Systematic ReviewResearchMedication Safety

Lack of training, interruptions, and missing guidelines were the factors most strongly tied to nurses' medication errors

Journal of Patient Safety (PubMed)Jun 29, 2026

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Brief summary

A systematic review and meta-analysis using the SEIPS human-factors model identified 34 significant risk factors for medication errors among nurses and found that lack of training, interruptions, and unavailable guidelines carried the strongest pooled associations.

What NurseJet pulled from the source

Searching OVID-MEDLINE, EMBASE, CINAHL, and four Korean databases through March 2025, this review included 16 studies and mapped risk factors onto the Systems Engineering Initiative for Patient Safety (SEIPS) work-system components: person, task, tool/technology, organization, and environment. It identified 34 statistically significant risk factors across four components, with none found in the tool/technology component. A random-effects meta-analysis of the three factors reported across multiple studies showed the strongest associations for lack of training (pooled AOR 3.75, 95% CI 1.89 to 7.43), interruptions (pooled AOR 3.06, 95% CI 1.67 to 5.59), and unavailable guidelines (pooled AOR 1.98, 95% CI 1.45 to 2.69). The authors conclude that preventing medication errors requires system-wide interventions and prioritize continuous education, interruption reduction, and accessible guidelines.

Why this matters for nurses

Medication administration is one of the highest-frequency, highest-risk nursing tasks, and errors are often blamed on the individual nurse. Framing the evidence through a systems lens, this review may matter for nurses because it shows the largest measured drivers are modifiable conditions of work: training, interruptions, and access to guidelines, rather than personal carelessness.

Bedside takeaway

Be aware that in a meta-analysis, the factors most strongly tied to nurses' medication errors were lack of training, interruptions, and unavailable guidelines, all modifiable conditions of work rather than personal carelessness.

Explain this for my unit

Key takeaways

Across 16 studies, 34 significant risk factors for nurse medication errors were identified across four SEIPS components, with none in the tool/technology component.
Lack of training carried the strongest pooled association (AOR 3.75, 95% CI 1.89 to 7.43).
Interruptions roughly tripled the odds of error (AOR 3.06, 95% CI 1.67 to 5.59).
Unavailable guidelines were also significant (AOR 1.98, 95% CI 1.45 to 2.69).

Practice implications

For nurses, the findings support protecting the medication-administration process from interruptions (for example, no-interruption zones or do-not-disturb signals during med passes), advocating for accessible, up-to-date medication guidelines at the point of care, and pursuing continued medication-safety education. For unit leaders, they argue for system-level fixes rather than individual blame when errors occur.

Limitations & cautions

The meta-analysis pooled only the three factors reported in enough studies, so most of the 34 identified factors were not quantified, and the included studies were correlational, showing association rather than causation. Definitions and measurement of medication errors varied across the 16 studies, several of which came from Korean databases, which may limit how directly the pooled estimates transfer to other settings.
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Citations

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Journal of Patient Safety (PubMed)

Journal of Patient Safety (PubMed). Factors Influencing Medication Errors in Clinical Nurses: A Systematic Review and Meta-analysis.

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https://pubmed.ncbi.nlm.nih.gov/42367092/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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BMJ Quality & Safety (PubMed)Mar 13, 2026Research Article

In a multicentre randomised controlled simulation trial with 82 nurses, independent double-checking detected more medication administration errors than single-checking overall, but the benefit was limited to experienced nurses, with no significant improvement among nurses with under five years of experience.

Med-Surg PedsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Double-checking medication administration is a common hospital safety practice, and independence between the two checkers is thought to be the key to its effectiveness, yet there has been no empirical evidence that independent double-checking (IDC) detects errors better than a single-nurse check. This multicentre randomised controlled simulation trial enrolled 82 nurses from two paediatric hospitals in 41 two-hour simulations, each involving two nurses who administered medication sets containing embedded errors under both single-checking and IDC conditions, with condition order and medication sets randomised. Across 1,160 dose administrations with 640 error-detection opportunities, nurses detected 72.2 percent of errors (95 percent CI 68.6 to 75.5). Overall, IDC yielded an 11 percent higher error detection rate than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent for IDC versus 66.3 percent for single checks). That benefit was limited to experienced nurses: among early career nurses (under 5 years of experience) IDC produced no significant improvement (adjusted incidence rate ratio 0.98, 95 percent CI 0.86 to 1.11, P = 0.7), while experienced nurses showed a 26 percent improvement (adjusted incidence rate ratio 1.26, 95 percent CI 1.11 to 1.44, P less than 0.001). Evidence of social loafing was seen, particularly among early career nurses, whose detection was 26.0 percent higher when single-checking than in the role of first checker in IDC, and IDC required significantly more time (mean difference 4.96 minutes per medication set, P less than 0.001). The authors conclude that, given its inconsistent benefits, resource demands, and susceptibility to social loafing, IDC may be unsuitable as a universal safety strategy, and that strengthening single-checking competence and clinical judgement may be a more effective, scalable approach.

