Research Article: Exploring facilitators and barriers to medication error reporting among healthcare professionals in Qatar using the theoretical domains framework: A mixed-methods approach

Date Published: October 2, 2018

Publisher: Public Library of Science

Author(s): Derek Stewart, Binny Thomas, Katie MacLure, Kerry Wilbur, Kyle Wilby, Abdulrouf Pallivalapila, Andrea Dijkstra, Cristin Ryan, Wessam El Kassem, Ahmed Awaisu, James S. McLay, Rajvir Singh, Moza Al Hail, Andrew Soundy.


There is a need for theory informed interventions to optimise medication reporting. This study aimed to quantify and explain behavioural determinants relating to error reporting of healthcare professionals in Qatar as a basis of developing interventions to optimise the effectiveness and efficiency of error reporting.

A sequential explanatory mixed methods design comprising a cross-sectional survey followed by focus groups in Hamad Medical Corporation, Qatar. All doctors, nurses and pharmacists were invited to complete a questionnaire that included items of behavioural determinants derived from the Theoretical Domains Framework (TDF), an integrative framework of 33 theories of behaviour change. Principal component analysis (PCA) was used to identify components, with total component scores computed. Differences in total scores among demographic groupings were tested using Mann-Whitney U test (2 groups) or Kruskal-Wallis (>2 groups). Respondents expressing interest in focus group participation were sampled purposively, and discussions based on survey findings using the TDF to provide further insight to survey findings. Ethical approval was received from Hamad Medical Corporation, Robert Gordon University, and Qatar University.

One thousand, six hundred and four questionnaires were received (67.9% nurses, 13.3% doctors, 12.9% pharmacists). Questionnaire items clustered into six components of: knowledge and skills related to error reporting; feedback and support; action and impact; motivation; effort; and emotions. There were statistically significant higher scores in relation to age (older more positive, p<0.001), experience as a healthcare professional (more experienced most positive apart from those with the highest level of experience, p<0.001), and profession (pharmacists most positive, p<0.05). Fifty-four healthcare professionals from different disciplines participated in the focus groups. Themes mapped to nine of fourteen TDF domains. In terms of emotions, the themes that emerged as barriers to error reporting were: fear and worry on submitting a report; that submitting was likely to lead to further investigation that could impact performance evaluation and career progression; concerns over the impact on working relationships; and the potential lack of confidentiality. This study has quantified and explained key facilitators and barriers of medication error reporting. Barriers appeared to be largely centred on issues relating to emotions and related beliefs of consequences. Quantitative results demonstrated that while these were issues for all healthcare professionals, those younger and less experienced were most concerned. Qualitative findings highlighted particular concerns relating to these emotional aspects. These results can be used to develop theoretically informed interventions with the aims of improving the effectiveness and efficiency of the medication reporting systems impacting patient safety.

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In 1999, the United States (US) Institute of Medicine (IOM) published its seminal report, ‘To Err Is Human: Building a Safer Health System’ [1], that led to greater focus on patient safety practices and research globally. The report called for comprehensive, coordinated efforts by governments, healthcare providers, consumers and others to promote patient safety, setting a minimum goal of 50% reduction in errors by 2004 [1]. While many advances have been made in healthcare practices, an estimated one in ten patients is still being harmed whilst receiving care [2]. In March 2017, the World Health Organization (WHO) published ‘Medication Without Harm, WHO Global Patient Safety Challenge’, to ‘drive a process of change to reduce patient harm generated by unsafe medication practices’ [3, 4]. Medication errors, defined by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) in the US as, ‘any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer’ [5], are highly prevalent, with associated global costs of US$ 42 billion annually [3, 4]. Interestingly, the goal of the WHO challenge in 2017 is remarkably similar to that of the IOM in 1999, to ‘gain worldwide commitment and action to reduce severe, avoidable medication-related harm by 50% in the next five years, specifically by addressing harm resulting from errors or unsafe practices due to weaknesses in health systems’ [3, 4].




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