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.
Keywords
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Article info
Publication history
Published online: October 18, 2007
Footnotes
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.
Identification
Copyright
© 2007 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
