Medication errors among health professionals in Nigeria: A national survey

Abstract

BACKGROUND: Medication errors are preventable causes of patient harm with significant contributions to adverse drug events but they remain understudied in Nigeria.

OBJECTIVES: To estimate the prevalence of self-reported medication errors among health professionals and examine their knowledge of medication errors with the hope of identifying appropriate measures to promote medication safety.

METHODS: A cross sectional survey among doctors, pharmacists and nurses in 10 tertiary hospitals. Information was obtained using a self-administered structured questionnaire. Correct responses evaluating the knowledge of prescription, dispensing and administration errors were scored one mark each and the composite scores computed. Appropriate statistics were applied to summarize and establish the relationship between variables at 5% level of significance using SPSS 17.0.

RESULTS: A total of 2,386 professionals participated in the study (46.3% nurses, 44.9% doctors, 8.8% pharmacists).The prevalence of self-reported medication errors was 47%.

The professional groups differ in their knowledge of all the aspects of medication errors with professional cadres influencing knowledge.

Overwork was the most reason for being error prone (59.2%) and only 35.5% had ever reported medication error. 33.4% did not think reporting was necessary.

CONCLUSIONS: The prevalence of medication errors is high among health care professionals in Nigeria. Knowledge gaps and practice deficiencies were identified requiring interventions.

Keywords

Medication errors health professionals Nigeria

1 Background

Medication errors have been defined broadly as “any error in prescribing, dispensing, or administration of drugs, irrespective of whether such errors lead to adverse consequences or not” [1]. They are essentially ‘failures of the treatment process that lead to, or has the potential to lead to, harm to the patients’ [2]. They are regarded as the most preventable causes of patient harm with significant contributions to adverse drug events occurrences in hospitalized patients and often a major reason for hospital admissions. Such adverse drug events due to preventable medication errors lead to prolonged hospital stay, significant increases in cost of care and occasionally to death [3–5].

The incidence of medication error varies widely worldwide between 2 and 14% as a result of the different definitions and methodologies employed in the studies [6, 7]. Prescribing and drug administration processes are found to be associated with the largest numbers of medication errors recorded irrespective of whether these results in harms or not [8–10]. A study by Bohand et al. assessing specifically the rate of dispensing errors by a unit drug dispensing system within the central pharmacy and cardiovascular department of a 354 bed military hospital in France found a rate of 2.5% [11]. The most frequent types of dispensing errors found were improper dose (31.8%) and omission (30.2%). Of all the errors detected, 29.2% and 16.6% had the potential to cause significant and serious adverse drug events respectively.

Causes of medication errors varies according to the aspect of the treatment process considered i.e prescribing, transcribing, manufacturing or compounding, dispensing and administration of drugs as well as monitoring of therapy. These separate activities have many components that could be error prone and are generally interrelated with errors in one aspect often leading to errors in others.A systematic review of quantitative and qualitative evidence of causes of medication administration errors revealed slips and lapses as the most commonly reported unsafe acts, followed by knowledge deficiencies and the least being deliberate acts [12]. Other identified causes of medication administration errors are error provoked conditions like inadequate written communications (prescriptions, documentations and transcriptions), medication supply and storage problems (pharmacy dispensing errors and ward stock management), high perceived work load, problems with ward based equipment (access, functionality), patient factors (availability, acuity) staff health status (fatigue, stress) and interruptions and distractions during drug administration [12]. A United Sates of America based study carried out on all admissions into eleven medical and surgical units in two tertiary care hospitals over a six months period to identify and evaluate the systems failures underlying medication errors causing adverse drug events and potential adverse drug events revealed the most common system failure (39%) occurring at the physicians ordering stage and were mostly due to lack of knowledge about the drugs and inadequate availability of information about the patient such as results of laboratory investigations associated with about 18% of the errors [13]. This analysis identified seven system failures to be accountable for 78% of the total errors identified, all of which can be improved upon by better information systems. Systems failures otherwise termed ‘latent failures’ underpinning medication administration errors have been further outlined by Lawton et al. in an exploratory study involving three medical wards in a United Kingdom hospital to include ward climate, local working environment, work load, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership and training[14].