Key takeaways

In 41 two-hour simulations, 82 nurses from two paediatric hospitals administered medication sets with embedded errors under both single-checking and independent double-checking conditions.
Overall, independent double-checking detected 11 percent more errors than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent versus 66.3 percent).
The benefit was limited to experienced nurses (26 percent improvement, P less than 0.001); among nurses with under five years of experience there was no significant improvement (P = 0.7).
Independent double-checking took about 5 minutes longer per medication set (mean difference 4.96 minutes, P less than 0.001), and social loafing lowered early career nurses' detection in the first-checker role.

Why this matters on shift

Independent double-checking is widely mandated and consumes considerable nursing time, yet its real benefit has been assumed rather than measured. This study may matter for nurses and safety leaders because it provides direct evidence that the practice helps experienced nurses catch errors but does not reliably help less experienced ones, which challenges applying it as a blanket rule.

Bedside takeaway

Be aware that in a simulation trial, independent double-checking caught more medication errors than single-checking only for experienced nurses, with no benefit for nurses under five years and signs of reduced individual vigilance when checking in pairs.

Nursing implications

For nurses and unit leaders, the findings suggest that independent double-checking is not automatically safer for every nurse or situation and can be undermined by social loafing, where a second checker relaxes their own vigilance. The results support investing in each nurse's own checking competence and clinical judgement, and reserving double-checks for the highest-risk medications, rather than treating a second signature as a guaranteed safety net.

Limitations & cautions

This was a simulation trial rather than a study of real bedside administration, so behavior with actual patients and consequences may differ, and it involved 82 nurses from two paediatric hospitals, which may limit how far the results extend to adult or other settings. Detecting deliberately embedded errors in a study scenario may not fully reflect the interruptions and workload of everyday practice.
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Citations · exact source links

BMJ Quality & Safety (PubMed). Is independent double-checking superior to single-checking in medication administration error detection? A randomised controlled simulation trial.

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Nurse Educator (PubMed)Jul 7, 2026Research Article

In a retrospective program evaluation across 13 semesters, a standardized, experiential medication dosage calculation program that combined instruction, simulation, and assessment was associated with significantly higher first-attempt pass rates among nursing students than the period before it was introduced.

Leadership Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyNew Grad FriendlyAI summary · original source linked below

Medication dosage calculation errors are a persistent patient-safety concern and a barrier to nursing student progression, and this program had seen significant declines in pass rates, with more than half of students across program levels failing their initial dosage calculation assessments. Educators at a nursing program implemented a standardized, experiential dosage calculation initiative that integrated instruction, simulation, and assessment, then conducted a retrospective evaluation of medication dosage calculation outcomes across 13 semesters, comparing the 4 semesters before implementation with the 9 semesters after. First-attempt pass rates were compared using a t test to assess program-level change over time. Mean semester-level pass rates were significantly higher after implementation (t(3.79) = -4.18, P = 0.016), and the post-implementation semesters consistently met or exceeded the program benchmark. The authors conclude that a standardized, experiential approach to dosage calculation instruction was associated with sustained improvements in program-level outcomes and offers practical guidance for nurse educators seeking data-driven curricular changes that support medication safety and student progression.

Key takeaways

More than half of students across program levels had been failing their initial medication dosage calculation assessments before the change.
Educators introduced a standardized, experiential dosage calculation program combining instruction, simulation, and assessment.
A retrospective evaluation compared 4 pre-implementation semesters with 9 post-implementation semesters using a t test.
Mean semester-level first-attempt pass rates were significantly higher after implementation (t(3.79) = -4.18, P = 0.016) and consistently met or exceeded the program benchmark.

Why this matters on shift

Dosage calculation competency underpins safe medication administration, yet many nursing students struggle to pass these assessments, which can delay progression and signal a downstream safety risk. This study may matter for nurse educators and new nurses because it links a structured, hands-on teaching approach to sustained improvement in first-attempt pass rates.

Bedside takeaway

Worth knowing that a standardized, hands-on dosage calculation program was linked to higher first-attempt pass rates for nursing students across 13 semesters.

