DOI: https://doi.org/10.14710/nmjn.v16i2.72025

Healthcare Professionals’ Knowledge and Experiences of Adverse Event Detection in Emergency Departments in Southwest Nigeria: A Mixed Methods Study

*Olamide Olajumoke Afolalu orcid scopus  -  Faculty of Nursing Sciences, Department of Medical-Surgical Nursing, Osun State University , Nigeria
Oluwaseyi Abiodun Akpor  -  Faculty of Nursing Sciences, Afe Babalola University, Nigeria
Sunday Adeniran Afolalu  -  Department of Mechanical and Mechatronics Engineering, Afe Babalola University, Nigeria
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Abstract

Background: Adverse events (AEs) in hospital emergency departments (EDs) significantly challenge patient safety and the quality of care provided globally and within the Nigerian healthcare system in terms of their nature, incidence, and severity. While AE reporting may capture some incidents, healthcare professionals’ experiences regarding the types and frequency of triggers and detection measures remain understudied.

Purpose: This study aimed to evaluate the knowledge and experiences of nurses and doctors regarding AEs in the EDs of three selected teaching hospitals in Southwestern Nigeria.

Methods: An explanatory sequential mixed methods design was used, involving 64 nurses and 57 doctors working in the emergency units of the hospitals. Data were collected using a 57-item structured and validated patient safety incident (PSI) questionnaire and six focus group discussions with 36 healthcare professionals purposively selected from the quantitative participants. Quantitative data were analyzed using descriptive statistics and the chi-square test, while qualitative data were analyzed thematically using ATLAS software.

Results: Quantitative findings revealed that 56.2% of healthcare professionals had good knowledge of commonly occurring AEs; however, 65.3% had poor knowledge of the frequency of triggers commonly occurring in EDs. Reporting methods mainly included forms and patient record reviews. Qualitative findings provided deeper insights into these results and revealed four key themes: experiences of AEs in emergency care, patterns and types, reporting practices and barriers, and suggestions for improved reporting. Participants reported equipment malfunctions and adverse drug reactions (ADRs) as frequently experienced AEs and cited heavy workloads, time constraints, the absence of standardized reporting protocols, fear of punishment, and restricted access to digital reporting tools as challenges to reporting.

Conclusion: Despite the good awareness demonstrated by healthcare professionals, significant organizational and system-level barriers hinder effective AE detection and reporting. Strengthening training on AE identification, introducing standardized digital reporting protocols, and promoting a non-punitive reporting culture may improve patient safety in EDs.

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Keywords: Adverse events; emergency care; health professionals; knowledge
Funding: Not Applicable