The interrelationship of the medication management processes in the causation of errors has been further corroborated by the findings of Carayon et al. in an observational study carried out in two tertiary intensive care units to characterize the complexity of medication safety using human factors approach [15]. While most of the errors occurred at the ordering (32%) and administration stages (39%), in 16–24% of potential and preventable adverse drug reactions, clusters of errors occurred either as sequence of errors for example delay in medication dispensing leading to delay in medication administration or grouped errors for example route and frequency errors in medication orders. Many of the sequences leading to medication administration errors were traceable to errors in earlier medication management processes.

Various aspects of medication errors have been extensively studied worldwide but there is relative paucity of literature on the knowledge of different categories of health personnel about what constitutes medication errors. A prospective study on medication administration errors among old people in long term care homes revealed that only 12 out of 41 staff administering drugs reported that they were aware of the potential drug administration errors in their care homes, resulting in high incidence of medication administration errors with over 52% of residents exposed to a serious error within the three months observation period [16].

While medical errors do occur commonly globally, the rate of their disclosure to either institutions or patients by health workers remains low. Surveys in the United States of America revealed that only 17–30% of physicians informed their patients when they experience medical errors inclusive of medication errors with attendant unmet emotional needs for both physicians and patients in such circumstances and the fear of litigation being the most important reason for failure of disclosures on the part of the physicians [17–19]. Similarly, in the same country, Ashcroft et al. found that community pharmacists and their support staff are unlikely to report adverse incidents when experienced in their practices because the likely consequences of blame in their considerations outweighs the potential advantages of reporting to them and the patients [20]. In a review of medication errors in Iran involving twenty-five studies on the subject, five studies were identified to focus on underreporting of medication errors. While the reports did not state in precise terms the rates of underreporting among the population of health workers studied, these five studies on underreporting identifies consistently among nurses and nursing students factors of fear, administrative barriers and difficult reporting processes as reasons for underreporting [21]. A Nigerian report on medication administration errors among peadiatric nurses revealed that only 30% of nurses reported errors committed in their practices to their superiors [22]. Similar to reasons for underreporting among the Iranian population, fear of intimidation, retribution or being punished and lack of clear policies and processes for reporting were the major barriers to reporting among the Nigerian nurses studied [22].

Diverse methods have been employed to reduce the incidents of medication errors at the various stages of medication management. The computerized physician order entry (CPOE) systems have significantly reduced the relative risks of both medication errors and adverse drug events [23]. Comparing CPOE systems with hand written prescription orders, Shamliyan et al. reported a significant reduction in total prescribing errors in 80% (8/10 studies) of the studies reviewed, 43% (3/7 studies) reduction in dosing errors and 37.5% (3/8 studies) reduction in adverse drug events. The use of CPOE was associated with 66% reduction in total prescribing errors in adults (Odd Ratio, OR = 0.34; 95% CI(0.22–0.52) [24]. These approaches however are also frothed with the drawback of possible confusion of drugs with similar names at the point of prescribing, a problem being addressed with some success by the introduction of indication alerts [25]. Of the 1.04 million medication errors reported to MEDMARK in the United States of America between 2003 and 2010, 63,040 were related to computerized physician order systems suggesting that enhanced monitoring, reporting and testing of CPOE systems are required to improve patients safety [26].

Other measures adopted in various clinical settings often in multimodal forms to reduce the incidence of medication related errors include unique ports for route of administration, computerized provider order entry, decision support systems and telemedicine, barcode medication administration, pharmacy and nursing students trainings, simulation for education, package changes to reduce look alike and sound alike confusion, standardized labelling and measurement devices for home administration especially in children, other means of in-patients involvements in promoting drug use safety, appropriate changes in systems and cultures and more importantly promotion of non-punitive reporting of errors by staff [27–30].

Furthermore, several approaches and methods have been used to enhance the detection of medication related problems and encourage reporting. These include chart review, claim data review, computer based monitoring, direct care observation, interviews, prospective data collection and incident reporting. According to a review by Manias on detection of medication related problems in hospital practice, there is relatively low identification of these problems with incident reporting suggesting that attention should be focused on combination of methods for more effectiveness [31]. Of note is a novel approach termed Medication Errors Self Reporting Tool (MESRT) developed and experimented by Kung et al. in a Swiss Cardiovascular Surgery department. This approach mandated all registered nurses to complete the MESRT anonymously at the end of their shift whether or not there was medication error over a month period. The result was a very high response rate with useful information gathered compared to the traditional incident reporting system. This was concluded to be an effective method to detect, report and describe medication errors in hospitals [32]. Other medication safety efforts by individual nations especially in the Western world include the establishment of specific institutions to oversee medication safety issues. Examples include Institute of Safe Medication Practices (ISMP) in Canada, European Foundation for the Advancement of Healthcare Practitioners (EFAHP) and The International Medication Safety Advisory Panel across Europe and The United States Pharmacopoeia (USP) Medication Error Reporting Program (MERP). These kinds of initiatives are either non-existing or at best in infancy stages in most of the developing countries [33].

