Difficulties Faced by Pediatric Nurses in Safe Medication Administration: A Literature Review

Öz

Safe medication administration is a multifaceted process that encompasses the storage, prescribing, verification, preparation, administration, documentation, and monitoring of drugs, all of which directly affect patient safety. Any disruption or deficiency in these steps may place patient safety at risk. In pediatric populations, physiological differences, narrow therapeutic ranges, and the lack of age-appropriate formulations further increase the likelihood of medication errors. The literature highlights that medication administration errors have serious clinical and economic consequences and represent a preventable patient safety issue. Ensuring safe medication practices is a fundamental component of pediatric nursing care; however, nurses continue to face numerous challenges in maintaining medication safety. These challenges may stem from insufficient knowledge and experience, inadequate working conditions, communication problems, limited collaboration between parents and nurses, and shortcomings in patient safety culture. This review identifies these multidimensional challenges and highlights the urgent need for interventions that strengthen nurses’ working conditions, enhance parent–nurse collaboration, and promote a positive safety culture. Practical implications include the development of structured education programs, supportive institutional policies, and evidence-based strategies to minimize error risks. Future research should focus on designing and implementing interventions that enhance pediatric medication safety, improve treatment outcomes, and ensure sustainable, high-quality care for children.

Anahtar Kelimeler

• Pediatric nursing
• Safe medication administration
• Medication errors
• Patient safety
• Difficulties
• Nursing interventions
• Healthcare systems

Kaynakça

1. Marufu TC, Bower R, Hendron E, Manning JC. Nursing interventions to reduce medication errors in paediatrics and neonates: systematic review and meta-analysis. J Pediatr Nurs. 2022;62:e139-47.
2. Smeulers M, Verweij L, Maaskant J, de Boer M, Krediet C, Nieveen van Dijkum E, Vermeulen H. Quality indicators for safe medication preparation and administration: a systematic review. PLoS One. 2015;10:e0122695.
3. Öz GÖ, Arslanli SE, Pekyiğit A. Pediatric nurses' experiences of implementing the ‘ten right principles’ in safe medication management: a descriptive phenomenological study. J Pediatr Nurs. 2024;78:97-105.
4. Coelho F, Furtado L, Mendonça N, Soares H, Duarte H, Costeira C, et al. Predisposing factors to medication errors by nurses and prevention strategies: a scoping review of recent literature. Nurs Rep. 2024;14(3):1553-69.
5. Henry Basil J, Mohd Tahir NA, Menon Premakumar C, Mhd Ali A, Seman Z, Ishak S, et al. Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units. PLoS One. 2024;19(7):e0305538.
6. National Coordinating Council for Medication Error Reporting and Prevention. About medication errors [Internet]. Rockville (MD): NCC MERP; 2025 [cited 2025 Aug 9]. Available from: https://www.nccmerp.org/about-medication-errors
7. World Health Organization. Medication without harm: the third WHO global patient safety challenge [Internet]. Geneva: World Health Organization; 2017 [cited 2025 Aug 9]. Available from: https://www.who.int/initiatives/medication-without-harm
8. Tek Ayaz S, Korkmaz Yenice G. İlaç hataları, ilaç hatalarının önlenmesi ve önleme stratejileri. In: Yıldırım Sarı H, Özgüven Öztornacı B, editors. Çocuklarda ilaç uygulamaları ve hemşirelik yönetimi. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.103-10.

