Role of Nurses in the Prevention and Management of Medication Errors in Hospital Settings: A Cross-Sectional Analytical Study from Tertiary Care Hospitals in Punjab, Pakistan

Abstract

Background: Medication errors are among the most common and preventable threats to patient safety worldwide. Nurses serve as the final safeguard before medication administration; however, evidence regarding the prevalence and determinants of medication errors in low- and middle-income countries, including Pakistan, remains limited. This study aimed to assess the prevalence, types, and contributing factors of medication errors among nurses in Pakistani hospitals and identify strategies for prevention.

Objectives: To determine the prevalence and patterns of self-reported medication errors among registered nurses, identify individual and organizational factors contributing to errors, and examine associations between nurse characteristics, institutional variables, and medication error occurrence.

Methods: A cross-sectional analytical study was conducted in six tertiary-care hospitals across Punjab, Pakistan, from September 2023 to January 2024. Using stratified random sampling, 300 registered nurses were recruited. Data were collected through a validated 60-item self-administered questionnaire covering socio-demographic characteristics, medication error prevalence, contributing factors, and preventive practices. Reliability was confirmed through Cronbach’s α (0.87) and test–retest reliability (ICC = 0.84). Data were analyzed using descriptive statistics, chi-square tests, correlation analyses, and binary logistic regression in IBM SPSS version 26, with statistical significance set at p < 0.05.

Results: Of the 300 participants (mean age 33.4 ± 7.8 years; 67.3% female), 71.7% reported at least one medication error during the previous 12 months. The most common errors were documentation/transcription mistakes (39.3%), wrong-time medication administration (34.3%), and omission of prescribed medications (32.3%). Major contributing factors included high patient-to-nurse ratios (87.3%), workload-related fatigue (84.7%), and illegible or incomplete prescriptions (79.3%). Error reporting remained low, particularly for documentation errors and medication omissions. Logistic regression showed that greater clinical experience, higher nursing education, structured medication safety training, and a non-punitive reporting culture significantly reduced error risk, whereas high patient-to-nurse ratios were the strongest independent predictor of medication errors.

Conclusion: Medication errors are highly prevalent among hospital nurses in Pakistan and are largely driven by systemic factors. Strengthening staffing levels, medication safety training, electronic medication systems, and non-punitive reporting mechanisms may substantially improve patient safety outcomes.