title: Identifying modifiable barriers to medication error reporting in the nursing home setting.
abstract: OBJECTIVE
  To have health care professionals in nursing homes identify organizational-level and individual-level modifiable barriers to medication error reporting.
  
  
  METHODS
  Nominal group technique sessions to identify potential barriers, followed by development and administration of a 20-item cross-sectional mailed survey.
  
  
  METHODS
  Representatives of 4 professions (physicians, pharmacists, advanced practitioners, and nurses) from 4 independently owned, nonprofit nursing homes that had an average bed size of 150, were affiliated with an academic medical center, and were located in urban and suburban areas.
  
  
  METHODS
  Barriers identified in the nominal group technique sessions were used to design a 20-item survey. Survey respondents used 5-point Likert scales to score factors in terms of their likelihood of posing a barrier ("very unlikely" to "very likely") and their modifiability ("not modifiable" to "very modifiable"). Immediate action factors were identified as factors with mean scores of <3.0 on the likelihood and modifiability scales, and represent barriers that should be addressed to increase medication error reporting frequency.
  
  
  RESULTS
  In 4 nominal group technique sessions, 28 professionals identified factors to include in the survey. The survey was mailed to all 154 professionals in the 4 nursing homes, and 104 (67.5%) responded. Response rates by facility ranged from 55.8% to 92.9%, and rates by profession ranged from 52.0% for physicians to 100.0% for pharmacists. Most respondents (75.0%) were women. Respondents had worked for a mean of 9.8 years in nursing homes and 5.4 years in their current facility. Of 20 survey items, 14 (70%) had scores that categorized them as immediate action factors, 9 (64%) of which were organizational barriers. Of these factors, the 3 considered most modifiable were (1) lack of a readily available medication error reporting system or forms, (2) lack of information on how to report a medication error, and (3) lack of feedback to the reporter or rest of the facility on medication errors that have been reported.
  
  
  CONCLUSIONS
  The study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting. Efforts to improve medication error reporting frequency should focus on organizational-level rather than individual-level interventions.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. handlersm@upmc.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Olshansky
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Studenski
authors.forename: David A
authors.initials: DA
authors.lastname: Nace
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Fridsma
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D001291:Attitude of Health Personnel; D004282:Documentation; D005246:Feedback; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D009735:Nursing Homes; D010414:Pennsylvania; D011785:Quality Assurance, Health Care; D012308:Risk Management; D011795:Surveys and Questionnaires