Irish Journal of Medical Science (1971 -)

, Volume 187, Issue 4, pp 867–871 | Cite as

Barriers to the medication error reporting process within the Irish National Ambulance Service, a focus group study

  • Eamonn ByrneEmail author
  • Gerard Bury
Original Article



Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy.


To identify, investigate and document the barriers to medication error reporting within the NAS.


An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis.


Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological.


Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.


Errors Medication Paramedics Pre-hospital Qualitative research Reporting 


Compliance with ethical standards

Exemption from full ethical review was granted by UCD Human Research Ethics Committee. Permission was given to recruit NAS personnel by NAS Research Committee. Informed consent was obtained from all individual participants included in the study. The author works for the NAS on a frontline ambulance. The co-author is a university professor and General Practitioner, neither have managerial roles in the NAS. While the study was self-funded by the author, attendance at an international conference was sponsored by the National Ambulance Service in 2017.


  1. 1.
    Ferner RE, Aronson JK (2006) Clarification of terminology in medication errors: definitions and classification. Drug Saf 29(11):1011–1022. CrossRefPubMedGoogle Scholar
  2. 2.
    Vilke GM, Tornabene SV, Stepanski B, Shipp HE, Ray LU, Metz MA, Vroman D, Anderson M, Murrin PA, Davis DP, Harley J (2007) Paramedic self-reported medication errors. Prehosp Emerg Care 11(1):80–84. CrossRefPubMedGoogle Scholar
  3. 3.
    Hobgood C, Bowen JB, Brice JH, Overby B, Tamayo-Sarver JH (2006) Do EMS personnel identify, report, and disclose medical errors? Prehosp Emerg care : Off J Nat Assoc EMS Phys Nat Assoc State EMS Directors 10(1):21–27. CrossRefGoogle Scholar
  4. 4.
    Health Information and Quality Authority (2014) Review of pre-hospital emergency care services to ensure high quality in the assessment, diagnosis, clinical management and transporting of acutely ill patients to appropriate healthcare facilities | H.I.Q.A., DublinGoogle Scholar
  5. 5.
    Health Service Executive (2016) National Ambulance Service Operational Plan. Accessed 05 Sep 2016
  6. 6.
    Oglesby AM (2013) Clinical adverse events notified to the State Claims Agency under the terms of the clinical indemnity scheme. Incidents occurring between 01/01/2012 and 31/12/2012—final report. State Claims AgencyGoogle Scholar
  7. 7.
    National Treasury Management Agency (2016) Risk Management | State Claims Agency. Accessed 31 may 2017
  8. 8.
    National Ambulance Service (2011) Policy for Management of Adverse Clinical Events. Health Service Executive. Accessed 26 June 2015
  9. 9.
    Department of Health and Children (2006) The Lourdes hospital inquiry: an inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda. Report of Judge Maureen Harding Clark S.C., / Department of Health & ChildrenGoogle Scholar
  10. 10.
    Commission on Patient Safety and Quality Assurance (2008) Building a culture of patient safety: report of the Commission on Patient Safety and Quality Assurance. Stationery Office, DublinGoogle Scholar
  11. 11.
    Pre-Hospital Emergency Care Council (2016) What we do. Accessed Sept 17 2016
  12. 12.
    Pre-Hospital Emergency Care Council (2017) Clinical Resources. The Pre-Hospital Emergency Care Council. 2017
  13. 13.
    Institute for Safe Medication Practice (2017) ISMP’s High-Alert Medications List. Accessed 24 Oct 2017
  14. 14.
    Pre-Hospital Emergency Care Council (2017) Clinical Resources. The Pre-Hospital Emergency Care Council. Accessed 26/10/2017 2017
  15. 15.
    Dall'alba G (1998) Medical practice as characterised by beginning medical students. Adv Health Sci Educ 3(2):101–118. CrossRefGoogle Scholar
  16. 16.
    Larsson J, Holmström I (2007) Phenomenographic or phenomenological analysis: does it matter? Examples from a study on anaesthesiologists’ work. Int J Qual Studies on Health and Well-being 2(1):55–64. CrossRefGoogle Scholar
  17. 17.
    Pfeiffer Y, Manser T, Wehner T (2010) Conceptualising barriers to incident reporting: a psychological framework. Qual Saf Health Care 19(6):e60. CrossRefPubMedGoogle Scholar
  18. 18.
    Mudiwa L (2015) Rebranded NIMS roll-out proceeds. Irish Medical Times, 2015-02-27,Google Scholar
  19. 19.
    The HSE National Incident Management Team (2014) Safety incident management policy. vol QPSD-D-060-1.1. Health Service ExecutiveGoogle Scholar
  20. 20.
    Boysen IIPG (2013) Just Culture: a foundation for balanced accountability and patient safety. Ochsner J 13(3):400–406. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Reason J (1998) Achieving a safe culture: theory and practice. Work & Stress 12(3):293–306. CrossRefGoogle Scholar
  22. 22.
    Jennings PA, Stella J (2011) Barriers to incident notification in a regional prehospital setting. Emerg Med J 28(6):526–529. CrossRefPubMedGoogle Scholar
  23. 23.
    Leape LL (2002) Reporting of adverse events. N E J Med 347(20):1633–1638. CrossRefGoogle Scholar
  24. 24.
    Hartnell N, MacKinnon N, Sketris I, Fleming M (2012) Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study. BMJ Qual Safety 21(5):361–368. CrossRefGoogle Scholar
  25. 25.
    Wu AW (2000) Medical error: the second victim. West J Med 172(6):358–359. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.National Ambulance ServiceMallowIreland
  2. 2.University College Dublin, Centre for Emegency Medical ScienceSchool of MedicineBelfieldIreland

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