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