The purpose of this study was to evaluate the frequency and underlying root causes of errors during medication administration among anaesthetists working in Amhara region, Ethiopia. The results of this study indicated that majority (64.4%) of anaesthetists had admitted MAEs. This result is comparable to the findings of a study from Saudi Arabia, which found that 69% of respondents had made at least one medication error while administering anaesthesia [15]. However, the study results from Santa Catarina, India and canada shows a higher rate of occurrence, where the authors reported that the prevalence of drug administration errors during anaesthesia practice among anesthesiologists is 91.8%, 75.6% and 85% respectively [12, 16, 17]. That might be because their study design was different from ours and they used direct observation to assess drug administration error in addition to a self-reported survey.

Even though Amponash et al. found that errors were more likely to occur during night shifts, our study found no correlation between shift of working time and MAEs. This could be as a result of that more than two thirds of participants said they worked an alternative shift with a similar caseload during both shifts. Additionally, this could be the result of the fact that fatigue brought on by a heavy workload is a significant contributing factor to MAEs regardless of the time of working shift [18]. Furthermore, this is supported by the result that shown medication errors are believed to occur at any time by the majority of respondents in a Saudi Arabian study [19].

Because of the multitasking nature of anaesthesia practise, it is possible for clinicians to misidentify a drug while attending to other tasks [20]. According to reports, the two most important preventive measures for MAEs are the use of color-coded syringes and double-checking the medication, which involves two people verifying the same information [7, 21]. However, nearly all participants in this study (97.11%) stated that their hospital does not have color-coded syringes. Also, 63.5% of anaesthetists don’t always double-check their medications before administration and almost half (49%) of the participants claimed they withdraw the medication before labelling the syringe. These factors could lead to incorrect syringe identification and, even worse, anaesthetists administering drugs incorrectly because they conflict with preventive standards for MAEs [11, 22]. This is supported by a related study from a hospital in China, where Zhang et al. reported that incorrectly labelled syringes are the root cause of syringe swapping, or the unintentional administration of the wrong medication. [23]. Additionally, inadequate syringe labelling was ranked by study participants as the third most important factor contributing to medication errors, behind a heavy workload and haste, according to the literature [20]. Instead, it is reported that two of the five strong evidence-based recommendations for minimising errors in the administration of intravenous anaesthetic drugs, labeling syringes always before administering drugs and double-checking labels with a second person using a formal organisation of drug drawers and workstations are the measures that lower MAEs [21].

Among participants who admitted MAEs, 51.92% did not report any drug administration related errors while they were at work. Despite the fact that this finding is alarming, it is consistent with earlier studies that have shown that most respondents who admitted to MAEs were unwilling to report even one drug error over the course of their careers [10, 14, 24]. Alternatively, it could be explained by scientific data showing that clinicians experience shame, guilt, or blame after disclosing their errors, which may discourage them from reporting errors [9,10,11].

When asked why they were reluctant to report their errors during medication administration process, 30.77% of respondents stated that they were concerned about the medicolegal repercussions of doing so. The final two reasons given by respondents as reasons why they were unable to disclose their errors were: not knowing to whom it was reported (24.04%) and fear of judgment by colleagues.

In response to a question, more than half of participants (53.8%) said that their hospital had no incident reporting system at all. Similarly, participants admitted they had no idea when or how their hospitals conducted the reported error audits. This finding might point to a lack of knowledge among clinicians regarding the hospital’s policies for reporting errors. It is consistent with earlier studies, where 23.9% of respondents had medication errors but only 6% were willing to admit to their errors [25].

In this study, participants who administer medications that have been prepared by someone else are about five times more likely to experience MAEs than participants who prepare their own anesthetic medications prior to administration. This may be the result of poor communication among anesthetists, as shown by the the study that only 35.57% of participants spoke to a colleague anesthetist when in doubt about drug administration process. This finding is in line with research by Leonard et al., which found that participants’ poor communication led to 48% of medication errors and 70% of medication error related adverse event [26].

The findings of this study showed that the presence of MAEs among the participants was significantly related to whether anaesthetists consistently double-check their anaesthetic drugs before administration. As a result, there was a 3.51 increase in the risk of MAEs among anaesthetists who did not always check their anaesthetic medications before administration. Among the potential safety advantages of double checking medications before administration is the reduction of endogenous (that originate from one person) and exogenous errors (that result from external factors, such as illegible text) [27]. our finding is supported by a randomized control trial from the United States, where multivariate regression revealed that double-checked administrations were significantly associated with a lower risk of any type of error [28].