Inappropriate Labeling Research Articles

Translating the Biology of Adversity and Resilience Into New Measures for Pediatric Practice.

As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.

P38 Audit and reaudit of penicillin allergy documentation in patients presenting through the Emergency Department at the Royal Berkshire Hospital

BackgroundPenicillin allergy is the commonest reported drug allergy in the UK. However, it is estimated that under 10% are true allergies. Evidence shows that using second-line antibiotics is associated with worse clinical outcomes, greater healthcare costs and increased risk of antimicrobial resistance.ObjectivesTo evaluate the completeness of allergy history taking as per Trust guidelines on penicillin allergy classification, for patients with a positive penicillin allergy status presenting through the Emergency Department (ED) at the Royal Berkshire Hospital (RBH).MethodsIn the first audit, 30 consecutive patients prescribed antibiotics in the acute medical unit (AMU) via ED at RBH were selected in April 2021. Electronic patient records were reviewed for the percentage documentation of the causative antibiotic, symptoms, time and management of reaction in those with an active penicillin allergy status. Findings were fed back to the ED team at departmental teaching. Thirty consecutive patients with recorded penicillin allergy presenting to ED were selected for re-audit in June 2021.ResultsA small improvement in penicillin allergy history documentation was seen between the first audit and re-audit (Figure 1). However, 56% of patients' notes still lacked enough information to classify severity. Under 5% of patients' documented allergy history constituted absolute contraindication to penicillin-based antibiotics (Figure 2).Figure 1.A bar chart comparing the completeness of penicillin allergy history documentation between audits 1 and 2.Figure 2.A pie chart summarizing the severity categorization by documented history in all audited patients with a recorded penicillin allergy.ConclusionsPenicillin allergy documentation in patients presenting through ED at RBH remained below the standard of Trust guidance despite educating the ED team on the issue. This project has instigated an update in the Trust penicillin allergy classification guidelines and a multidisciplinary quality improvement project to identify and challenge inappropriate penicillin allergy labels.

Impact of an inpatient nurse-initiated penicillin allergy delabeling questionnaire.

Penicillin allergy delabeling is an important component of antimicrobial stewardship and improves patient outcomes. We demonstrated the successful use of a nurse-initiated questionnaire to remove inappropriate penicillin allergy labels in inpatients. Nurses can play a key role in improving antibiotic allergy assessment and more broadly in interprofessional antimicrobial stewardship.

«Нақты уақыт» режиміндегі полимеразды тізбекті реакция әдісімен тамақ өнімдерінің түрлік фальсификациясын анықтау бойынша хаттама әзірлеу

Adulteration of meat products is becoming a serious problem all over the world, including inappropriate labeling, prohibited additives, or replacement of expensive ingredients with cheaper components. The consequences of such manipulations can be dangerous for the health of a consumer. For example, it may cause food allergies and poisoning. In this article, there was developed a protocol for the qualitative determination of the DNA of the mitochondrial genome of chicken (Gallus gallus) by the polymerase chain reaction in real-time in raw and heat-treated meat products. The study was carried out to determine mixtures of meat and meat products from chicken, turkey, horse, lamb, pork, and beef. There were prepared 11 samples of 9 types of meat and two types of plants for the study of falsification. DNA isolation kits PrepMan Ultra (Thermo Fisher, USA) were used to obtain DNA with a high concentration between 1,900 ng/ml and 140 ng/ml. The selection of special primers and fluorescent probes was based on the alignment of the sequence of the chicken mitochondrial gene (Gallus gallus) from GenBank. All circuits are aligned using Primer Designer 3.0 software and synthesized by ThermoFisher. The authors have developed a protocol to determine the specific falsification of food products by a polymerase chain reaction in "real-time" mode. The PCR protocol was tested on a collection of DNA samples to determine specificity, and PCR with different DNA content was delivered to determine sensitivity. Chicken DNA was clearly traced in the DNA matrix in the range of 0.01-10%. Studies have shown that the developed protocol is a highly sensitive and specific express method for determining chicken DNA by a polymerase chain reaction in "real-time" mode, which allows them to be used in the diagnosis of animal DNA detection.

Pilot and Feasibility Studies in Rehabilitation Research: A Review and Educational Primer for the Physiatrist Researcher.

Pilot and feasibility studies are conducted early in the clinical research pathway to evaluate whether a future, definitive study can or should be done and, if so, how. Poor planning and reporting of pilot and feasibility studies can compromise subsequent research efforts. Inappropriate labeling of studies as pilots also compromises education. In this review, first, a systematic survey of the current state of pilot and feasibility studies in rehabilitation research was performed, and second, recommendations were made for improvements to their design and reporting. In a random sample of 100 studies, half (49.5%) were randomized trials. Thirty (30.0%) and three (3.0%) studies used "pilot" and "feasibility" in the study title, respectively. Only one third (34.0%) of studies provided a primary objective related to feasibility. Most studies (92.0%) stated an intent for hypothesis testing. Although many studies (70.0%) mentioned outcomes related to feasibility in the methods, a third (30.0%) reported additional outcomes in the results and discussion only or commented on feasibility anecdotally. The reporting of progression plans to a main study (21.0%) and progression criteria (4.0%) was infrequent. Based on these findings, it is recommended that researchers correctly label studies as a pilot or feasibility design based on accepted definitions, explicitly state feasibility objectives, outcomes, and criteria for determining success of feasibility, justify the sample size, and appropriately interpret and report the implications of feasibility findings for the main future study.

