BackgroundMany studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses’ work experience in relation to the risk and type for medication errors.MethodsAll medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses’ work experience and associations within and between the errors and contributory factors, Fisher’s exact test was used, and Cohen’s kappa (k) was performed to estimate the magnitude and direction of the associations.ResultsThere were a total of 613 medication errors in the 585 cases, the most common being “Wrong dose” (41 %), “Wrong patient” (13 %) and “Omission of drug” (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being “Negligence, forgetfulness or lack of attentiveness” (68 %), “Proper protocol not followed” (25 %), “Lack of knowledge” (13 %) and “Practice beyond scope” (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being “Role overload” (36 %), “Unclear communication or orders” (30 %) and “Lack of adequate access to guidelines or unclear organisational routines” (30 %). The errors “Wrong patient due to mix-up of patients” and “Wrong route” and the contributory factors “Lack of knowledge” and “Negligence, forgetfulness or lack of attentiveness” were more common in less experienced nurses. The experienced nurses were more prone to “Practice beyond scope of practice” and to make errors in spite of “Lack of adequate access to guidelines or unclear organisational routines”.ConclusionsMedication errors regarded as malpractice in Sweden were of the same character as medication errors worldwide. A complex interplay between individual and system factors often contributed to the errors.

DRPs were common. Potential drug interactions and adverse drug reactions dominated. Hospital-based medication review by a clinical pharmacologist was not associated with reduced rates of re-hospitalisation and/or death. The clinical relevancy of DRPs might be overestimated as a risk for re-hospitalisation or death. It is of great importance to clarify if and how drug-related problems can be prevented. In designing such studies, one should consider choosing inclusion criteria that accumulate risk.

ObjectivesSafe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses’ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses’ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists.DesignA cross-sectional survey.SettingThe study was conducted in 17 European countries, each with their own health systems.ParticipantsPharmacists, physicians and nurses with an active role in PC were surveyed.Main outcome measuresNurses’ involvement in PC, experiences of interprofessional collaboration and communication and views on nurses’ competences.ResultsA total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses’ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC.ConclusionsME, MMA, PEI and prescribing are part of nurses’ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more.

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