Handwriting, Workload and Missing Digital Safeguards: Nigerian Clinicians Map the Roots of Medication Errors

Medication errors remain one of the most stubborn threats to patient safety worldwide, and in low- and middle-income countries the problem is often amplified by fragile infrastructure, heavy workloads, and limited access to safety technology. A new cross-sectional study from Kwara State, Nigeria, published in BMC Health Services Research, offers a detailed snapshot of how the people closest to the prescribing, dispensing, and administration of medicines perceive the risks around them. Drawing on responses from 450 physicians, nurses, pharmacists, and pharmacy technicians across nine healthcare facilities in all three senatorial districts of the state, the research team led by Idowu Olapemi Makinde of the Global Health and Infectious Diseases Control Institute at Nasarawa State University set out to measure not just how much clinicians know about medication errors, but which factors they believe drive them and what safeguards their institutions actually have in place.

The study, a secondary analysis of data collected with a pretested structured questionnaire, classified participants’ knowledge using ten scored items, with a total score of six or above defined as good knowledge and five or below as poor. The results showed that 271 of the 450 respondents, or 60.2 percent, met the study-defined threshold for good knowledge of medication errors. That figure, while encouraging on its surface, leaves nearly four in ten frontline professionals below the level the researchers considered adequate, a gap with potentially serious consequences in settings where a single prescribing or dispensing mistake can cascade into patient harm.

What makes the findings particularly valuable is the specificity of the perceived contributing factors. Poor handwriting topped the list, cited by 62.9 percent of respondents, followed by inadequate communication at 54.9 percent, workload at 52.0 percent, look-alike or sound-alike medicines at 48.0 percent, and inadequate training at 45.1 percent. These are not abstract system-level abstractions but the daily friction points that clinicians in resource-constrained environments encounter on every shift. A prescription scrawled in haste, a verbal order misheard across a busy ward, a pair of drug names that differ by a single syllable, or a nurse stretched across too many patients each represent a well-documented pathway from system pressure to clinical error.

The organizational and health-system dimensions of the problem emerge clearly from these perceptions. Workload, communication failures, and inadequate training are all factors that reflect how healthcare institutions are structured, staffed, and resourced rather than individual lapses in competence or diligence. This framing aligns with a substantial body of patient-safety research showing that medication errors rarely stem from a single careless actor but instead arise from the interaction of human factors with organizational conditions and health-system constraints. In Kwara State, where the study spanned facilities across urban and rural districts, the consistency of these concerns among different professional groups suggests they are systemic rather than localized.

Perhaps the most striking finding concerns the near-absence of digital safeguards. Only 15.6 percent of respondents reported that their facilities used electronic prescribing, and just 8.7 percent reported barcode medication administration. These technologies, which in high-income countries have been shown to reduce medication errors substantially by eliminating transcription mistakes and verifying drug-patient matches at the bedside, remain rare in the facilities surveyed. The gap between what is known to work and what is actually available represents one of the central challenges for medication safety in low- and middle-income countries, where the infrastructure, funding, and technical support needed to deploy such systems are often lacking.

The researchers went beyond descriptive statistics to examine which characteristics were associated with good knowledge of medication errors. Using multivariable logistic regression, they found that being a physician, being a pharmacy technician, having eleven or more years of professional experience, and reporting the availability of electronic prescribing were each associated with higher odds of good knowledge. These associations are non-causal, as the authors emphasize, but they point to patterns worth investigating. Physicians and pharmacy technicians may encounter medication-error concepts more directly in their training and daily roles, while longer experience may expose clinicians to more error events and safety discussions over time.

Intriguingly, two factors were associated with lower odds of good knowledge: male sex and reported availability of training programmes. The latter finding is counterintuitive at first glance, since one might expect that access to training would improve knowledge. The authors suggest several possible explanations, including the possibility that respondents who perceived training programmes as available may have been in facilities where such programmes existed on paper but were not actually attended or effective, or that those with poor knowledge were less aware of what training was available to them. The association with male sex is harder to interpret without further data but may reflect differences in professional composition, role assignment, or exposure to safety education across gender lines within the Nigerian healthcare workforce.

The study’s methodology deserves attention for its geographic and professional breadth. By selecting nine facilities across Kwara State’s three senatorial districts and including four categories of healthcare professionals, the researchers captured a range of perspectives that narrower studies might miss. The use of a pretested questionnaire strengthens confidence in the consistency of the instrument, and the application of chi-square tests and multivariable logistic regression allowed the team to adjust for potential confounders while examining associations between respondent characteristics and knowledge levels. The authors also reported checking for multicollinearity using the variance inflation factor, a statistical safeguard that helps ensure the reliability of regression estimates.

Medication-error reporting practices emerged as another area of concern in the broader context of the study. While the abstract highlights the perceived contributing factors and the scarcity of digital tools, the research also examined how frequently errors are reported and what improvement strategies professionals would like to see. Underreporting of medication errors is a well-documented phenomenon globally, driven by fear of blame, lack of feedback mechanisms, and cumbersome reporting processes. In settings where electronic reporting systems are absent, the problem is compounded because there is often no structured channel through which errors can be captured, analyzed, and used to drive systemic improvements.

The authors conclude that respondents identified organizational, human, and health-system concerns while digital safeguards were uncommon, and they call for prospective studies to evaluate context-appropriate medication-safety interventions. This is a measured but important recommendation. Rather than simply importing solutions from high-income settings, the emphasis on context-appropriateness acknowledges that interventions must fit the realities of staffing, infrastructure, and resources in places like Kwara State. Whether that means simplified electronic prescribing tools, structured communication protocols, targeted training programmes that address the specific knowledge gaps identified here, or system-level reforms to reduce workload and improve staffing, the path forward will require both political will and sustained investment. What this study provides is a clear, evidence-based map of where the risks lie as seen by the professionals who navigate them every day, and that map is an essential starting point for any effort to make medication use safer for patients across Nigeria and similar settings.

Subject of Research: Healthcare professionals' perspectives on medication-error contributing factors and safeguards in Kwara State, Nigeria

Article Title: Healthcare professionals’ perspectives on organizational, human, and health-system factors relevant to medication errors in Kwara State, Nigeria: a cross-sectional study

Article References: Makinde, I. O., Egwuda, K., Anya-Awa, E. A., & Ehiemere, C. C. (2026). Healthcare professionals’ perspectives on organizational, human, and health-system factors relevant to medication errors in Kwara State, Nigeria: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15726-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15726-1

Keywords: medication errors, patient safety, Nigeria, healthcare professionals, electronic prescribing, health systems, medication safety, low- and middle-income countries, cross-sectional study, pharmacovigilance, organizational factors, reporting practices