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Medication errors are a common source of patient harm. This systematic review synthesizing qualitative evidence concluded that nurses’ perceived causes of medication administration errors are multifactorial, interconnected, and stem from systems issues. Perceived causes included lack of medication knowledge, fatigue, complacency, heavy workloads, and interruptions.

Human factors, such as cognitive load, are main contributors to prescribing errors. This study assessed the relationship between medication prescribing errors and a physician’s workload, successive work shifts, and prescribing experience. The researchers reviewed presumed medication errors flagged by a computerized decision support system (CDSS) in acute care settings (excluding intensive care units) and found that longer hours and less experience in prescribing specific medications increased the risk of prescribing errors.

Fatigue has been linked to safety-related outcomes among many types of healthcare providers and settings. Using exploratory factor analysis, this study found physical and mental fatigue were the primary drivers of occupational fatigue in pharmacists. To increase safety, organizational interventions should strive to prevent burnout among pharmacists .

Based on survey data of a sample of nurses, the authors identified a significant association between perceived risk of near miss medication errors and both poor sleep quality and short resting time after a night shift.  

This direct observation study of emergency physicians found that interruptions, multitasking, and poor sleep were associated with making more medication prescribing errors. These results add to the evidence that clinical environments prone to interruptions may pose a safety risk.

This special issue includes articles exploring systems-oriented safety improvement in surgical care.

Articles in this special issue detail how human factors and ergonomics concepts can contribute to patient safety efforts through improving design, training, and equipment usability.

This special issue explores adverse events in nursing, including nurses' perceptions and attitudes towards adverse events, the effect of fatigue on shift work, and how to improve clinical decision making.

Prescribing errors in a pediatric emergency department were more frequent on weekends and at night, and residents committed errors more frequently than attending physicians.

A considerable amount of attention has been paid to the issue of physician work hours and patient safety, thanks in part to regulations limiting duty hours for resident physicians. Fatigue has also been demonstrated to be a risk factor for errors among nurses, particularly when nurses work overtime or extended duration shifts. In this analysis, the authors found that among nurses, working voluntary overtime or working more than 40 hours per week were strongly correlated with an increase in self-reported errors, particularly needlestick injuries and medication errors. While legislative efforts have focused on restricting mandatory overtime for nurses, these results raise concern that the widespread practice of taking voluntary overtime shifts could negatively affect patient safety.

This article describes how patient safety and team coordination in the ICU are connected. The author recommends team training as an approach to enhance collaboration.