
most common errors in a healthcare setting which may give a negative impact to
patients’ outcome.
– Types of Error
– Near miss: an error that has the potential to cause an adverse event (patient
harm) but fails to do so because of chance or because it is intercepted
– Actual error: an error that actually reaches patient
– ME reporting tools have been developed either nationally or locally in many
countries and healthcare organizations

– Ministry of Health Malaysia had introduced Medication Error Reporting System

(MERS) in August 2009 [Guideline on Medication Error Reporting, Ministry of Health Malaysia]

– Medication Error Reporting System (MERS) [Guideline on Medication Error Reporting, Ministry of Health
Malaysia]

– Objective: collecting information and maintaining a proper database

– Information are then analyzed and used as a foundation in developing
appropriate preventive measures
– In Malaysia, medication error reporting is at the moment on a voluntary basis.
– The majority of submitted ME reports were related to the stage of the medication process, which is
medication prescription involving near misses and medications that did not result in any harm to
patients [Samsiah, A., et al. , 2016 ].
– Pharmacy, nurses and doctor are studied due to they are frequently involved in the medication
process.
Classification of Medication Error Severity
– Although reporting systems have been introduced, underreporting of MEs still
persists and remains prevalent.
– Aboshaiqah (2013) in his study reported that up to 79% of actual errors were not
reported when he conducted a study among nurses in a tertiary hospital in Saudi
Arabia.
– From survey at Perak on ME practice, study by Doris, et al. (2018), less than half
(44.8%) of the respondents who had encountered ME eventually reported them.
The survey are conducted to both pharmacy and doctor all over Perak and the
result show that a underreporting are exist.
– Another study in Malaysia, where a interview session are conducted to healthcare practitioner over
nine publicly funded, primary care clinics, most of the participants agreed that MEs were
underreported despite the availability of a reporting system. (Samsiah, A., et al. , 2016 )
– The prevalence of underreporting of MEs may occur due to the existence of several barriers.
I. Harnell et al. in 2012 suggested that among the reasons of underreporting were being unsure of
what and how to report, increased burden of effort for the healthcare professionals.
II. Organisational factors such as lack of feedback were also reported as a factor of MEs underreporting
by Jeffe et al in 2004.
III. Blaming the individual instead of the system and fear-related factors were suggested by Toruner et
al. based on their study done in 2012.
 LITERATURE REVIEW
AUTHOR BC, Teoh & AA, Alrasheedy & Hassali, Mohamed & Tew, Mei-Mei & Samsudin, Mohd.

STUDY Perceptions of Doctors and Pharmacists towards Medication Error Reporting and
Prevention in Kedah, Malaysia: A Rasch Model Analysis.

CONTENT Objectives: to explore the perceptions of doctors and pharmacists towards reporting of
medication errors and to explore perceived factors that could cause or prevent medication
errors
Method: cross-sectional mail survey and Rasch model was used in data analysis
Findings: both doctors and pharmacists had relatively the same perceptions
• did not agree that their workload interferes with their ability to report medication errors
• moderately agreed that individuals could be blamed when an error is reported in the
department
• fear of blame could prevent some doctors and pharmacists from reporting medication
errors
 LITERATURE REVIEW
AUTHOR Sarvadikar A, Prescott G, Williams D.

STUDY Attitudes to reporting medication error among differing healthcare professionals

CONTENT Objectives: to investigate attitudes of healthcare professionals (doctors, nurses, and

pharmacists) in reporting medication errors.
Method:  questionnaire using two different clinical scenarios (involving oral and intravenous
administration of a drug) and four questions with an ascending order of worsening patient
outcome was used. A Likert scale ranging from 1 (unlikely) to 5 (likely) was used to describe
the likelihood of reporting a medication error
Findings:
• doctors were unlikely to report less-serious medication errors
• Nurses and pharmacists were likely to report less-serious as well as serious medication
errors despite their fears of receiving disciplinary action
• All healthcare professionals were more likely to report an error as the clinical scenarios
had a progressively worsening outcome for the patient.
MEDICATION ERROR REPORT
IN HTF
YEAR TOTAL MEDICATION ERROR REPORT
2014 38
2015 110
2016 54
2017(JAN-SEPT) 338
 Near Miss and True Error
Reported in Year 2014-2016.
120

100

80

60 [109] [53]

40
[10
]
20 [28]

[1] [1]
0
2014 2015 2016

True Error Near Miss

Number of Medication Error
Reports by Months in 2017
Near Misses and Actual Error Reported

60

50

40

30

20

10

0
January Februar March April May June July August Septem
y ber
Near miss 40 29 43 30 40 51 31 22 47
Actual error 0 1 0 1 0 1 2 0 0
Near Miss Error in 2017

35

298

Dispensing Error Prescribing Error

RESEARCH QUESTION

– What are the perception of doctors, pharmacists and nurses

towards medication error reporting?
– What are the culture of medication error reporting in HTF?
 OBJECTIVES