9. Özalp Gerçeker G, Göçer İ. Çocuklarda ilaç uygulamalarındaki farklılıklar. In: Yıldırım Sarı H, Özgüven Öztornacı B, editors. Çocuklarda ilaç uygulamaları ve hemşirelik yönetimi. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.6-11.
10. D'Errico S, Zanon M, Radaelli D, Padovano M, Santurro A, Scopetti M, et al. Medication errors in pediatrics: proposals to improve the quality and safety of care through clinical risk management. Front Med (Lausanne). 2022;8:814100.
11. Kapoor DU, Garg R, Gaur M, Patel MB, Minglani VV, Prajapati BG, et al. Pediatric drug delivery challenges: enhancing compliance through age-appropriate formulations and safety measures. J Drug Deliv Sci Technol. 2024;96:105720.
12. Nukpezah RN, Anyaba NA, Osman W. Investigating pediatric nurses’ perceptions of factors contributing to MAEs at Yendi Hospital, Ghana. BMC Pediatr. 2024;24(1):792.
13. MacDonald M. Patient safety: examining the adequacy of the 5 rights of medication administration. Clin Nurse Spec. 2010;24(4):196-201. doi:10.1097/NUR.0b013e3181e3605f.
14. Edwards S, Axe S. The 10 ‘R’s of safe multidisciplinary drug administration. Nurse Prescribing. 2015;13(8):398-406. doi:10.12968/npre.2015.13.8.398.
15. Martyn JA, Paliadelis P. Safe medication administration: perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia. Nurse Educ Pract. 2019;34:111-6.
16. Martyn JA, Paliadelis P, Perry C. The safe administration of medication: nursing behaviours beyond the five-rights. Nurse Educ Pract. 2019;37:109-14. doi:10.1016/j.nepr.2019.05.006.
17. Kuitunen SK, Niittynen I, Airaksinen M, Holmström A-R. Systemic defenses to prevent intravenous medication errors in hospitals: a systematic review. J Patient Saf. 2021;17(8):e1669.
18. Alshyyab MA, Ebbini MA, Alslewi AA, Hughes J, Borkoles E, FitzGerald G, et al. Factors influencing medication administration errors as perceived by nurses in pediatric units in a Jordanian tertiary hospital: a qualitative descriptive study. West J Nurs Res. 2024;46(3):201-9.
19. Ali L, Saifan A, Alrimawi I, Atout M. Nurses’ perceptions toward factors that cause medication errors in Jordan: a qualitative study. Perspect Psychiatr Care. 2021;57(3):1417-24.
20. Thomas B, Paudyal V, MacLure K, et al. Medication errors in hospitals in the Middle East: a systematic review of prevalence, nature, severity and contributory factors. Eur J Clin Pharmacol. 2019;75(9):1269-82.
21. Di Muzio M, De Vito C, Tartaglini D, Villari P. Knowledge, behaviours, training and attitudes of nurses during preparation and administration of intravenous medications in intensive care units (ICU): a multicenter Italian study. Appl Nurs Res. 2017;38:129-33.
22. Eltaybani S, Abdelwareth M, Abou-Zeid N, Ahmed N. Recommendations to prevent nursing errors: content analysis of semi-structured interviews with intensive care unit nurses in a developing country. J Nurs Manag. 2020;28:690-8.
23. Chua S-S, Choo S-M, Sulaiman CZ, Omar A, Thong M-K. Effects of sharing information on drug administration errors in pediatric wards: a pre–post intervention study. Ther Clin Risk Manag. 2017;13:345-53.
24. Mulac A, Taxis K, Hagesaether E, Granas AG. Severe and fatal medication errors in hospitals: findings from the Norwegian Incident Reporting System. Eur J Hosp Pharm. 2021;28(e1):e56-61.
25. Li B, Yue L, Peng H, Chen X, Sohaib M, Peng B, et al. Analysis of the incidence and factors influencing medication administration errors among nurses: a retrospective study. J Clin Nurs. 2025;34(7):2852-63.
26. Gracia J, Serrano R, Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res. 2019;19:640.
27. Fathizadeh H, Mousavi SS, Gharibi Z, Rezaeipour H, Biojmajd AR. Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis. BMC Nurs. 2024;23(1):175.
28. Schutijser BCFM, Klopotowska JE, Jongerden IP, Spreeuwenberg PMM, de Bruijne MC, Wagner C. Interruptions during intravenous medication administration: a multicentre observational study. J Adv Nurs. 2019;75(3):555-62.