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Section: Articles
Language : EN
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  1. Adamuz, J., Juvé-Udina, M.-E., González-Samartino, M., Jiménez-Martínez, E., Tapia-Pérez, M., López-Jiménez, M.-M., Romero-Garcia, M., & Delgado-Hito, P. (2020). Care complexity individual factors associated with adverse events and in-hospital mortality. PLoS ONE, 15(7), e0236370. https://doi.org/10.1371/journal.pone.0236370
  2. Adler, R. H. (2022). Trustworthiness in qualitative research. Journal of human lactation, 38(4), 598-602. https://doi.org/10.1177/08903344221116620
  3. Afolalu, O. O., Akpor, O. A., & Afolalu, S. A. (2025). A systematic review of interventions for reducing and reporting adverse events in emergency departments: Multidisciplinary approaches and technological innovations. Collegian. https://doi.org/10.1016/j.colegn.2024.12.001
  4. Afolalu, O. O., Jordan, S., & Kyriacos, U. (2021). Medical error reporting among doctors and nurses in a Nigerian hospital: A cross‐sectional survey. Journal of Nursing Management, 29(5), 1007-1015. https://doi.org/10.1111/jonm.13238
  5. Al-Ghabeesh, S. H., Thabet, A., Rayan, A., & Abu-Snieneh, H. M. (2023). Qualitative study of challenges facing emergency departments nurses in Jordan. Heliyon, 9(3), e14141. https://doi.org/10.1016/j.heliyon.2023.e14141
  6. Alassaf, W., Albrahim, R., Abukhaled, J. K., Aldhaif, M., Mohammed, M. A., Al Baiz, A., & Aljahany, M. (2025). Correlation between emergency department crowding and adverse occurrences in an academic hospital: A retrospective cohort study. Risk Manag Healthc Policy, 18, 561-568. https://doi.org/10.2147/rmhp.S504578
  7. Alhadi, A., Alanazi, H., S, A., F, A., Alanazi, T., Alruwaili, F., Alanazi, A., J, A., Alenezi, N., Alanazi, F., & A, A. (2024). The role of nurses in early recognition and prevention of patient deterioration in general wards. International Journal of Computational and Experimental Science and Engineering, 10. https://doi.org/10.22399/ijcesen.4604
  8. Amaniyan, S., Faldaas, B. O., Logan, P. A., & Vaismoradi, M. (2020). Learning from patient safety incidents in the emergency department: A systematic review. The Journal of Emergency Medicine, 58(2), 234-244. https://doi.org/https://doi.org/10.1016/j.jemermed.2019.11.015
  9. Assunção-Costa, L., Pinto, C. R., Machado, J. F. F., Valli, C. G., & De Souza, L. E. P. F. (2023). Assessing the severity of medication administration errors identified in an observational study using a valid and reliable method. Journal of Pharmaceutical Policy and Practice, 16(1), 143. https://doi.org/10.1186/s40545-023-00653-x
  10. Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. Sage, London
  11. Dawkins, B., Renwick, C., Ensor, T., Shinkins, B., Jayne, D., & Meads, D. (2021). What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health, 26(10), 1177-1188. https://doi.org/10.1111/tmi.13651
  12. Dosunmu, O., Dwinta, E., & Fatimah, F. S. (2026). Interventions on Medication Administration Errors in Nigerian and Indonesian Hospitals: A Narrative Review. Christian Journal for Global Health, 13(1). https://doi.org/10.15566/kxb1x733
  13. Dresser, S., Teel, C., & Peltzer, J. (2023). Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study. International Journal of Nursing Studies, 139, 104436. https://doi.org/10.1016/j.ijnurstu.2023.104436
  14. Eze, J. N., Edelu, B. O., Ndu, I. K., & Oguonu, T. (2023). Paediatric emergency medicine practice in Nigeria: A narrative review. BMC Emergency Medicine, 23(1), 31. https://doi.org/10.1186/s12873-023-00790-1
  15. Fekadu, G., Muir, R., Tobiano, G., Ireland, M. J., Engidaw, M. T., & Marshall, A. P. (2025). Patient safety incident reporting systems and reporting practices in African healthcare organisations: A systematic review and meta-analysis. BMJ Open Qual, 14(1). https://doi.org/10.1136/bmjoq-2024-003202
  16. Fekadu, G., Muir, R., Tobiano, G., Tura, A. K., Ireland, M. J., & Marshall, A. P. (2026). “Unsafe and unspoken”- Exploring barriers to patient safety and incident reporting in resource-limited intensive care units: A qualitative study. Intensive and Critical Care Nursing, 94, 104325. https://doi.org/https://doi.org/10.1016/j.iccn.2025.104325
  17. Gqaleni, T. M., & Bhengu, B. R. (2020). Analysis of Patient Safety Incident reporting system as an indicator of quality nursing in critical care units in KwaZulu-Natal, South Africa. Health SA Gesondheid, 25(1), 1-8. https://doi.org/10.4102/hsag.v25i0.1263
  18. Griffey, R. T., Schneider, R. M., & Sharp, B. (2021). Trigger tools for adverse event detection in the emergency department. Journal of patient safety, 17(1), 71-72. https://doi.org/10.1097/PTS.0000000000000614
  19. Gutiérrez-Mendoza, L. M., Manias, E., & Nicholson, P. (2025). Predictive values of trigger tools for identifying adverse events in hospitalized patients using a medical record review: A systematic review. Int J Qual Health Care, 37(4). https://doi.org/10.1093/intqhc/mzaf119
  20. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th Ed.). Cengage Learning. Cengage
  21. Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523. https://doi.org/10.1016/j.socscimed.2021.114523
  22. Hennink, M. M., Kaiser, B. N., & Weber, M. B. (2019). What influences saturation? Estimating sample sizes in focus group research. Qualitative health research, 29(10), 1483-1496. https://doi.org/10.1177/1049732318821692
  23. Howard, I., Howland, I., Castle, N., Al Shaikh, L., & Owen, R. (2022). Retrospective identification of medication related adverse events in the emergency medical services through the analysis of a patient safety register. Sci Rep, 12(1), 2622. https://doi.org/10.1038/s41598-022-06290-9