Nursing implications

For nurse educators and preceptors, the findings suggest that building dosage calculation skills through repeated, experiential practice tied to instruction, simulation, and assessment, rather than one-off lessons, may raise competency and support medication safety. For students and new graduates, it reinforces that dosage calculation is a skill strengthened by structured practice over time.

Limitations & cautions

This was a retrospective, single-program evaluation comparing pass rates before and after one curricular change, without a separate control group, so other factors over the 13 semesters could have contributed. Because it reports program-level pass rates rather than individual student outcomes or actual medication errors at the bedside, it does not show whether the gains reduced real-world administration errors.
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Citations · exact source links

Nurse Educator (PubMed). Innovative Educational Strategies to Improve Dosage Calculation Competency in a Nursing Program.

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Scientific Reports (PubMed)Jun 26, 2026Research Article

In a single-center quasi-experimental study of 60 inpatients at pressure injury risk, adding a structured Interaction Model of Client Health Behavior nursing program to routine care was associated with fewer new pressure injuries and more wound healing at 3 months than routine care alone.

Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

This non-randomized, non-equivalent control group study at one Chinese hospital enrolled 60 inpatients who had a pressure injury or were at high risk for one between June 2022 and June 2023. Patients were allocated by admission period to routine care or to nursing based on the Interaction Model of Client Health Behavior (IMCHB) for 3 months. Outcomes were measured with a caregiver pressure injury knowledge questionnaire, the Generic Quality of Life Inventory-74, dynamic observation for new pressure injuries, the Pressure Ulcer Scale for Healing (PUSH), and a nursing satisfaction scale. Baseline characteristics were comparable between the groups. After 3 months, the intervention group had higher caregiver knowledge scores than the control group (31.90 plus or minus 5.24 vs 26.37 plus or minus 6.85, P = 0.001) and higher social, physical, and material function scores (all P less than 0.001). New pressure injury incidence was lower in the intervention group (3.33 percent vs 26.67 percent, Fisher's exact P = 0.026). Wound improvement or healing did not differ significantly at 1 month (60.00 percent vs 40.00 percent, P = 0.196) but was higher in the intervention group at 3 months (93.33 percent vs 60.00 percent, Fisher's exact P = 0.005). Nursing satisfaction scores were also higher (all P less than 0.001). The authors conclude that IMCHB-based nursing may support sustained pressure injury prevention and wound outcomes, while noting that larger randomized studies are needed.

Key takeaways

Sixty inpatients with a pressure injury or high pressure injury risk were allocated by admission period to routine care or to nursing based on the Interaction Model of Client Health Behavior for 3 months.
New pressure injury incidence was lower with the structured program (3.33 percent vs 26.67 percent, Fisher's exact P = 0.026).
Wound improvement or healing was similar at 1 month (60.00 percent vs 40.00 percent, P = 0.196) but higher with the program at 3 months (93.33 percent vs 60.00 percent, Fisher's exact P = 0.005).
Caregiver knowledge and nursing satisfaction scores were also higher in the intervention group (P = 0.001 and all P less than 0.001).

Why this matters on shift

Preventing pressure injuries and supporting wound healing depend on consistent behaviors from nurses, patients, and caregivers over time, which is hard to sustain with usual care. This study may matter for wound and med-surg nurses because it tests a structured behavior-focused nursing model and links it to fewer new pressure injuries and more healing over 3 months.

Bedside takeaway

Worth knowing that in a small single-center study, a structured behavior-focused nursing program was linked to fewer new pressure injuries and more wound healing at 3 months than routine care alone.

Nursing implications

For nurses caring for patients at pressure injury risk, the findings suggest that a structured program engaging patients and caregivers in prevention behaviors, alongside routine skin and repositioning care, may reinforce pressure injury prevention and wound healing. Because this was a small, single-center, non-randomized study, the model is best viewed as a promising addition to established prevention bundles rather than a proven replacement.

Limitations & cautions

This was a single-center, non-randomized quasi-experimental study of only 60 inpatients, with groups assigned by admission period rather than randomization, so unmeasured differences between the groups could have influenced the results. The 3-month follow-up at one Chinese hospital may not generalize to other settings, and the authors themselves call for larger randomized trials.
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Citations · exact source links

Scientific Reports (PubMed). Interaction model of client health behavior-based nursing intervention improves outcomes in patients with pressure injury: A quasi-experimental study.

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Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Independent double-checking caught more medication errors than single-checking only for experienced nurses in a simulation trial

A standardized, hands-on dosage-calculation program raised nursing students' first-attempt pass rates across 13 semesters

A structured client-behavior nursing model was linked to fewer new pressure injuries and more healing in a small inpatient study