Effects of working conditions on intravenous medication errors in a Japanese hospital

The aim of this study was to explore quantitatively which working conditions influence the occurrence of medical near-miss errors related to intravenous medication at a hospital in Japan.

Although working conditions such as stress, fatigue and inexperience have been reported to contribute to medical errors, countermeasures to these conditions have been delayed, and working conditions have deteriorated in many Japanese medical sites.

A self-reporting questionnaire analysing working conditions that can lead to near-miss errors relating to intravenous medication was sent to 90 nurses working in four wards of one Japanese hospital in 2001. Eighty-eight subjects responded (response rate: 97.8%). Among 534 person-days in which 88 nurses attended works, 525 person-days of data were used for the analyses.

Among 525 person-days, the number of near-miss errors was 94 (17.9%). There was no significant difference in the occurrence of near-miss errors among the three shifts (day shift, 19.2%; evening shift, 19.2%; night shift, 12.5%). During the day shift, errors were reported at a significantly higher frequency when the nursing services were delayed longer due to workload. During the evening shift, errors were reported when the nursing services were delayed longer due to workload and when years of experience at the current ward were shorter. In addition, nurses whose perceived level of fatigue before work was lower during the day shift, and nurses whose years of experience as a nurse were longer and who had longer sleep duration during the evening shift experienced near-miss errors with a significantly higher frequency than other nurses. These latter factors could be important conditions that encourage the detection of errors before they occur.

Workload and lack of experience at the current ward are two conditions that can lead to errors. Furthermore, lack of fatigue and long experience as a nurse may help encourage the detection of errors before they occur. It is important to improve working conditions so that health care workers can detect errors before patients are harmed and decrease the number of errors that occur.