While the subject of medication errors has been studied extensively in other parts of the world, its prevalence and impacts remains understudied within the Nigerian health care systems. Available reports are limited to some aspects of the subject and were carried out within specific areas of practice and locations [22, 34, 35].

This study was therefore carried out to estimate the national prevalence of self-reported medication errors by the major groups of health professionals in Nigeria, examine their knowledge of medication errors and how medication errors are handled with the hope that these findings will inform appropriate interventional measures to promote medication safety and error proof medication handling among healthcare professionals in Nigeria.

2 Methodology

2.1 Study design and sampling

A cross sectional multicenter survey was carried out by the Nigerian group of International Network for Rationale Use of Drugs (INRUD) among doctors, pharmacists and nurses in Nigerian tertiary health institutions between November 2012 and April 2013. The participating institutions were selected by convenience sampling method according to the spread of the membership of the Nigerian group of INRUD and availability of personnel to carry out the study. Total sampling was targeted with all doctors, pharmacists and nurses in these institutions approached to participate in the study.

2.2 Study sites

The study sites included ten tertiary hospitals in Nigeria spread across the entire six geo-political zones and the Federal Capital Territory of the country thereby giving a national coverage. These are:

North Central: University of Jos Teaching Hospital, Jos

North West: Ahmadu Bello University Teaching Hospital, Zaria

North East: University of Maiduguri Teaching Hospital, Maiduguri

Federal Capital Territory: National Hospital, Abuja

South East: Imo State University Teaching Hospital, Orlu

South-South: University of Benin Teaching Hospital, Benin City

Delta State University Teaching Hospital, Asaba

South West: University College Hospital, Ibadan

Lagos University Teaching Hospital, Idi-Araba, Lagos

Lagos State University Teaching Hospital, Ikeja, Lagos

2.3 Ethical consideration

Ethical approval was obtained from the Nigerian National Health Research Ethic Committee before the commencement of this study. The participants also completed the questionnaire anonymously.

2.4 The study tool

The study tool was a self-administered structured questionnaire designed to obtain information on the socio-demography of the participants, their knowledge and the occurrences of medication errors as well as their reporting practices.

It was designed by the study team comprising of doctors, pharmacists, nurses, medical statisticians and epidemiologist using some of the information obtained from relevant literatures. The questionnaire was pretested among doctors, nurses and pharmacists in a non-participating health institution and the responses obtained were used to modify the study tool into the final version used in the survey.

It is divided into two sections A and B respectively. Section A was designed to collect information on the socio-demographic parameters of the respondent namely; age, sex, profession, number of years of practice, professional status/cadre and areas of practice. Section B obtained information on the areas of medication management process the individual has been involved in, what the individual considers to be medication errors out of a list of suggested items categorized into prescription, dispensing and administration errors, whether or not the respondent has committed medication error in his or her practice and the number of times, the time of the day that most errors occurred, specification of the type of error ever committed, what the individual felt was responsible for the error committed out of a list of suggested possible reasons and whether the incident was reported or not, to whom it was reported and if not reported, reasons for not reporting. Lastly, the respondent was to indicate the availability or otherwise of an institutional structure and process for handling medication errors in their hospitals.

Participants answered either ‘Yes’ or ‘No’ or ‘Don’t Know’ to the sets of questions evaluating their knowledge of the three aspects of medication errors studied. These sets of questions are as follows:

2.4.1 Prescription errors

A total of ten sets of questions namely Patient name omitted, Patient Identity Number Omitted, Patient age not specified, Incorrect choice of drug/s for diagnosis made, Incorrectly stated doses, Doses not stated in mg/g rather than number of tablets, Wrong route of administration prescribed, Use of brand names of drugs, Prescription not dated and Prescription not initialed.

2.4.2 Dispensing errors

A total of four sets of questions namely wrong drug dispensed, drug dispensed not labelled, drug incorrectly labelled and incorrect doses stated.