General objective
 To understand the perception of doctors, pharmacists and nurses in
HTF towards medication error reporting
 Specific Objectives 
– To explore the perceptions of doctors, pharmacists and nurses
towards reporting of medication errors and
– To explore the culture of medication errors reporting in HTF
 METHODOLOGY

Study Type and Design

- This is a cross-sectional self-administer questionnaire.
Study Population 
– Population study are all pharmacist and doctors in Hospital Tuanku
Fauziah, HTF.
 METHODOLOGY

Inclusion Criteria
– Inclusion criteria are all doctors, nurses and pharmacists who are working in out
patient department (OPD), in patient department (IPD) and clinical department of
HTF.
Exclusion Criteria 
– The exclusion criteria are students attached to HTF healthcare facility and nurses,
doctors or pharmacists who are on long leave (one month or longer).
Withdrawal Criteria
– Participants who had given informed consent may withdraw from this study at any
time.
 • Survey will be distributed along with the consent form to
ADMINISTRATION each department
• Explanation will be done to each department

COLLECTION • All questionnaires will be collected after two weeks time

ORGANIZING • The data will be collected and sorted in SPSS

• Mann Whitney test

ANALYSIS • Kruskal Wallis test
STATISTICAL ANALYSIS

– Mann Whitney test

– Compare the perception and culture of MER between gender and working
experience
– Kruskal Wallis test
– Compare the perception and culture of MER between profession and department
 GANTT CHART

MONTHS/ NOV DEC JAN FEB MAR APR MAY

ACTIVITIES
Discussion and literature review
Proposal presentation
Preparing and conducting data collection
Data analysis and result
Final writing and submission of research paper
Result presentation
APPENDIX
APPENDIX
APPENDIX
APPENDIX
DEFINITION

– Culture define as the set of conventions or social practice associated with a

particular field or activity.
– Perception is define as a though, belief or opinion that held by people.
REFERENCES

– J.K. Aronson; Medication errors: what they are, how they happen, and how to avoid them, QJM: An
International Journal of Medicine, Volume 102, Issue 8, 1 August 2009, Pages 513–521,
https://doi.org/10.1093/qjmed/hcp052
– Ministry Of Health Malaysia (2009) Guideline on medication error reporting.
– Samsiah, A., Othman, N., Jamshed, S., & Hassali, M. A. (2016). Perceptions and Attitudes towards
Medication Error Reporting in Primary Care Clinics: A Qualitative Study in Malaysia. PloS one, 11(12),
e0166114. doi:10.1371/journal.pone.0166114
– 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.
– Hartnell N, MacKinnon N, Sketris I, Fleming M. Identifying, understanding and overcoming barriers to
medication error reporting in hospitals: a focus group study. BMJ Qual Saf. 2012;21(5):361–8. doi:
10.1136/bmjqs-2011-000299 [PubMed]
REFERENCES

– Glavin RJ (2010) Drug errors: Consequences, mechanisms, and avoidance. Br J Anaesth 105:
76-82.
– Samsiah, A., et al. “Medication Errors Reported to the National Medication Error Reporting
System in Malaysia: a 4-Year Retrospective Review (2009 to 2012).” European Journal of
Clinical Pharmacology, vol. 72, no. 12, 2016, pp. 1515–1524., doi:10.1007/s00228-016-2126-x.
– George, Doris, et al. “Medication Error Reporting: Underreporting and Acceptability of
Smartphone Application for Reporting among Health Care Professionals in Perak, Malaysia.”
Cureus, 2018, doi:10.7759/cureus.2746.
– Samsiah, A., et al. “Perceptions and Attitudes towards Medication Error Reporting in Primary
Care Clinics: A Qualitative Study in Malaysia.” Plos One, vol. 11, no. 12, 2016,
doi:10.1371/journal.pone.0166114.
REFERENCES

– Jeffe DB, Dunagan WC, Garbutt J, Burroughs TE, Gallagher TH, Hill PR, et al. Using focus groups to
understand physicians’ and nurses' perspectives on error reporting in hospitals. Jt Comm J Qual Saf.
2004. September;30(9)471–9. [PubMed]
– Toruner EK, Uysal G. Causes, reporting, and prevention of medication errors from a pediatric nurse
perspective. Aust J Adv Nurs. 2012;29(4):28–35.
– Ashcroft DM. Likelihood of reporting adverse events in community pharmacy: an experimental study.
Qual Saf Heal Care. 2006. February 1;15(1):48–52. [PMC free article] [PubMed]
– Wagner LM, Damianakis T, Pho L, Tourangeau A. Barriers and facilitators to communicating nursing
errors in long term care settings. J Patient Saf. 2013;9(1):1–7. [PubMed]
– Sarvadikar A, Prescott G, Williams D. Attitudes to reporting medication error among differing healthcare
professionals. Eur J Clin Pharmacol. 2010;66:843–53. doi: 10.1007/s00228-010-0838-x[PubMed]