Abstract

Background Medication errors are frequent but preventable. Critically ill patients may suffer, on average, 1.7 medical errors each day & some of which may be life-threatening. Such errors can be life-threatening because of the severity of the patients and comorbidities they have.

Objectives To assess the knowledge about medication error and safety among critical care nurses and assess the effect of implementation of focused intervention sessions to improve medication safety.

Methods This is a quantitative cross-sectional study, including all nurses working in critical care areas of a tertiary level hospital. A validated questionnaire was used to collect data on Knowledge, Perception & Behavior of nurses on medication errors and patient safety. Demographic data were analyzed using descriptive statistics. All data were analyzed via SPSS using McNemar’s test.

Results Our study found high baseline compliance with protocol-driven safety practices. There was a significant difference in nurses’ knowledge after education intervention in the use of CPOE reducing medication errors (p 0.00) and alarm noises and ward emergencies increase error risk (p 0.001). Significant differences were noted in perception of the effects of protocols/ guidelines on ensuring proper management of therapeutic processes (p 0.014). The behavioral findings demonstrate near-perfect baseline compliance across all safety practices (98.4-100%), leaving minimal room for measurable improvement.

Conclusion This study highlights significant impact of targeted education on improving critical care nurses’ understanding of computerized order entry and alarm-related risks, reinforcing protocol adherence. Our findings confirm mature safety cultures, and focused interventions effective than broad retraining efforts.

Executive Summary Medication errors are frequent; they can be serious, however, are also preventable. Actually, health care delivery is not perfect and errors are very common. In intensive care units (ICU), critically ill patients may suffer, on average, 1.7 medical errors each day and some of which may be life-threatening. Medication errors can happen anywhere in the hospital; however, those happening in intensive care units can be life-threatening because of the severity of the patients and various comorbidities they have. Almost one-fifth (19%) of the errors in ICU are life-threatening and almost half (42%) cause the addition of other life-sustaining supports, adding emotional, psychological and financial burdens to the patient and family. Although medication errors are increasingly accepted as a significant patient safety issue, research and studies on this topic is limited in low and middle income countries (LMICs), where healthcare systems face various restrictions. There has been minimal research on the knowledge, attitudes, and behaviors of critical care nurses concerning medication safety, especially in the administration of intravenous medications. This study aims to address the gap by evaluating ICU nurses’ comprehension of medication errors, their compliance with safety procedures, and the effect of focused interventions on enhancing safe medication practices.

The objective of this study is to evaluate the nurses’ understanding of medication errors and patient safety. We planned to assess knowledge, perception and behavior of nurses regarding patient safety. After that, we planned to implement and analyze the impact of a focused intervention session, mainly informative meetings with each participant. Thus, we conducted a quantitative, quasi experimental, cross-sectional study with pretest - posttest design. For this, we selected nurses working in critical care settings in a tertiary hospital, namely in the ICU, CCU, HDU and post-operative ward. A validated questionnaire covering key variables - knowledge, perception, behavior and demographic details was used. Post-intervention sessions were conducted 1 week after data collection pertaining to explanation and discussion of correct answers to enhance knowledge. All the responses pretest and posttest were coded for McNemar’s test to assess statistical significance. Data were analyzed using SPSS, with confidence level 95%.

Our study found high baseline compliance with protocol-driven safety practices. There was a significant difference in nurses’ knowledge after education intervention in the use of CPOE reducing medication errors (p 0.00) and alarm noises and ward emergencies increase error risk (p 0.001). Statistically significant differences were noted in participants’ perception of the effects of protocols/ guidelines/ procedures on ensuring proper management of therapeutic processes (p 0.014). The behavioral findings demonstrate near-perfect baseline compliance across all safety practices (98.4-100%), leaving minimal room for measurable improvement through intervention.

This study highlights the significant impact of targeted education on improving critical care nurses’ understanding of computerized order entry and alarm-related risks, reinforcing protocol adherence where initial agreement was incomplete. Despite these improvements, the near-perfect baseline compliance with core medication safety behaviors and strong pre-existing safety perceptions indicate that most fundamental practices are already well institutionalized within the clinical setting. These findings suggest that in mature safety cultures, focused interventions are more effective than broad retraining efforts, as educational programs yield greater success when directed at specific areas requiring enhancement rather than reinforcing well-established norms. We acknowledge there is a need for further research in developing country settings to establish broader trends.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Hospital for Advanced Medicine and Surgery/ Institutional Review Committee Number 03-2024

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

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Ethical Approval Ethical approval was obtained from the Hospital For Advanced Medicine and Research Institutional Research Committee (HAMS-IRC) (approval number: 03/2024).

Consent for Publication Informed consent has been obtained from the participants involved.

Availability of Data and Materials The data that support the findings of this study are available within the article.

Funding No funds were received from any agency or institution.

Conflict of Interest The authors report no conflicts of interest relevant to this article.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

List of AbbreviationsBNBachelor in NursingCDSSClinical decision support systemCPOEComputerized physician order entry systemICUIntensive Care UnitIVIntravenousHDUHigh Dependency UnitCCUCoronary Care UnitLMICLow and middle income countryNSCCMNepalese Society of Critical Care Medicinep-valueProbability ValueRNRegistered Nurse