Knowledge and Attitudes Regarding Medication Errors among Nurses: A Cross-Sectional Study in Major Jeddah Hospitals

Round 1

Reviewer 1 Report

Dear authors. 

Revise sub-titles. There is extra punctuation marks and sequential numbers error.

I believe you should not identify the settings where the study was performed. Consider saying the number and the region.

section 2.3: what does KAP acronym stand for?

Results section: is it essential to differentiate the four settings?

Figure 2 - please revise/transform cheese graphics into bar graphics. Also, there is missing information in Figure 2 a) and b). It cannot be understandable graphics legends. Also, revise if the text number figure matches the number figure.

Discussion section: lines 324-325, you report medication errors by nurses and physicians. However, your results are about nurses' medication errors. Please rewrite the meaning of this sentence.

The results may be very different when you compare your study with others conducted in different countries. Are the instruments used the same? What are the nurses' characteristics in that country?

Please consider redrafting your discussion section. As your study was performed in Saudi Arabia, culture and nurses' backgrounds may influence your results. And when you refer to physicians' prescriptions, did you explore, in those settings, how it was performed (e.g. handwriting, electronic reporting systems, or other) and pharmacists' medication prescriptions receipt and dispense, as this also contributes to medication errors?

If you have nurses not from Saudi Arabia, how can you state the nursing curriculum as a problem? For that, you would have to compare all nursing curricula from the respondents.

I wish best luck with your manuscript,

Author Response

Point 1: Revise sub-titles. There is extra punctuation marks and sequential numbers error.

Response 1: All the sub-titles were corrected

Point 2: I believe you should not identify the settings where the study was performed. Consider saying the number and the region.

Response 2: We include the hospitals names to compare between the 4 hospitals where all of the hospitals from one region. However, we have approval letter from each hospitals to publish the results.

Point 3: section 2.3: what does KAP acronym stand for?

Response 3:  It is for nowledge attitude and practice, We already included.

Point 4: Results section: is it essential to differentiate the four settings?

Response 4: We this it is important compare between the 4 hospitals.

Point 5: Figure 2 - please revise/transform cheese graphics into bar graphics. Also, there is missing information in Figure 2 a) and b). It cannot be understandable graphics legends. Also, revise if the text number figure matches the number figure.

Response 5: Figure 2: we changed the figure 1c to  bar graphics. For figure 1 a and b, we add more information.  Figure 1a,  for the prevalence of medication error, Yes (Performed medication error) No (Non Performed medication error). For figure 1 b, we add reported and unreported.

Point 6: Discussion section: lines 324-325, you report medication errors by nurses and physicians. However, your results are about nurses' medication errors. Please rewrite the meaning of this sentence.

Response 6: We corrected to be only the nurses, where this study was conducted only among nurse.

Point 7: The results may be very different when you compare your study with others conducted in different countries. Are the instruments used the same? What are the nurses' characteristics in that country?

Response 7: The difference in our results compared to the others might be due to the variety of the education curriculum or training courses in the hospital regarding medication error. In addition, the sample size, sampling technique, and study instruments were different.

Point 8: Please consider redrafting your discussion section. As your study was performed in Saudi Arabia, culture and nurses' backgrounds may influence your results. And when you refer to physicians' prescriptions, did you explore, in those settings, how it was performed (e.g. handwriting, electronic reporting systems, or other) and pharmacists' medication prescriptions receipt and dispense, as this also contributes to medication errors?

Response 8: The refer to physicians' prescriptions include the wrong decisions by the physician, and poor review by the latter during prescription and the prescriptions performed either handwriting, electronic reporting system. Also, the pharmacist may dispense the wrong medication or the wrong dose and it will be given by the nurse to the patients.

Point 9: If you have nurses not from Saudi Arabia, how can you state the nursing curriculum as a problem? For that, you would have to compare all nursing curricula from the respondents.

Response 9: Regardless of nationality, the nursing curriculum that studies at the university or is taught in hospitals, including training opportunities and educational and training programs about medication error and medication error reporting, influences knowledge of medication errors and thus affects the practice.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors,
Thank you for the opportunity to read your manuscript.
It touches on important issues concerning medical errors and the factors associated with them. It is a very interesting study.
However, I have a concern regarding the topic, which is: Knowledge and attitudes regarding medication errors among nurses: Cross-cultural comparisons in major Jeddah hospitals. Should it be cross-cultural or cross-sectional study in the title? If it should stay cross-cultural - I did not find an explanation of the cultural elements in the text.
In line 47 you wrote that "Americans die due to a medication error". What does this issue look like in the Kingdom of Saudi Arabia? Your research was not conducted among Americans.
I also have a question about the organisation of the research. Where did the participants answer the questions: at home or at work? What about those who did not have access to the Internet for some reason? How many minutes did the survey last?

Author Response

Response to Reviewer 2 Comments

Point 1: However, I have a concern regarding the topic, which is: Knowledge and attitudes regarding medication errors among nurses: Cross-cultural comparisons in major Jeddah hospitals. Should it be cross-cultural or cross-sectional study in the title? If it should stay cross-cultural - I did not find an explanation of the cultural elements in the text.

Response 1: We corrected the title, where the study is a cross-sectional study and no cultural elements.

Point 2: In line 47 you wrote that "Americans die due to a medication error". What does this issue look like in the Kingdom of Saudi Arabia? Your research was not conducted among Americans.

Response 2: There are no reports from the Saudi Ministry of Health on the true number of medication errors or deaths as a result of a medical error.

This study was mentioned to show the extent of the problem on a global level. Many countries do not provide numbers of deaths due to medication errors.

Point 3: I also have a question about the organisation of the research. Where did the participants answer the questions: at home or at work? What about those who did not have access to the Internet for some reason? How many minutes did the survey last?

Response 3: Due to the busyness of nurses and the nature of their work. Google Form was used to collect data for easy collection of data from nurses in their spare time, nurses may fill out the questionnaire anytime and anywhere .Participation in the research and completing the questionnaire is expected to take about 15 to 20 minutes. The link of the questionnaire avalible in https://docs.google.com/forms/d/e/1FAIpQLSdvZfjT9LZkNlyPTVB1HEWdVvLU2bes5tpuLNshEqVdiiKXFQ/viewform?usp=sf_link

Author Response File: Author Response.docx