METHODOLOGY
Research Design
The study utilized a sequential mixed-method design. The study was structured into two
phases that involve collecting and analyzing quantitative data, followed by collecting and
analyzing qualitative data. The method described the extent of medication error reporting
practices among the staff nurses with the different variables followed by an in-depth exploration
of nurses' practice in reporting medication error during the qualitative phase.
Descriptive correlational design was applied in the quantitative phase. A descriptive
correlational study was employed because the researcher was primarily interested in describing
relationships among variables without establishing a causal connection (Polit & Beck, 2004).
The method included collecting data, which comprises the respondents' demographic data, and
its relationship to reporting medication error.
For the qualitative phase of the study, a descriptive phenomenology was used as a design.
Phenomenology was utilized as a descriptive study featuring a structured way of understanding
nurses' experiences on medication administration error reporting. The design is an approach to
qualitative research that focuses on the commonality of a lived experience among nurses in the
Province of Nueva Vizcaya through a phone call interview. The primary goal is to arrive at a
description of the nature of the specific phenomenon (Creswell, 2013). A phenomenological
qualitative design allows the participants to discuss their practices in reporting medication errors,
employing a semi-structured approach. The approach was chosen to obtain the most accurate
image of the participant's experiences.
Figure 1
Flow chart of Research Process
PHASE 1: Quantitative Phase
PHASE 2: Qualitative Phase
Data Collection
Data Collection
Data Transcription
Statistical treatment
Development of initial code
Establishment of themes
Data Analysis
Identification of themes
Validation of themes
Quantitative Result
Qualitative Result
Triangulation of results
Validation of Report
Development of a Guideline on Medication Administration Error Reporting
Phase I: Quantitative Phase
Locale and Population. The study respondents included staff nurses from the primary
(comprising infirmary, municipal, and district hospitals), secondary and tertiary hospitals in the
Province of Nueva Vizcaya.
Criteria for selecting the respondents were as follows: hospital-based full-time or
contractual registered nurse who administers medication. They must be employed in either
government or private-funded hospitals regardless of their years of experience, educational level,
and unit assignment. These nurses have incurred medication errors for the past three years to
address recall bias. Hassan et al. (2005) stated that an individual completely loses 20% of the
memories for a particular event up to three years while 50% of the memories is diminished for
the past five years.
Middle to top-level nursing administrators (nurse supervisors to chief nurse) was
excluded since they do not administer medication to patients.
Total enumeration was employed in the study. The hospitals in the province have a total
population of 670 staff nurses. However, out of the total population, only 374 respondents were
recruited to participate in the study. The researcher could not reach out to other nurses as every
institution restricted entering an isolation area to minimize or prevent contracting Corona Virus
Disease-19 (COVID-19). Some were presently deployed in the COVID-isolation ward, while
others were quarantined during the data-gathering phase. Also, some nurses in the private
hospitals had already resigned.
Table 1 shows the demographic profile of the study. The table depicts that most
respondents (31.6%) were employed in the same institution between 0-2 years. Most of them
(75.4%) have a Bachelor of Science in Nursing as their educational level. They were deployed
from 13 different units, and 64 out of 374 nurses (16.6%) came from the hospital ward, which
counted the most. Nurses from the hospital ward cater to patients with different disease
classifications. These nurses are usually employed in primary hospitals, unlike in a secondary or
tertiary hospital in which the hospital wards are departmentalized or classified according to the
patient’s condition.
Table 1
Demographic Profile
Variable
Frequency
Years of Experience
0-2
118
3-5
89
6-10
112
11-20
38
21-30
2
31years and above
6
Educational Level
Bachelor
282
Master’s/ with master’s units
76
Doctorate/ with Doctorate units
1
Unit Assignment
Intensive Care Unit
58
Obstetrics/Gynecology Ward
20
Medical Ward
44
Surgical Ward
26
Pediatric Ward
14
Operating Room
21
Labor and Delivery
8
Emergency Room
46
General ward
62
Dialysis
11
COVID Isolation
8
OPD
11
Rotated/Mixed*
40
*Nurses who were regularly rotated to different wards.