2.4.3 Drug administration errors

A total of five sets of questions namely wrong drug administered, wrong doses administered, wrong route of administration, incorrect recording of drug administered and forgetfulness in charting administered drug/s.

2.5 Statistics

Correct responses to questions evaluating the knowledge about prescription, dispensing and administration errors were scored one mark each while other responses were scored zero and the composite scores computed. Appropriate statistics were applied to summarize and establish the relationship between variables using SPSS 17.0. Continuous variables were expressed as means (standard deviation), categorical variables as proportions. Comparisons of categorical variables were done using the chi square and means using the Student ‘t’ test and ANOVA as appropriate with a Post Hoc Analysis carried out as indicated. All the tests were carried out at 5% level of significance.

3 Results

3.1 Socio-demographic characteristics of respondents

A total of 2,386 health care professionals predominantly females (60.7%) participated in the study with nurses constituting 46.3%, medical and dental practitioners 44.9%, and pharmacists 8.8% (see Table 1). The mean age of participants was 33.7 (8.1) years with age range between 20 and 72 years. Their mean number of years of practice was 7.19 (7.60) years with a range of 1 to 38 years. Their areas of practice included a wide range of the sub-specialties of medicine with general medical practice (36%), internal medicine (14%) and surgery (12%) constituting the three most common areas (Fig. 1).

3.2 Involvement of participants in the medication management processes

Majority of the respondents (74.1%) were involved with drug administration, 57.9% in drug prescription and 21.2% in drug dispensing. Table 2 and Fig. 2a, 2b and 2c respectively show the involvement of the professional groups in the different stages of the medication management processes with 76.4% of the pharmacists and 72.3% of the nurses being involved with drug prescription.

3.3 Knowledge of medication errors

The three professional groups differ in their knowledge of prescription, dispensing, drug administration and total medication errors as shown in Table 3a. Post hoc analyses (LSD) revealed medical and dental practitioners (doctors) had superior knowledge of prescription errors to nurses and pharmacists and superior knowledge of dispensing errors to nurses. Both doctors and nurses had superior knowledge of drug administration errors to the pharmacists. The total medication error knowledge of doctors was superior to that of the nurses while it was not different from that of the pharmacists (see Table 3b).

3.4 Influence of professional status/cadre on knowledge of medication errors

The professional cadres differ significantly with respect to all the three aspects of medication errors studied with the professional status established as a factor influencing individual’s knowledge of all aspects of medication errors.

Among the nurses, the nursing officers had the highest mean knowledge score of prescription errors. This decreased progressively as the cadre rises with the senior and principal nursing officers and then showed a slight rise with the chief nursing officers and above. In contrast, the knowledge of prescription errors among the pharmacists improved progressively as the professional status rose. Among the doctors, the prescription error knowledge was least with the house officers, rising progressively from the medical officers to those in the senior medical officers and above category. Thereafter, there was a decline with the registrars’ category and a rise with the senior registrars and the consultants progressively (Fig. 3a).

Figure 3b showed the plots of the mean dispensing errors knowledge scores according to the professional status among the participants. The pattern of progression is similar to those outlined above with knowledge of prescription errors among the three professional groups.

The knowledge of drug administration errors also followed similar patterns among the nurses and the pharmacists (Fig. 3c) but differs with the trend recorded in the knowledge of prescription and dispensing errors among the doctors. There was a decline with the senior medical officers and above in contrast to the rise recorded with this group in the knowledge of prescription and dispensing errors.

The pattern of the total medication errors knowledge among the nurses was consistent with the previous ones (Fig. 3d). The nursing officers had the highest score with progressive decline with the senior and principal nursing officers and a rise with the chief nursing officers and above. In contrast to the previously recorded trends among the pharmacists, there was a decline in the total knowledge of medication errors with the senior pharmacists and a rise thereafter with the chief pharmacists and above. The doctors however displayed a progressive rise in total knowledge of medication errors along the professional cadres with the least score recorded with the house officers and the highest with the consultants.

There were no differences in the knowledge of medication errors in all aspects of the medication management processes studied with respect to the specialties or areas of practice.

3.5 Self-reported medication errors

A total of 1122 of respondents had committed medication errors in the past giving the prevalence of self-reported medication errors among health care professionals studied as 47%. The various types of errors committed are shown in Table 4. The major reasons identified for being error prone were overwork (59.2%) and tiredness (41.6%) while 20.4% could not identify any particular reason (Table 5).

