JMIR Publications

ABSTRACT

Background:

Medical errors occur more frequently in healthcare than in other industries because of challenges in patient safety education for nurses and students. To address this, it is important to identify the factors, structure, and nature of clinical errors and apply these insights to backward-designed educational programs for clinical nurses and nursing students. Medication-related errors are highly preventable with appropriate interventions, underscoring the need for data-driven safety education and systematic frameworks. Previous research suggests that unit adaptation, rather than clinical experience alone, plays a critical role in error occurrence. Focusing on “adaptive performance,” an underexplored concept in nursing, can help identify new educational strategies and interventions.

Objective:

This study aimed to clarify the structural differences in medication-related errors among nurses through Bayesian network modeling (BNM) based on unit experience. The secondary aim was to examine the influence of total nursing experience on these models.

Methods:

This mixed-methods study performed a qualitative Root Cause Analysis (RCA) of medication error reports to extract causal factors. BNM, an Artificial Intelligence-based approach, was used to visualize error-generation flows and compare models with years of experience within the current unit. Data were obtained from 2023 medication-related error reports submitted by nurses to the Japan Council for Quality Health Care.

Results:

RCA of 119 reports identified 10 types of medication-related events and 23 contributing factors. The cases were categorized into low-, moderate-, and high-adaptation groups, and separate Bayesian network models were constructed. The moderate- and high-adaptation models exhibited fewer complex error networks, with weaker chains of unsafe conditions or actions than the low-adaptation model. Extensive clinical experience did not always prevent errors; rather, it was often linked to lapses in verification behavior.

Conclusions:

Nurses’ adaptation to clinical units plays a pivotal role in patient safety. Higher adaptation enhances flexibility, resilience, and communication, thereby reducing medication errors, whereas excessive experience may lead to complacency. Patient safety education should promote adaptation among new and transferred nurses and include ongoing reminders for all staff. Future data-driven research should inform patient safety education aligned with institutional contexts and clinical needs.