Causes of medical errors and its under-reporting amongst pediatric nurses in Iran : a qualitative study

Objectives: To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. Design: A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. Settings: The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. Participants: The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital’s ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. Main outcome measure(s): Pediatrics nurses’ views on the causes of ME and under-reporting. Results: We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. Conclusion: Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.