Abstract
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Background: Medication errors are among the top 10 causes of mortality, the most common cause in clinical settings and remains a significant global patient-safety concern, ranking among the leading cause of preventable harm in healthcare settings [1]. Nurses and midwives, as primary medication administrators, play a crucial role in safeguarding patients and ensuring accurate medication practices. This mixed methods systematic review seeks to examine the prevalence, contributing factors, and types of medication administration errors involving registered nurses, midwives, and enrolled nurses within hospital environments.
Methods: This systematic review was conducted using seven electronic databases including: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, ScienceDirect, Cochrane’s Library, Scopus, Embase and ProQuest. The search strategy incorporated Medical Subject Headings and text words in various combination including (i) evaluation terms: “medication” OR “drug” OR “medication administration error*” OR “dispensing error (ii) population terms: (“Nurs*” AND “Midwi*) (iii) design terms: (“quantitative” OR “experimental”). The search limiters used were “hospital settings”, “January 2017 to October 2025” and those published in English. Exclusion criteria included systematic or scoping review, “model, guidelines, protocols, allied health care professional, doctor, and grey literature. This systematic review used the 27-item Preferred Reporting Items for Systematic reviews and Metanalysis checklist [2]. The protocol is registered with PROSPERO 2026 registration number CRD420251182294.
Results: The search of the seven data bases resulted in 3965 articles, with 1452 duplicates removed using Endnote, resulting in 2513 articles that were imported into the Joanna Briggs Institute SUMARI platform. Screening at the title and abstract level resulted in 130 full-text articles. Of these, 105 were excluded for not meeting the inclusion criteria, leaving 25 studies included in the final review. The prevalence of self-reported medication errors among nurses and midwives varied from 36.2% to 86.5% over the course of a career [3-27]. Patient-related included multiple comorbidities and increased care complexity. Health-care professional involved communication breakdown, personal issues, poor patient-nurse relationships, reduced years of experience, inadequate knowledge and diploma level education [3-26]. System-level contributors were high workload, inadequate safe medication training, work environments, inadequate staffing, night shift, lack of guidelines/policies, rotating shift schedules and interruptions [3-27]. Common types of medication errors identified were wrong preparation, wrong route, wrong medication, miscalculations, wrong time, wrong patient, not checking for allergies, omitted or additional doses, and documentation errors [3 – 27].
Implications: Medication administration errors are multifactorial in order to reduce medication errors by nurses and midwives, considerations include patient related complexities such as increased co-morbidities, polypharmacy, and pediatric weight-based dosing. Strengthening educational and professional support in drug preparation and safety principles, alongside improved communication frameworks for medication checking, can reduce risk. Minimizing workflow disruptions and fostering a strong culture of safety are also critical to improving medication administration practices.
Conclusion: Overall, the evidence strongly supports a shift away from person-centred blame toward system-level redesign, with particular emphasis on high-risk medications and routes, high-risk times of administration, optimized electronic medication systems, and supportive safety cultures that encourage learning from error.
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