Perceived Factors Associated with Medication Errors and Nurses’ Knowledge, Attitudes, and Practices Regarding Medication Safety at Federal Medical Centre Nguru, Nigeria: A Cross-Sectional Study
Authors and Affiliations
- Department of Nursing Services, Federal Medical Centre Nguru, Yobe State, Nigeria.
- Department of Pharmacology and Therapeutics, Federal University Kashere, Gombe State, Nigeria.
- College of Nursing Sciences, Federal Medical Centre Nguru, Yobe State, Nigeria.
- The Operating Room Global (TORG).
Corresponding author: Ahmed Shuaibu Tsafi · [email protected]
Received: 25 August 2026
Accepted: 23 October 2026
Available online: 11 November 2026
Original Research · TORGJ 2(4), 124–137
ISSN: 3105-3262
Licence: CC BY 4.0
Abstract
Background: Medication errors pose a significant threat to patient safety, and nurses play a central role in their prevention through medication administration and monitoring. However, evidence regarding perceived contributing factors and medication safety practices in northeastern Nigeria remains limited.
Objective: To assess nurses’ perceived factors contributing to medication errors, their knowledge, attitudes, and practices regarding medication safety and error reporting, and their preferred prevention strategies at Federal Medical Centre (FMC) Nguru, Yobe State, Nigeria.
Methods: A descriptive cross-sectional survey was conducted among registered nurses at FMC Nguru, with a target population of 254. A sample size of 97 was calculated using the Taro Yamane formula. Participants were recruited through stratified sampling with convenience selection within strata. Data were collected using a self-administered questionnaire with a four-point Likert scale and analysed descriptively using frequencies and percentages.
Results: Most respondents were male (78.4%), and 40.2% were aged 30–39 years. The most frequently perceived contributors to medication errors were heavy workload (86.6%), inadequate staffing (80.4%), fatigue (80.4%), inadequate supervision (78.4%), and look-alike medication names or packaging (59.8%). Knowledge of the rights of medication administration was high (93.8%); however, 22.7% reported inadequate understanding of the hospital’s medication error-reporting procedures. Although 99.0% agreed that medication errors should be reported even when no patient harm occurs, 66.0% identified fear of punishment as a barrier to reporting. All respondents (100%) supported regular in-service training and clear medication administration guidelines, while 96.9% endorsed improved communication, 93.8% adequate staffing, and 87.6% medication administration technologies.
Conclusion: Nurses at FMC Nguru perceived medication errors as predominantly associated with system-level factors, including workload, staffing shortages, fatigue, and inadequate supervision. Strengthening workforce capacity, continuous professional training, institutional guidelines, and non-punitive error-reporting systems may improve medication safety.
Keywords: Medication errors; Medication safety; Nurses; Patient safety; Error reporting; Nigeria.
Introduction
Medication administration requires precision, knowledge, attentiveness and accountability. Medication errors can occur at any stage of the medication-use process, including prescribing, dispensing, administration and monitoring. The study addresses a local evidence gap at Federal Medical Centre Nguru, where workload, staffing and system-related challenges were considered possible contributors.
Study objectives: identify perceived contributors to medication errors; assess knowledge, attitudes and practice regarding medication safety and reporting; and determine preferred strategies for prevention and patient safety improvement.
Materials and Methods
Design and setting
A non-experimental descriptive cross-sectional survey was conducted at Federal Medical Centre Nguru, Yobe State, northeastern Nigeria.
Population, sampling and instrument
The population comprised 254 registered nurses. The calculated sample size was 97 using the Taro Yamane formula with an 8% margin of error. Respondents were stratified by clinical unit and selected by convenience within each stratum. A structured, self-administered questionnaire assessed demographics, perceived contributors, knowledge/attitudes/practice and prevention strategies using a four-point Likert scale.
Analysis and ethics
Frequencies and percentages were reported; agreement combines strongly agree and agree. No inferential tests were performed. Ethical approval was granted by the Health Research Ethics Committee of FMC Nguru (FMC/N/CL.SERV/355/VOL.VII/505, 23 April 2026). Participation was voluntary and anonymous.
Respondents by unit
| Clinical unit | Planned | Analysed |
|---|---|---|
| Medical ward | 26 | 18 |
| Surgical ward | 15 | 15 |
| Paediatric ward | 15 | 18 |
| Intensive care unit | 10 | 6 |
| Other units | 31 | 40 |
| Total | 97 | 97 |
The realised distribution differed from the planned allocation.
