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 unre-ported 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.