Document Type : Original Article
Authors
1 Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
2 Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract
Background: Medical errors are particularly significant in the operating room due to their potential to critically affect patient care. For students, one of the key challenges is learning how to identify and report these errors during treatment and understanding their potential consequences. Accordingly, this study aimed to explore the challenges faced by the operating room interns in reporting medical errors.
Methods: This qualitative study was conducted using a content analysis approach from March to June 2024 in the operating theaters of teaching hospitals affiliated with Hamadan University of Medical Sciences in Hamadan, Iran. Data were collected through semi-structured interviews with ten operating room interns, selected via purposive sampling. Data were analyzed using conventional content analysis, following the methodology outlined by Graneheim and Lundman.
Results: Two main themes emerged from the analysis, including personal challenges and organizational barriers. These themes were further divided into five categories, including perceptions of errors, emotional hurdles, structural limitations, educational challenges, and workplace culture.
Conclusion: Addressing both personal and organizational challenges in error reporting is essential for improving patient safety outcomes. Fostering a culture of open communication and enhancing educational frameworks can empower operating room interns to actively participate in error reporting, thereby improving the overall quality of patient care.
Keywords
- Jung JJ, Elfassy J, Jüni P, Grantcharov T. Adverse events in the operating room: definitions, prevalence, and characteristics. A systematic review. World J Surg. 2019;43(10):2379-92. doi: 10.1007/s00268-019-05048-1.
- Mohamadi Khoshoui R, Salehi S, Saeedian N. A qualitative investigation into components of patient safety organizational culture in the medical education centers: a medical errors management approach. J Qual Res Health Sci. 2020;8(4):49- 58. doi: 10.22062/jqr.2020.90990.
- Imani B, Bahrami Jalal S. Surgical technologists› live experiences of professionalization: A Phenomenological study. J Qual Res Health Sci. 2022;11(4):231-236. doi:10.34172/ jqr.2022.11.
- El-Sayed WM, Eldeeb IE, Khater MK, Morsy TA. Operating room and patient safety: an overview. J Egypt Soc Parasitol. 2021;51(2):391-404.
- Azarabad S, Zaman SS, Nouri B, Valiee S. Frequency, causes and reporting barriers of nursing errors in the operating room students. Res Med Educ. 2018;10(2):18-27. doi: 10.29252/ rme.10.2.18. [Persian].
- Sarhadi M, Sheikhbardsiri H, Dastres M, Moein H. A comparative study of barriers to reporting medication errors in nursing students in Zahedan University of Medical Sciences, Iran. Journal of Management and Medical Informatics School. 2014;2(1):38-46. [Persian].
- Eweida RS, Rashwan ZI, Desoky GM, Khonji LM. Mental strain and changes in psychological health hub among intern-nursing students at pediatric and medical-surgical units amid ambience of COVID-19 pandemic: a comprehensive survey. Nurse Educ Pract. 2020;49:102915. doi: 10.1016/j. nepr.2020.102915.
- Tavakkol R, Karimi A, Fereidouni A, Amiri A, Nazari Far E. The relationship between physical and mental health and coping strategies in operating room. J Health Sci Surveill Syst. 2022;10(3):358-64. doi: 10.30476/jhsss.2021.89984.1172.
- Bam V, Safowaa A, Lomotey AY, Nkansah AS. Nursing students’ perception of medical errors: a cross-sectional study in a university. Nurs Open. 2021;8(6):3152-60. doi: 10.1002/ nop2.1028.
- Fusco LA, Alfes CM, Weaver A, Zimmermann E. Medication safety competence of undergraduate nursing students. Clin Simul Nurs. 2021;52:1-7. doi: 10.1016/j.ecns.2020.12.003.
- Li H, Kong X, Sun L, Zhu Y, Li B. Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study. Nurse Education Today. 2021;98:104738. doi:10.1016/j. nedt.2020.104738.
- Mohsenpour M, Shamabadi Z, Zoka A, Borhani F, Chakani F. Nursing errors and their causes among nursing students. Clinical Ethics. 2020;16(2):137-143. doi:10.1177/1477750920958561.
- Ellahham S. The domino effect of medical errors. Am J Med Qual. 2019;34(4):412-3. doi: 10.1177/1062860618813735.
- Heydarikhayat N, Ghanbarzehi N, Sabagh K. Strategies to prevent medical errors by nursing interns: a qualitative content analysis. BMC Nurs. 2024;23(1):48. doi: 10.1186/s12912- 024-01726-1.
- World Health Organization (WHO). Reporting and Learning Systems for Medication Errors: The Role of Pharmacovigilance Centres. WHO; 2014.
- Ghobadian S, Zahiri M, Dindamal B, Dargahi H, Faraji-Khiavi F. Barriers to reporting clinical errors in operating theatres and intensive care units of a university hospital: a qualitative study. BMC Nurs. 2021;20(1):211. doi: 10.1186/s12912-021- 00717-w.
- Song Q, Tang J, Wei Z, Sun L. Prevalence and associated factors of self-reported medical errors and adverse events among operating room nurses in China. Front Public Health. 2022;10:988134. doi: 10.3389/fpubh.2022.988134.
- Oyebode F. Clinical errors and medical negligence. Med Princ Pract. 2013;22(4):323-33. doi: 10.1159/000346296.
- Shah NA, Jue J, Mackey TK. Surgical data recording technology: a solution to address medical errors? Ann Surg. 2020;271(3):431-3. doi: 10.1097/sla.0000000000003510.
