Medication errors as malpractice-a qualitative content analysis of 585 medication errors by nurses in Sweden

Area of Science:

• Nursing Practice
• Patient Safety
• Healthcare Malpractice

Background:

• Limited research exists on medication errors severe enough to constitute malpractice.
• Studies often analyze individual and system factors contributing to medication errors.
• Nurses play a critical role in medication administration, with conflicting reports on experience-error relationships.

Purpose of the Study:

• To analyze medication errors resulting in malpractice claims against nurses in Sweden.
• To classify error types and identify individual and system contributory factors.
• To investigate the association between nurses' work experience and error characteristics.

Main Methods:

• Qualitative content analysis of 585 malpractice cases involving nurses over 11 years in Sweden.
• Classification of medication errors by type and contributory factors (individual and system).
• Statistical analysis (Fisher's exact test, Cohen's kappa) to assess differences based on nurse experience.

Main Results:

• Most common errors: Wrong dose (41%), Wrong patient (13%), Omission of drug (12%).
• Frequent individual factors: Negligence/forgetfulness (68%), Protocol not followed (25%), Lack of knowledge (13%).
• Frequent system factors: Role overload (36%), Unclear communication (30%), Inadequate guidelines/routines (30%).
• Less experienced nurses: More prone to 'Wrong patient,' 'Wrong route,' 'Lack of knowledge,' and 'Negligence.'
• Experienced nurses: More prone to 'Practice beyond scope' and errors despite unclear guidelines.

Conclusions:

• Medication errors leading to malpractice in Sweden share characteristics with global trends.
• A complex interplay of individual and system factors consistently contributes to these errors.
• Nurse experience is linked to specific error types and contributing factors, suggesting tailored safety strategies.