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

Stewart, Derek; Thomas, Binny; MacLure, Katie; Wilbur, Kerry; Wilby, Kyle; Pallivalapila, Abdulrouf; Dijkstra, Andrea; Ryan, Cristin; El Kassem, Wessam; Awaisu, Ahmed; McLay, James S.; Singh, Rajvir; Al Hail, Moza

Abstract

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. The study used 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 behavioural determinants derived from the Theoretical Domains Framework (TDF) - an integrative framework of thirty-three theories on 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 were based on survey findings using the TDF in order to provide further insight into survey findings. Ethical approval was received from Hamad Medical Corporation, Robert Gordon University and Qatar University. 1,604 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. In conclusion, 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 who were younger and less experienced were the 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 that impact patient safety.

Citation

STEWART, D., THOMAS, B., MACLURE, K., WILBUR, K., WILBY, K., PALLIVALAPILA, A., DIJKSTRA, A., RYAN, C., EL KASSEM, W., AWAISU, A., MCLAY, J.S., SINGH, R. and AL HAIL, M. 2018. Exploring facilitators and barriers to medication error reporting among healthcare professionals in Qatar using the theoretical domains framework: a mixed-methods approach. PLoS one [online], 13(10), article ID e0204987. Available from: https://doi.org/10.1371/journal.pone.0204987

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2018
• Online Publication Date: Oct 2, 2018
• Publication Date: Oct 2, 2018
• Deposit Date: Oct 5, 2018
• Publicly Available Date: Oct 5, 2018
• Journal: PLoS ONE
• Print ISSN: 1932-6203
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 10
• Article Number: e0204987
• DOI: https://doi.org/10.1371/journal.pone.0204987
• Keywords: Healthcare professionals; Qatar medication error reporting; Theoretical domains framework; Drug safety
• Public URL: http://hdl.handle.net/10059/3161