title: Barriers to reporting medication errors and near misses among nurses: A systematic review.
abstract: OBJECTIVE
  To explore barriers to nurses' reporting of medication errors and near misses in hospital settings.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, CINAHL, PubMed and Cochrane Library in addition to Google and Google Scholar and reference lists of relevant studies published in English between January 1981 and April 2015 were searched for relevant qualitative, quantitative or mixed methods empirical studies or unpublished PhD theses. Papers with a primary focus on barriers to reporting medication errors and near misses in nursing were included.
  
  
  METHODS
  The titles and abstracts of the search results were assessed for eligibility and relevance by one of the authors. After retrieval of the full texts, two of the authors independently made decisions concerning the final inclusion and these were validated by the third reviewer. Three authors independently assessed methodological quality of studies. Relevant data were extracted and findings were synthesised using thematic synthesis.
  
  
  RESULTS
  From 4038 identified records, 38 studies were included in the synthesis. Findings suggest that organizational barriers such as culture, the reporting system and management behaviour in addition to personal and professional barriers such as fear, accountability and characteristics of nurses are barriers to reporting medication errors.
  
  
  CONCLUSIONS
  To overcome reported barriers it is necessary to develop a non-blaming, non-punitive and non-fearful learning culture at unit and organizational level. Anonymous, effective, uncomplicated and efficient reporting systems and supportive management behaviour that provides open feedback to nurses is needed. Nurses are accountable for patients' safety, so they need to be educated and skilled in error management. Lack of research into barriers to reporting of near misses' and low awareness of reporting suggests the need for further research and development of educational and management approaches to overcome these barriers.
authors.affiliation: University of Maribor Faculty of Health Sciences, Žitna ulica 15, 2000 Maribor, Slovenia. Electronic address: dominika.vrbnjak@um.si.
authors.forename: Dominika
authors.initials: D
authors.lastname: Vrbnjak
authors.affiliation: Waterford Institute of Technology, Department of Nursing & Health Care Co. Waterford, Ireland. Electronic address: sdenieffe@wit.ie.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Denieffe
authors.affiliation: Waterford Institute of Technology, Department of Nursing & Health Care Co. Waterford, Ireland. Electronic address: cogorman@wit.ie.
authors.forename: Claire
authors.initials: C
authors.lastname: O'Gorman
authors.affiliation: University of Maribor Faculty of Health Sciences, University of Maribor Faculty of Medicine, Maribor, Slovenia. Electronic address: majda.pajnkihar@um.si.
authors.forename: Majda
authors.initials: M
authors.lastname: Pajnkihar
mesh_terms: D005239:Fear; D008508:Medication Errors; D009741:Nursing Staff, Hospital / Q000523:psychology; D012308:Risk Management; D012941:Social Responsibility
keywords: Barrier; Medication errors; Near miss; Nurses; Patient safety; Systematic review