Only 35.5% had ever reported medication errors in their practice while about a third (33.4%) of the respondents did not think reporting was necessary. Other reasons for not reporting were as shown in Table 6. Only 20.2% were aware of mechanisms for reporting medication errors in their hospitals.

4 Discussion

This study is an important addition to the currently existing body of knowledge on the subject of medication errors in Nigeria as it addresses broader aspects of the subject among the three major groups of health care professionals with an appreciable national spread. The participants were mostly nurses (46.3%) and medical and dental practitioners (44.9%). This is a reflection of the ratio of different groups of health workers in Nigeria as there are usually more nurses and doctors than pharmacists in each unit of the health sector of Nigeria.

It is not surprising that the majority of the health workers (74.1%) were involved in drug administration. The nurses and doctors that constituted the majority of the respondents are often involved in one form of drug administration or the other. Drug administration forms one of the core responsibilities of nurses while some aspects of drug administration like parenteral routes of administration are carried out by doctors in many settings within the Nigerian health sector especially within the tertiary institutions studied.

Of note are the findings of 76.4% of the pharmacists and 72.3% of the nurses studied being involved in drug prescriptions. Our study did not capture the setting within which they practice drug prescription but it is unlikely to be within the setting of the tertiary health institutions studied as the existing practice stipulates that drug prescriptions are only done by the doctors. The current practice in Nigeria involves clinical and community pharmacists as well as nurses and midwives who could operate maternity homes and offer some forms of primary health cares prescribing some drugs especially the ‘over the counter drugs’ (OTCs). While in some other parts of the world, a subset of the nurses and pharmacists are trained and empowered to carry out some specified aspects of drug prescription, the legal frameworks and regulations of this practice among Nigerian nurses and pharmacists remains unclear. It will be instructive to investigate these findings further with the view of ensuring that these groups of professionals are adequately prepared by education and training for what they practice within the limits of enabling regulations.

Prescribing and drug administration processes have been found to be associated with the largest numbers of medication errors recorded irrespective of whether these results in harms or not [8–10]. The involvements of a good proportion of the Nigerian health workers in the two aspects of prescribing and administration suggest a high level of error prone activities in the medication management processes among these groups of workers.

4.1 Knowledge of medication errors

The differences in the knowledge of the three professional groups recorded with respect to the different aspects of the medication management processes is consistent with the expected areas of strength of the group concerned. It is not surprising that the doctors exhibited superior knowledge of prescription errors over the nurses and the pharmacists. Doctors are prepared by education and trainings to carry out drug prescription. The pharmacists had superior knowledge of dispensing errors to the nurses, a finding that is not unexpected since drug dispensing is a core responsibility of pharmacists. The total medication error knowledge of doctors was superior to that of the nurses while it was not different from that of the pharmacists (Table 3a). There is relative scarcity of studies that have compared the knowledge of these professional groups about the different aspects of medication errors in the body of literature making comparisons not feasible with findings in other parts of the world regarding these aspects of the study. A prospective study on medication administration errors among old people in long term care homes in the United States of America revealed that only 12 out of 41 staff administering drugs reported that they were aware of the potential drug administration errors in their care homes [16]. It is hoped that this study will form the basis upon which similar studies will be compared in the future.

4.2 Influence of professional status/cadre on knowledge of medication errors

The differential levels of knowledge of medication errors with respect to the three aspects studied among the professional cadres within each group studied are clear indicators of the existing knowledge gaps about the subject among Nigerian health professionals.

The nursing officers who are at the bottom of the nursing professional cadres’ demonstrated better knowledge in all aspects of the medication errors studied over their superior officers. It could be inferred that the knowledge base of nurses studied decline progressively as they advance in years of practice especially within the mid carrier till they get to the apex of their carriers as chief nursing officers and above where probably as they take a lot more supervisory responsibilities, they tend to refresh their knowledge as reflected in the findings in this study with some improvements in the knowledge of nurses at this cadre about the subject.

Pharmacists showed a progressive increase in the knowledge of medication errors with the advancement in professional cadre except with the total knowledge of medication errors where there was a decline with the senior pharmacists. These findings however might not be truly representative of the knowledge base of the pharmacists about the subject of medication errors owing to the fact that the total number of respondents among this group was relatively small, 55(8.8%). However, the decline in the total knowledge of medication errors recorded at the level of the senior pharmacists is also an indication of some knowledge gaps amongst this group about medication errors.

