Exploring nurses’ knowledge, attitudes, and perceptions of medication errors in a general hospital in Malta – a cross-sectional survey

Abstract

Background: Medication errors (MEs) continue to pose a significant risk to patient safety despite established safety measures. Nurses are central to administering medications, and their knowledge, experience, and work environment influence both the likelihood of errors and whether they are reported. This study explored nurses’ perspectives on MEs, reporting practices, and barriers to reporting in a general hospital in Malta. Methods: A quantitative cross-sectional study was conducted using an anonymous online questionnaire informed by the Theory of Planned Behaviour. Of the 429 nurses invited, 301 completed the survey (response rate 70.2%). The questionnaire addressed the prevalence of MEs, reporting behaviours, knowledge of medications, perceived contributing factors, and attitudes towards reporting. Descriptive and inferential statistics were used to analyse the data. Results: Most nurses (88%, n = 265/301) reported having made at least one medication error. Reporting was inconsistent: 54% (n = 163/301) had never reported an error, 35% (n = 105/301) reported some, and only 11.6% (n = 35/301) reported all incidents. The area of work was significantly linked to perceived barriers and reporting behaviour. Nurses in reliever pools (92.6%), medical wards (89.9%), and surgical wards (79.7%) were more likely to feel concerns or barriers about reporting. Reporting practices also varied by area, with lower reporting in paediatric (36.8%) and orthopaedic wards (44.0%) and higher reporting in reliever pools (67.9%). While most nurses valued reporting (89%, n = 268/301), only 34% (n = 102/301) would report errors causing no harm, and 78% (n = 235/301) were reluctant to report colleagues. Conclusions: The findings reveal that MEs are common and underreported. Knowledge gaps, communication challenges, and systemic issues such as staffing shortages create barriers to safe medication management. Fear of repercussions further discourages reporting, highlighting the need for supportive, transparent practices. Hospitals should foster a non-punitive reporting culture, strengthen training, and improve interprofessional communication. Addressing these challenges can reduce medication errors and enhance patient safety and care quality.