Results
Respondent characteristics
Among the 97 respondents, 76 (78.4%) were male; 39 (40.2%) were aged 30–39 years; 51 (52.6%) held a BNSc degree; and 31 (32.0%) reported 11–15 years of experience.
Perceived factors associated with medication errors (Table 3)
| Perceived factor | Agree / strongly agree | Percentage |
|---|---|---|
| Heavy workload | 84 of 97 | 86.6% |
| Inadequate staffing | 78 of 97 | 80.4% |
| Fatigue / long working hours | 78 of 97 | 80.4% |
| Inadequate supervision | 76 of 97 | 78.4% |
| Similar drug names / packaging | 58 of 97 | 59.8% |
Knowledge, attitudes and practice (Table 4)
| Statement | Agree / strongly agree | Percentage |
|---|---|---|
| Knowledgeable about rights of medication administration | 91 of 97 | 93.8% |
| Understand hospital error-reporting procedures | 75 of 97 | 77.3% |
| Errors can occur at any stage of administration | 76 of 97 | 78.4% |
| Reporting errors improves patient safety | 88 of 97 | 90.7% |
| Report errors even if no harm occurred | 96 of 97 | 99.0% |
| Fear of punishment discourages reporting | 64 of 97 | 66.0% |
| Double-check medications before administration | 88 of 97 | 90.7% |
Preferred prevention strategies (Table 5)
| Strategy | Agree / strongly agree | Percentage |
|---|---|---|
| Regular in-service training | 97 of 97 | 100.0% |
| Clear medication guidelines and protocols | 97 of 97 | 100.0% |
| Improved communication | 94 of 97 | 96.9% |
| Adequate staffing | 91 of 97 | 93.8% |
| Medication administration technology | 85 of 97 | 87.6% |
All figures reflect respondents’ self-reported agreement, not observed medication-error rates or intervention effectiveness. Full original tables and Figure 1 appear in the published PDF.
Discussion and Interpretation
System-level contributors
Workload, staffing shortages, fatigue and supervision were the most frequently perceived contributors. Look-alike or sound-alike drug names and packaging were also endorsed by a majority, though less frequently.
Reporting culture
Despite near-unanimous agreement that errors should be reported even without patient harm, 22.7% did not understand local reporting procedures and 66.0% identified fear of punishment as a barrier. These results indicate a perceived gap between reporting attitudes and institutional reporting conditions.
Prevention priorities
Respondents strongly supported training, clear protocols, communication improvements, staffing and technology. The findings indicate acceptability of these approaches but do not establish their effectiveness.
Study Limitations
- Single-centre, cross-sectional design based on self-reported perceptions, without observed error incidence.
- Convenience selection within strata and differences between planned and achieved unit allocations.
- Four-point, one-direction questionnaire items may have encouraged agreement or social-desirability bias.
- Descriptive analysis only; subgroup associations were not tested.
- Instrument reliability coefficient was not reported in the published manuscript.
Conclusion and Recommendations
Nurses at FMC Nguru perceived medication errors as multifactorial and largely preventable. The most frequently endorsed contributors were workload, staffing shortages, fatigue and inadequate supervision. Although reported knowledge of safe medication administration was high, reporting-procedure gaps and fear of punishment remained important concerns.
Recommendations
- Review staffing levels, workload, shifts and rest periods.
- Strengthen supervision during medication administration, particularly in high-demand units.
- Establish and communicate a clear, non-punitive error-reporting system with feedback.
- Institutionalise continuing training on safe medication administration and high-alert or look-alike medicines.
- Make standardised medication protocols available and improve handovers and communication.
- Conduct future multicentre studies measuring actual medication errors and evaluating interventions.
Declarations
Ethical approval: Health Research Ethics Committee, Federal Medical Centre Nguru, Yobe State, Nigeria; reference FMC/N/CL.SERV/355/VOL.VII/505, dated 23 April 2026.
Conflict of interest: The authors declare no conflicts of interest.
Funding: Personally funded by the researchers; no external funding.
Author contributions: Saje Aminu Mohammed – conceptualization and data collection; Ahmed Shuaibu Tsafi – supervision and critical review; Abdullahi Ibrahim Doma – original draft; Zubaina Mahmud Yarima – review and editing; Alfa Ndakotsu – proofreading and reference verification.
Data availability: Dataset available from the corresponding author on reasonable request, subject to ethical and institutional requirements.
Acknowledgements: The participating nurses, FMC Nguru Research Ethics Committee and College of Nursing Sciences are acknowledged in the article.
Licence: Creative Commons Attribution 4.0 International (CC BY 4.0).
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