- Battard J. Nonpunitive response to errors fosters a just culture. Nurs Manage. 2017;48(1):53-5. doi: 10.1097/01. NUMA.0000511184.95547.b3.
- Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Prevention. Treasure Island, FL: StatPearls Publishing; 2020.
- Forbes-Jewell C. Recognizing a Medical Error and Medical Error Recovery: A Qualitative Study of BSN Students’ Experience [dissertation]. Capella University; 2022.
- Chen YC, Issenberg SB, Chiu YJ, Chen HW, Issenberg Z, Kang YN, et al. Exploration of students’ reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events. Med Teach. 2023;45(4):368-74. doi: 10.1080/0142159x.2022.2137394.
- Marshall C, Van Der Volgen J, Lombardo N, Hamasu C, Cardell E, Blumenthal DK. A mixed methods approach to assess the impact of an interprofessional education medical error simulation. Am J Pharm Educ. 2020;84(2):7133. doi: 10.5688/ajpe7133.
- Strandberg S, Backåberg S, Fagerström C, Ekstedt M. Self-care management and experiences of using telemonitoring as support when living with hypertension or heart failure: a descriptive qualitative study. Int J Nurs Stud Adv. 2023;5:100149. doi: 10.1016/j.ijnsa.2023.100149.
- Mayring P. Qualitative content analysis: theoretical background and procedures. In: Bikner-Ahsbahs A, Knipping C, Presmeg N, eds. Approaches to Qualitative Research in Mathematics Education: Examples of Methodology and Methods. Dordrecht: Springer; 2015. p. 365-80. doi: 10.1007/978-94-017-9181-6_13.
- Tongco MD. Purposive sampling as a tool for informant selection. Ethnobot Res Appl. 2007;5:147-58.
- Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105- 12. doi: 10.1016/j.nedt.2003.10.001.
- Kheirandish E, Rahnama M, Noorisanchooli H, Rashki Ghalenow H, Abdollahimohammad A. Qualitative analysis of nurses’ experiences during the COVID-19 crisis. Health Educ Health Promot. 2021;9(3):287-93.
- Anney VN. Ensuring the quality of the findings of qualitative research: looking at trustworthiness criteria. J Emerg Trends Educ Res Policy Stud. 2014;5(2):272-81.
- Aghamohammadi F, Imani B, Moghadari Koosha M. Operating room nurses’ lived experiences of ethical codes: A phenomenological study in Iran. International Journal of Nursing Sciences. 2021;8(3):332-8. doi:10.1016/j. ijnss.2021.05.012.
- Fagerdahl AM, Torbjörnsson E, Sondén A. An interprofessional e-learning resource to prepare students for clinical practice in the operating room-a mixed method study from the students’ perspective. Healthcare (Basel). 2021;9(8):1028. doi: 10.3390/ healthcare9081028.
- Soydemir D, Seren Intepeler S, Mert H. Barriers to medical error reporting for physicians and nurses. West J Nurs Res. 2017;39(10):1348-63. doi: 10.1177/0193945916671934.
- Aljabari S, Kadhim Z. Common barriers to reporting medical errors. ScientificWorldJournal. 2021;2021:6494889. doi: 10.1155/2021/6494889.
- Anton NE, Athanasiadis DI, Karipidis T, Keen AY, Karim A, Cha J, et al. Surgeon stress negatively affects their non-technical skills in the operating room. Am J Surg. 2021;222(6):1154-7. doi: 10.1016/j.amjsurg.2021.01.035.
- Gohal G. Models of teaching medical errors. Pak J Med Sci. 2021;37(7):2020-5. doi: 10.12669/pjms.37.7.4506.
- Kang HJ, Park H, Oh JM, Lee EK. Perception of reporting medication errors including near-misses among Korean hospital pharmacists. Medicine (Baltimore). 2017;96(39):e7795. doi: 10.1097/md.0000000000007795.
- Fathi A, Hajizadeh M, Moradi K, Zandian H, Dezhkameh M, Kazemzadeh S, et al. Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting. Epidemiol Health. 2017;39:e2017022. doi: 10.4178/epih.e2017022.
- Hall N, Bullen K, Sherwood J, Wake N, Wilkes S, Donovan G. Exploration of prescribing error reporting across primary care: a qualitative study. BMJ Open. 2022;12(1):e050283. doi: 10.1136/bmjopen-2021-050283.
- Koehn AR, Ebright PR, Draucker CB. Nurses’ experiences with errors in nursing. Nurs Outlook. 2016;64(6):566-74. doi: 10.1016/j.outlook.2016.05.012.
- Farzi S, Abedi HA, Ghodousi A, Yazdannik AR. Medication errors experiences of nurses who working in hospitals of Isfahan at 1391. J Qual Res Health Sci. 2013;2(4):310-9. [Persian].
- Mousavi-Roknabadi RS, Momennasab M, Askarian M, Haghshenas A, Marjadi B. Causes of medical errors and its under-reporting amongst pediatric nurses in Iran: a qualitative study. Int J Qual Health Care. 2019;31(7):541-6. doi: 10.1093/ intqhc/mzy202.
- Chiang HY, Lee HF, Lin SY, Ma SC. Factors contributing to voluntariness of incident reporting among hospital nurses. J Nurs Manag. 2019;27(4):806-14. doi: 10.1111/jonm.12744.
- Lee W, Kim SY, Lee SI, Lee SG, Kim HC, Kim I. Barriers to reporting of patient safety incidents in tertiary hospitals: A qualitative study of nurses and resident physicians in South Korea. Int J Health Plann Manage. 2018;33(4):1178-88. doi: 10.1002/hpm.2616.