Percent
31.6
23.8
29.9
10.2
0.5
1.6
75.4
20.3
0.3
15.5
5.3
11.8
7.0
3.7
5.6
2.1
12.3
16.6
2.9
2.1
2.9
10.7
Data Gathering Tool. A self-made questionnaire was developed as the primary tool to
gather sufficient and relevant data. The instrument was derived from the local and international
literature and policies on the practices of hospital-based staff nurses in medication error reporting
(Alsulami et al., 2019; Ramos & Calidgid, 2018). The questionnaire was specifically designed to
meet the objectives for the quantitative phase of the research endeavor.
The tool consists of two parts. Part 1 contains the respondents' demographic data, and
part 2 comprises the practices of staff nurses on medication error reporting. The practice on
medication error reporting is a 22-item question categorized into three parameters, namely a)
rights in administering medication, b) writing a report, and c) submitting a report. The tool will
be rated by the respondents using a Likert scale (highly practiced, moderately practiced, low
practiced, not practiced).
The tool was subjected to validity and reliability testing to ensure that the data collected
was valid and substantial. A pool of content and research experts were invited to evaluate the
tool. The content experts were Baguio General Hospital and Medical Center's assistant chief
nurse and Saint Louis University, Hospital of the Sacred Heart chief nurse. On the other hand,
the researcher requested the help of a research expert of Saint Mary's University Language
Department to evaluate the technical aspect of the study. The experts generously gave their
comments, suggestions, and recommendations, which were then carried out. The content validity
index was computed with a result of 0.9855, indicating excellent reliability.
After content validity testing, the tool's reliability was measured through pilot testing to
30 staff nurses from different hospitals in the province. The nurses shared similar characteristics
as the subjects under study but were not included during the data gathering process. A simple test
method was used for the pre-test with Cronbach's coefficient alpha of 0.926, signifying excellent
reliability.
Data Gathering Procedure. Before data collection, ethical clearance was sought from
the ethics review board of Saint Louis University. After securing the approval, the data collection
started with a request letter addressed to the Chief of Hospital. For the tertiary hospital, the
request letter was forwarded to the Institutional Research Board Committee for approval.
However, for the private and primary hospitals, the Medical Director or the Chief of Hospital
approved the request then was endorsed to the chief nurse. The chief nurse positively responded
to the request then assisted the researcher in conducting the survey.
To adhere to the present pandemic, the hospital administration did not allow the
researcher to conduct the survey in a conference room; instead, the hospital administrators
allowed the researcher to conduct the study in each ward when they were not preoccupied with
their busy schedule. According to them, administering the survey after duty hours may not be
feasible as nurses have already been exhausted because they are on a 12-hour duty shift. The
researcher was given the time to conduct the study during the monthly staff meeting in three
primary hospitals. During the conduct of the study, the researcher strictly followed precautionary
measures against the COVID-19 infection. Following the mandate of the WHO, the health
protocols are social distancing, maintaining the use of mask and face shield, and the use of hand
sanitizers.
Before starting the data gathering process, the researcher stated the purpose of the study
to the respondents. After which, respondents gave their oral consent to participate in the study.
The researcher personally distributed the tool together with the written consent form. Each
respondent signed the written consent form. They are requested to answer the questionnaire on
their extent of medication error reporting practices for 15-20 minutes. Answering the tool with
honesty was also emphasized. Once completed, the researcher retrieved the tool from the
respondents, then checked for completeness and any missed data. The data-gathering phase
commenced from November 2020 to the second week of February 2021 with a reasonable
sample size.
Data Analysis and Statistical Treatment. The overall weighted mean was computed to
determine the extent of medication error reporting practices of staff nurses. The weighted means
were interpreted using a scale, as shown below, to reveal the extent of medication error reporting
practices of staff nurses.
Table 2
Interpretation of the Results
Score
Extent of Practice
3.25 – 4.00
Highly practiced
2.50 – 3.24
Moderately practiced
1.75 – 2.49
Lowly practiced
1.00 – 1.74
Not practiced
Description
Practices reporting medication error every
time an error is committed
Practices reporting of medication error 5099% of total medication errors committed for
the past 3 years of professional practice
Practices reporting of medication error 149% of total medication errors committed for
the past 3 years of professional practice
Does not practice reporting of medication
error
Log-linear analysis was applied to determine the significant relationships between
medication error practices and the variables being studied. The variables are discrete, and the
data are categorical.