The least knowledge in all the aspects of medication errors studied was recorded with house officers (interns) among the doctors and also a consistent decline with the registrars along the professional cadre. While these findings are not surprising as the house officers are in their first year of practice after graduation, it identifies a definite gap in the medical school curriculum that needs to be filled. The identified knowledge gaps seem to have persisted to the level of registrars who are already undergoing specialist training in the various fields of medicine. Many of the registrars might have graduated from medical school several years before being admitted into the various training programs. These knowledge gaps are probably sustained as a result of lack of continuous professional training that addresses this subject in the period between graduation and their current training positions.

The senior medical officers and above had superior knowledge of prescription, dispensing and total medication errors and a decline in their knowledge of drug administration errors. The fact that these categories of doctors have been exposed to the teaching hospital system and practice for appreciable length of time will explain their superior knowledge over the house officers, medical officers and registrars in the aspects of prescription and dispensing errors. However, their relative less knowledge of dispensing error may be a reflection of the fact that they are less involved in this aspect of the medication management processes. These are probably delegated to the junior cadres.

4.3 Self-reported medication errors

The prevalence of self-reported medication errors of 47% among Nigerian health professional obtained in this study was consistent with the high prevalence reported with respect to specific aspects of medication errors studied previously in Nigeria [22, 33, 34]. Since this was an estimate of prevalence, it could not be strictly compared with the global medication errors incidence of 2–14% [6, 7]. Such comparisons will only be appropriate with a study that investigates the incidence of medication errors in Nigeria.

The various types of medication errors reported in our study (Table 5) are consistent with those in the available literature [15]. Our study revealed that only 35.5% of the participants had ever reported medication error committed in their practice. This is also consistent with the poor rates of reporting established by other researchers. A United States of America survey revealed that only 17–30% of physicians informed their patients when they experience medical errors inclusive of medication errors [17]. Similarly, Ashcroft et al. found that community pharmacists and their support staff are unlikely to report adverse incidents when experienced in their practices [20]. The same patterns of reporting have been established among Iranian nurses and among a group of Nigerian peadiatric nurse with only 30% of them noted to have reported medication error committed in the past [21, 22].

While our study participants also admitted a number of reasons for not reporting medication errors that are consistent with those reported in other parts of the world like fear of litigation and disciplinary actions, fear of accusation of incompetence, fear of fatal consequences to the patients and protection of self-ego, the finding that the most common reason (33.4%) why our study participants did not report medication errors was the fact that they did not think it was necessary to report is of serious concern. This underscores a very urgent need for appropriate interventional measures among these groups of healthcare professionals [17–20].

The reasons for being medication error prone identified by these groups of Nigerian healthcare professionals were overwork (59.2%), tiredness (41.6%), knowledge gap (16.5%), floppiness (14.2%) and no particular reasons in 20.4%. These factors are all consistent with the established root causes of medication errors among health care professionals in other parts of the world though in slightly different orders of importance. Keers et al. in a systematic review of quantitative and qualitative causes of medication administration errors had reported slips and lapses as the most commonly reported unsafe acts, followed by knowledge deficiencies and the least being deliberate acts [12]. Other factors reported by these workers were error provoked conditions like inadequate written communications, medication supply and storage problems, high perceived work load, staff fatigue and stress and interruptions and distractions during drug administration [12]. Furthermore, Leape et al. had reported that the most common system failure (39%) causing potential adverse drug events occurs at the physicians ordering stage due to lack of knowledge about the drugs while Lawton et al. in an exploratory study involving three medical wards in a United Kingdom hospital also identified the problem of work load among other factors as the causes of medication errors [13, 14].

5 Conclusions

The self-reported prevalence of medication errors is high among health care professionals in Nigeria, many of which are not been reported. Knowledge gaps, inadequate work environments and practice deficiencies were identified as reasons for being error prone. These requires urgent attention through trainings, provision of modern infrastructures and appropriate local and national policies. Nigeria can borrow from the efforts being made in other parts of the world to reduce the incidence of medication errors and its attendant adverse drug events and promote the reporting of medication errors when they occur.

Conflict of interest

The authors declare there is no conflict of interest.

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