Page 120 - GHES-2-3

Global Health Economics and
Sustainability
Prevalence and causes of medication transcription errors

Table 5. Nurses’ opinion about the likely causes of transcription errors
Variable n (%)
Disagree Neutral Agree
Illegibility of the prescriber’s writing can lead to transcription errors on the wards. 5 (9.3) 0 (0.0) 49 (90.7)
Transcription errors can occur when transcribed orders are not double-checked by a second nurse. 11 (20.4) 8 (14.8) 35 (64.8)
Poor knowledge of medicines, e.g., the strength of a drug by the nurse transcribing, can lead to a transcription error. 8 (14.8) 8 (14.8) 38 (70.4)
Distractions like chatting with colleagues or chatting on the phone while transcribing can lead to transcription errors. 7 (13.0) 0 (0.0) 47 (87.0)
High workload, e.g., having fewer staff members to work on the wards, can lead to transcription errors since one 8 (14.8) 4 (7.4) 42 (77.8)
nurse will have to carry out many procedures alone.
Negligence on the part of the nurse transcribing can lead to errors. 6 (11.1) 8 (14.8) 40 (74.1)

children in Ethiopia, where five MTEs were observed for In our study, antibacterials for systemic use were most
every 100 admissions (Dedefo et al., 2016). However, in frequently involved in MTEs, which corroborates with
another study conducted within an intensive care unit in findings from other studies in resource-limited settings
Morocco, more than 400 MTEs occurred per 100 admissions (Dedefo et al., 2016; Jennane et al., 2011; Mekonnen et al.,
(Jennane et al., 2011). Moreover, in a more recent report 2018; Shehata et al., 2016). In the prospective observational
from a tertiary hospital in Sri Lanka, researchers observed study within an intensive care unit in Morocco, Jennane
a higher rate of transcription errors (88.6%) compared to et al. (2011) found that anti-infective medications were
our study (Ratnapala et al., 2022). The differences in these involved in the highest proportion of errors (33%),
findings might be attributed to variations in the medication which was lower than what was observed in our study.
use process, targeted populations, severity of illness, lack Another study conducted among hospitalized children in
of uniformity in definitions for MTEs, and methods of Ethiopia reported a higher rate (71%) of antimicrobials
reporting errors. Literature shows that studies focusing on the implicated in MTEs compared to our findings (Dedefo
reporting of prescription and administration errors typically et al., 2016). Despite the differences in rates across studies,
report low MTE rates (Mekonnen et al., 2018). In our setting, anti-infective medications were consistently involved in
the transcription step of the medication use process is the highest number of medication errors in most studies
duplicated, and the majority of the MTEs occurred in both from resource-limited settings (Dedefo et al., 2016;
stages. There is evidence that multiple steps in the medicine Jennane et al., 2011; Mekonnen et al., 2018; Shehata et al.,
use process increase the likelihood of errors. Approaches 2016). This observation might be partially explained by the
that standardize and simplify the medication use process can high prevalence of communicable diseases in these settings
improve medication safety (McComas et al., 2014). and the increased consumption of antimicrobials among
In this study, the omission of start and stop orders was hospitalized patients, leading to a higher chance of errors.
the most frequent MTEs observed, which is in coherence In a recent systematic review of MTEs and adverse
with an earlier report in an oncology unit that used a events in hospitals across nine African countries, lack
similar two-step transcription process (Pichon et al., of knowledge, lack of training, distractions, and high
2002). However, other reports indicate that the most workload were frequently cited as contributing factors to
frequent MTEs included errors related to the patient, route MTEs, which is consistent with our findings (Mekonnen
of administration, frequency, and medication (Jennane et al., 2018). Nurse’s opinions on the likely causes of
et al., 2011; Ratnapala et al., 2022); Shehata et al., 2016; errors in our study are comparable to evidence from
South et al., 2015. Data from certain studies carried out the literature, with the highest cause of MTEs attributed
in hospitals in Africa suggest that wrong dose errors were to illegible prescriptions, as observed in earlier reports
consistently high, which corroborates our findings, where (Armutlu et al., 2008; Mahmoud et al., 2020; Shehata
wrong doses constituted over 18% of MTEs (Mekonnen et al., 2016). There are a number of strategies that could be
et al., 2018). The frequency of different error types reported implemented to reduce the incidence of errors, including
depends on factors such as the study methodology, the clear and non-confusing writing of orders by prescribers,
medication use process within a particular setting, and the direct communication between all healthcare professionals
classification used for different error types. Most of the studies involved in the medication use process, clarifications
that categorized errors by type focused on prescription and with prescribers for illegible prescriptions, adoption of
administration errors, and differences in approach and computerized provider order entry systems, elimination
methodology might account for the discrepancies observed. of extended work schedules for physician and nurses, and

Volume 2 Issue 3 (2024) 5 https://doi.org/10.36922/ghes.2457