Factors contributing to medication errors : A descriptive qualitative study of Italian nursing students

Background: It is estimated that 20–40 % of medication errors (MEs) made by nursing students are not reported, thus creating a gap in learning from mistakes. There is scarce literature on the reasons for the underreporting of MEs made by nursing students. Objectives: The aim was to analyse the opinions of nursing students about MEs, types and causes and factors that facilitate or discourage ME reporting during clinical training. Design: Qualitative descriptive design. Settings: Nursing School affiliated with Milan University, Italy. Participants: A purposeful sample of third-year or near-graduation nursing students. Methods: Data were collected between October and November 2019 through focus groups until data saturation. A semi-structured interview was used for conducting the focus groups and categories were identified by content analysis. Triangulation of researchers and member checking were performed to ensure result trustworthiness. Results: The study sample was 37 students assigned to four focus groups. Four ME categories were identified: type; cause(s); barriers; and facilitators of reporting. The most common errors were wrong drug, incorrect drug dosage and dilution, which were attributed to individual and/or organizational factors. The main barrier to ME reporting was fear of receiving a negative evaluation by the head nurse. Nonetheless, constructive reflexive evaluation was perceived as a facilitator of ME reporting. Conclusions: Our findings show that MEs made by nursing students during their placement oftentimes go unreported to avert negative evaluation. Barriers to ME reporting may be reduced by enhancing risk awareness and error analysis with the support of clinical nurses and nursing mentors.