Original study
Identifying Modifiable Barriers to Medication Error Reporting in the Nursing Home Setting

https://doi.org/10.1016/j.jamda.2007.06.009Get rights and content

Objectives

To have health care professionals in nursing homes identify organizational-level and individual-level modifiable barriers to medication error reporting.

Design

Nominal group technique sessions to identify potential barriers, followed by development and administration of a 20-item cross-sectional mailed survey.

Participants and Setting

Representatives of 4 professions (physicians, pharmacists, advanced practitioners, and nurses) from 4 independently owned, nonprofit nursing homes that had an average bed size of 150, were affiliated with an academic medical center, and were located in urban and suburban areas.

Measurements

Barriers identified in the nominal group technique sessions were used to design a 20-item survey. Survey respondents used 5-point Likert scales to score factors in terms of their likelihood of posing a barrier (“very unlikely” to “very likely”) and their modifiability (“not modifiable” to “very modifiable”). Immediate action factors were identified as factors with mean scores of <3.0 on the likelihood and modifiability scales, and represent barriers that should be addressed to increase medication error reporting frequency.

Results

In 4 nominal group technique sessions, 28 professionals identified factors to include in the survey. The survey was mailed to all 154 professionals in the 4 nursing homes, and 104 (67.5%) responded. Response rates by facility ranged from 55.8% to 92.9%, and rates by profession ranged from 52.0% for physicians to 100.0% for pharmacists. Most respondents (75.0%) were women. Respondents had worked for a mean of 9.8 years in nursing homes and 5.4 years in their current facility. Of 20 survey items, 14 (70%) had scores that categorized them as immediate action factors, 9 (64%) of which were organizational barriers. Of these factors, the 3 considered most modifiable were (1) lack of a readily available medication error reporting system or forms, (2) lack of information on how to report a medication error, and (3) lack of feedback to the reporter or rest of the facility on medication errors that have been reported.

Conclusions

The study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting. Efforts to improve medication error reporting frequency should focus on organizational-level rather than individual-level interventions.

Section snippets

Study Participants and Settings

The participants in our study were health care professionals who worked at 1 of 4 independently owned, nonprofit nursing homes affiliated with the University of Pittsburgh. One nursing home is in an urban setting, and the others are in suburban settings. The average number of beds in these nursing homes was 150 (range, 126 to 180), and the total number of regular full-time and part-time health care professionals who were classified as physicians, pharmacists, advanced practitioners, and nurses

Nominal Group Technique Sessions

The nominal group sessions involved a total of 28 participants (Table 1). The majority of participants were women (67.9%), were full-time employees (89%), and had worked for an average of 11.2 years in nursing homes. In each of the 4 individual sessions, participants discussed an average of 19.3 barriers to medication error reporting.

Survey

Of 154 surveys distributed, 104 (67.5%) were returned. Facility response rates ranged from 55.8% to 92.9%. Pharmacists had the highest response rate (100%), and

Discussion

Our study provides a broad-based account of barriers to medication error reporting in nursing homes, as viewed from multiple clinical perspectives. To our knowledge, this is the first study that has focused on this topic in the nursing home setting. We found that about two thirds of the modifiable factors requiring immediate action were organizational factors. This finding is consistent with recommendations made by various organizations, including the Institute of Medicine, the Joint Commission

Conclusion

The study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting. Our findings suggest that efforts to improve medication error reporting should focus on organizational rather than individual-level interventions. Further research is needed to determine if such organizational interventions would increase the frequency of medication error reporting and ultimately improve medication safety.

Acknowledgment

For their assistance throughout the study, we thank the staff of Asbury Health Center, Baptist Homes of Western Pennsylvania, RxPartners-LTC, UPMC Senior Living Seneca Place, and UPMC Senior Living Heritage Shadyside.

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    This study was supported in part by an American Medical Directors Association Foundation/Pfizer Quality Improvement Award, by a Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology, and by NIH grants 1K12HD049109–01, 5T32AG021885, P30-AG024827, and AG027017.

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