"It's Not Just a System Error": A Qualitative Study of Nurses' Perspectives on Medication Safety in Saudi Hospitals

Background: Medication errors remain a major threat to patient safety in acute care settings worldwide and are associated with preventable morbidity, mortality, and increased healthcare costs. Nurses play a critical role in identifying, intercepting, and preventing medication-related harm. However, limited qualitative evidence has explored nurses' perspectives on medication safety within the Saudi Arabian healthcare context. This study explored nurses' experiences of medication safety, perceived systemic challenges, and strategies for error prevention in Saudi hospitals. Methods: A qualitative descriptive design was employed. Fourteen (n = 14) nurses from two major referral hospitals in Saudi Arabia participated in semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's six-phase thematic analysis framework. Results: Five overarching themes were identified: (1) Communication gaps; (2) Medication processes; (3) Technology and safety; (4) Workload and staffing; and (5) Staff competence. Participants described how communication failures, staffing pressures, workflow interruptions, and documentation ambiguities compromised medication safety. While barcode systems and EHRs were perceived as valuable safeguards, participants emphasized that their effectiveness depended on staff vigilance, adequate training, and supportive workplace cultures. Conclusions: Medication safety is a dynamic socio-technical process shaped by communication, competence, staffing capacity, and human interaction with technology. Improving safety requires integrated organizational strategies that combine workforce investment, structured communication practices, continuous professional education, and non-punitive incident reporting cultures. These findings provide practical insights for healthcare leaders seeking to strengthen medication safety systems in Saudi Arabia and comparable settings.