Medication errors in inpatient care are frequent, and improvements to increase safety are vital. More attention to medication administration techniques, administration instructions and attitudes toward safety are needed to prevent problems.

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Based on the study's findings and the limitations of each method, a combination of different methods should be used to discover representative information concerning medication administration errors. To increase medication administration safety, advanced multiprofessional collaboration, effective communication, adequate skills, more systematic medication processes, and distraction-free work environments are needed.

Aim To describe medication safety, transformational leadership and their relationship as evaluated by Registered Nurses. Background Medication safety is one of the aspects of patient safety and an important part of nurses' daily practices. Nurse managers can ensure medication safety by adopting a transformational leadership style. However, little evidence exists regarding how transformational leadership relates to medication safety. Methods Data were collected from Registered Nurses (n = 161) in three Finnish hospitals in May 2016 using an electronic questionnaire incorporating the Transformational Leadership Scale (TLS) and Medication Safety Scale (MSS). Data were analysed using statistical analyses including descriptive analyses, principal component analysis and multivariate analyses. STROBE reporting guidelines were followed (see Appendix ). Findings Nurses evaluated medication safety and transformational leadership in their units to be excellent and good, respectively. There was a moderate but statistically significant correlation between transformational leadership and medication safety. The medication competence of nurses and the management of nursing processes were significantly related to medication safety. Conclusions Nurse managers' transformational leadership style can promote medication safety in units. The medication competence of nurses must be addressed because assurance and confidence in their own expertise in pharmacotherapeutic tasks positively affects their perceptions of medication safety.

Background: Some medications carry increased risk of patient harm when they are given in error. In incident reports, names of the medications that are involved in errors could be found written both in a specific medication field and/or within the free text description of the incident. Analysing only the names of the medications implicated in a specific unstructured medication field does not give information of the associated factors and risk areas, but when analysing unstructured free text descriptions, the information about the medication involved and associated risk factors may be buried within other non-relevant text. Thus, the aim of this study was to extract medication names most commonly used in free text descriptions of medication administration incident reports to identify terms most frequently associated with risk for each of these medications using text mining. Method: Free text descriptions of medication administration incidents (n = 72,390) reported in 2016 to the National Reporting and Learning System for England and Wales were analysed using SAS® Text miner. Analysis included text parsing and filtering free text to identify most commonly mentioned medications, followed by concept linking, and clustering to identify terms associated with commonly mentioned medications and the associated risk areas. Results: The following risk areas related to medications were identified: 1. Allergic reactions to antibacterial drugs, 2. Intravenous administration of antibacterial drugs, 3. Fentanyl patches, 4. Checking and documenting of analgesic doses, 5. Checking doses of anticoagulants, 6. Insulin doses and blood glucose, 7. Administration of intravenous infusions. Conclusions: Interventions to increase medication administration safety should focus on checking patient allergies and medication doses, especially for intravenous and transdermal medications. High-risk medications include insulin, analgesics, antibacterial drugs, anticoagulants, and potassium chloride. Text mining may be useful for analysing large free text datasets and should be developed further.

Aim To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription‐related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. Background Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. Design A sequential exploratory mixed‐method design. Methods Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR’s SRQR checklist was followed in reporting. Results Twenty‐eight communication pairs were identified, with nurse–nurse (68.2%; n = 341), nurse–physician (41.6%; n = 208) and nurse–patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. Conclusions The interventions should be prioritised to (a) enhancing communication about work‐processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. Relevance to clinical practice Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.

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Aims To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients’ own homes (reporters’ profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. Design A retrospective study using descriptive statistical analysis and text mining. Methods Medication administration incidents (N = 19,725) reported to have occurred in patients’ homes between 2013–2018 in one district in Finland were analysed, describing the data by the reporters’ occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. Results Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was ‘mild harm’ (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were ‘communication and flow of information’ (25.5%, N = 5,038), ‘patient and relatives’ (22.6%, N = 4,451), ‘practices’ (9.9%, N = 1,959), ‘education and training’ (4.8%, N = 949), and ‘work environment and resources’ (3.0%, N = 598). Conclusion There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. Impact These findings about MA incidents that have occurred in patients’ homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.