BMJ Qual Saf 21:361-368 doi:10.1136/bmjqs-2011-000299
  • Original research

Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study

  1. Mark Fleming3
  1. 1College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
  3. 3Department of Psychology Saint Mary's University, Halifax, Nova Scotia, Canada
  1. Correspondence to Nicole Hartnell, 205 Carmel Crescent, Fall River, NS B2T1Y8; hartnelln{at}
  1. Contributors NH, NM, IS and MF conceived the study design. NH collected and analysed the data. All authors were involved in the interpretation of the data. NH drafted the article, and all authors were involved in critical revisions and approved the final version.

  • Accepted 18 January 2012
  • Published Online First 2 March 2012


Objectives The under-reporting of medication errors can compromise patient safety. A qualitative study was conducted to enhance the understanding of barriers to medication error reporting in healthcare organisations.

Methods Focus groups (with physicians, pharmacists and nurses) and in-depth interviews (with risk managers) were used to identify medication error reporting beliefs and practices at four community hospitals in Nova Scotia, Canada. Audio tapes were transcribed verbatim and analysed for thematic content using the template style of analysis. The development and analysis of this study were guided by Safety Culture Theory.

Results Incentives for medication error reporting were thematised into three categories: patient protection, provider protection and professional compliance. Barriers to medication error reporting were thematised into five categories: reporter burden, professional identity, information gap, organisational factors and fear. Facilitators to encourage medication error reporting were classified into three categories: reducing reporter burden, closing the communication gap and educating for success. Participants indicated they would report medication errors more frequently if reporting were made easier, if they were adequately educated about reporting, and if they received timely feedback.

Conclusions Study results may lead to a better understanding of the barriers to medication error reporting, why these barriers exist and what can be done to successfully overcome them. These results could be used by hospitals to encourage reporting of medication errors and ultimately make organisational changes leading to a reduction in the incidence of medication errors and an improvement in patient safety.


  • Funding Funding for this study was provided by the Dalhousie University Killam Foundation, the Dalhousie University College of Pharmacy Endowment Fund, the Nova Scotia Health Research Foundation, and the Canadian Institutes for Health Research. Nicole Hartnell received a Canadian Graduate Student Award to complete this study as part of her PhD requirements.

  • Competing interests None.

  • Ethics approval Dalhousie University, all four study hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Audio tapes, notes and unpublished data from this study are securely stored and only available to Nicole Hartnell.

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