  24. Jessurun, J. G., Hunfeld, N. G. M., de Roo, M., van Onzenoort, H. A. W., van Rosmalen, J., van Dijk, M., & van den Bemt, P. M. L. A. (2023). Prevalence and determinants of medication administration errors in clinical wards: A two‐centre prospective observational study. Journal of Clinical Nursing, 32(1-2), 208-220. https://doi.org/10.1111/jocn.16215
  25. Kakar, Z. U. H., Rasheed, R., Rashid, A., & Akhter, S. (2023). Criteria for assessing and ensuring the trustworthiness in qualitative research. https://academicworks.cuny.edu/yc_pubs/342
  26. Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: The canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5). https://doi: 10.1056/CAT.21.0217
  27. Khalili, M., Enayati, M., Patel, S., Huschka, T., Cabrera, D., Parker, S. J., Pasupathy, K., Mahajan, P., & Bellolio, F. (2025). Identifying diagnostic errors in the emergency department using trigger-based strategies. BMJ Open Quality, 14(3). https://doi.org/10.1136/bmjoq-2025-003389
  28. Lee, S. E., & Lee, J. W. (2024). Effects of hierarchical unit culture and power distance orientation on nurses’ silence behavior: the roles of perceived futility and hospital management support for patient safety. Journal of Nursing Management, 2024(1), 6564570. https://doi.org/10.1155/jonm/6564570
  29. Lima-Júnior, A. J., Zanetti, A. C. B., Dias, B. M., Bernardes, A., Gastaldi, F. M., & Gabriel, C. S. (2023). Occurrence and preventability of adverse events in hospitals: A retrospective study. Rev Bras Enferm, 76(3), e20220025. https://doi.org/10.1590/0034-7167-2022-0025
  30. Mira, J. J., Lorenzo, S., Aranaz-Andrés, J. M., Macías-Maroto, M., Cobos-Vargas, Á., Moreno Campoy, E. E., Pérez-Pérez, P., Trillo-López, P., Corpas-Nogales, E., Gea Velázquez de Castro, M. T., Arencibia-Jiménez, M., Asencio, A., Díez Herrero, D., Molina-Ribera, J., Calderón, E., Lozano-Gago, P., Libano Beristain, A., Navarro Maciá, C., San Jose Saras, D., Gil-Hernández, E., & Carrillo, I. (2025). Understanding and reframing clinical errors through just culture: protocol for the DECIDE mixed-methods study in Spanish healthcare and community contexts. BMJ Open, 15(10), e101421. https://doi.org/10.1136/bmjopen-2025-101421
  31. Mohamed-Badran, F. M., Rahman Gaber Khalifa, M. A. E., Elghannam, H. M., & Mohamed Ali, E. H. (2026). From blame to learning: implementing a just culture program for head nurses and its impact on silent behavior and error reporting among staff nurses. BMC Nurs, 25(1), 96. https://doi.org/10.1186/s12912-025-04265-5
  32. Murphy, D. R., Meyer, A. N., Sittig, D. F., Meeks, D. W., Thomas, E. J., & Singh, H. (2019). Application of electronic trigger tools to identify targets for improving diagnostic safety. BMJ quality & safety, 28(2), 151-159. https://doi.org/10.1136/bmjqs-2018-008086
  33. O'cathain, A., Murphy, E., & Nicholl, J. (2008). The quality of mixed methods studies in health services research. Journal of health services research & policy, 13(2), 92-98. https://doi.org/10.1258/jhsrp.2007.007074
  34. O'Connell, K. J., Shaw, K. N., Ruddy, R. M., Mahajan, P. V., Lichenstein, R., Olsen, C. S., Funai, T., Blumberg, S., Chamberlain, J. M., & Network, P. E. C. A. R. (2018). Incident reporting to improve patient safety: The effects of process variance on pediatric patient safety in the emergency department. Pediatric Emergency Care, 34(4), 237-242. https://doi.org/10.1097/PEC.0000000000001464
  35. Omoleke, S. A., & de Kiev, L. C. (2024). An evaluation of the surveillance system for monitoring and reporting adverse events following immunization in Kebbi State, Northern Nigeria: A mixed method approach. BMC Public Health, 24(1), 2906. https://doi.org/10.1186/s12889-024-20356-5
  36. Omotola, N. J., Madu, O. T., Egbuonu, E. F., Isreal, C. E., & H.C, O. (2025). Medication administration error and its associated factors among nurses in a tertiary hospital, Southeast Nigeria. Online Journal of Health and Allied Sciences, 24(1). https://www.ojhas.org/issue93/2025-1-6.html
  37. Rodziewicz, T. L., Houseman, B., Vaqar, S., & Hipskind, J. E. (2024). Medical error reduction and prevention. In StatPearls. StatPearls Publishing
  38. Samadbeik, M., Staib, A., Boyle, J., Khanna, S., Bosley, E., Bodnar, D., Lind, J., Austin, J. A., Tanner, S., Meshkat, Y., de Courten, B., & Sullivan, C. (2024). Patient flow in emergency departments: A comprehensive umbrella review of solutions and challenges across the health system. BMC Health Serv Res, 24(1), 274. https://doi.org/10.1186/s12913-024-10725-6
  39. Singh, A. (2024). Principal factor analysis in scale construction. International Journal of Indian Psychȯlogy, 12(3). https://doi.org/10.51737/2766-4813.2024.099
  40. Sojitra, B., Patel, C., Pandya, S., Virani, P., Shah, P., Patel, J., Shah, A., & Virani, P. H. (2024). Knowledge, attitude, and practice of materiovigilance among healthcare professionals at a tertiary care teaching hospital. Cureus, 16(7). https://doi.org/10.7759/cureus.64978
  41. Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in science education, 48(6), 1273-1296. https://doi.org/10.1007/s11165-016-9602-2
  42. Usoro, A., Aiwonodagbon, B., Strong, J., Kivlehan, S., Akodu, B. A., & Olufadeji, A. (2021). Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: A qualitative appraisal. BMJ Open, 11(8), e043869. https://doi.org/10.1136/bmjopen-2020-043869
  43. World Health Organization. (2021). Global patient safety action plan 2021-2030: Towards eliminating avoidable harm in health care. World Health Organization
  44. World Health Organization. (2024). Global patient safety report 2024: Executive summary
  45. Yusoff, M. S. B. (2019). ABC of content validation and content validity index calculation. Education in medicine journal, 11(2), 49-54. https://doi.org/10.21315/eimj2019.11.2.6

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