Analysis of the labelling of a sample of commercial foods for infants and young children in 13 countries.

The World Health Organisation (WHO), European Commission (EC) and Public Health England (PHE) published evidence of inappropriate content, marketing and labelling of commercial foods for infants and young children. Despite this, EC regulations are not yet established. To reduce rates of noncommunicable diseases (NCDs) a better understanding of the food environment is needed. This study aimed to assess the labelling and listed macronutrient and sodium content of commercially available pureed foods marketed for infants and young children under 3years of age (0-36months) in 13 countries. A standardized protocol was developed to guide photograph collection and a sample of 155 products were obtained. All products were within current WHO and EC guidelines. However, 103 (67.7%) products were marketed for infants between 4 and 6months, and many and contained added sugars. Action is needed to improve the nutrient composition, marketing and labelling of these products to reduce NCDs.

Perlindungan Hukum terhadap Konsumen dalam Peredaran Barang yang Diproduksi Tidak Sesuai dengan Label

In this era, the growth of the goods and services industry has had a positive impact. One of the positive impacts is providing sufficient quantity and higher quality demand, as well as there are a lot of alternative choices for consumers to meet their needs. On the other hand, there are also negative impacts, namely the use of technology and the impact of business behavior due to increased competition which has an impact on the consumer community. This study aims to determine whether business actors are responsible for consumer losses related to goods that are not produced in accordance with the label, and to find out what legal sanctions have been imposed on business actors for violations due to inappropriate labels and manufactured goods. This type of research is normative legal research. The results show that the responsibility of commercial actors is related to the mismatch between the label and the goods produced, namely compensation for damage, pollution, and consumption of goods or services. Then, legal sanctions can be imposed for violations of business actors, including imprisonment for a maximum of 5 (five) years or a maximum fine of Rp. 2 billion. Thus, it can be concluded that business actors can be held accountable for the incompatibility of labels with goods that have been produced, and if the violation is too detrimental to consumers, they can be prosecuted in accordance with applicable laws and regulations.

Assessing Use of a Standardized Allergy History Questionnaire for Patients with Reported Allergy to Penicillin

Inappropriate allergy labelling is associated with significant clinical and pharmacoeconomic implications. Detailed antimicrobial allergy assessments represent a key component of antimicrobial stewardship and aid in identifying true type I (immediate hypersensitivity) reactions. The allergy history form currently used at the University Hospital of Northern British Columbia (UHNBC), in Prince George, relies on the assessor's ability to ask appropriate prompting questions to obtain a thorough history, but it may not be sufficient to accurately identify true allergies. To compare a standardized allergy history questionnaire and the current allergy history form in terms of the quality and quantity of documentation gathered. This prospective observational study involved patients who were admitted to medical and surgical services at UHNBC from November 2018 to January 2019 with a penicillin-class allergy reported on their electronic medical record (EMR). A list of patients with EMR-reported allergies was generated by the hospital's health information software system, and these patients were interviewed using the standardized allergy history questionnaire. A total of 48 patients were assessed during the study period. Nineteen (40%) of the patients had an inappropriate allergy label on their EMR. Only 36 (75%) had an allergic reaction described on their EMR. Furthermore, only 36 (75%) of the 48 patients had the same allergy recorded on the EMR and on the allergy history form contained in their paper chart, of whom 22 had a documented reaction. The mean time to complete the standardized allergy history questionnaire was 2 minutes. At the study institution, documentation of allergy histories was often incomplete. Detailed allergy assessments are the first step in identifying true immunoglobulin E-mediated hypersensitivity reactions. Utilization of a standardized allergy history questionnaire is feasible and may serve to improve documentation and overall antimicrobial stewardship.

Marx, Foucault, and state–corporate harm: a case study of regulatory failure in Australian non-prescription medicine regulation

Risk-based regulation has underpinned Australian prescription and non-prescription medicine regulation for over three decades. However, data consistently demonstrate high rates of non-compliance among non-prescription medicine sponsors, with most breaches a result of inappropriate labelling and advertising, a lack of evidence to substantiate therapeutic claims, and product formulation and manufacturing. This paper seeks to understand why the regime fails to achieve compliance from non-prescription medicine sponsors. Using a state–corporate harm lens, and Marxist and Foucauldian perspectives, it is argued that regulatory failure is the product of the regime’s congruence with neoliberal governmentality. This governmentality is inextricably linked to a neoliberal market hegemony that attempts to minimize forms of market intervention detrimental to the accumulation of capital.

Overcoming challenges to removing inappropriate penicillin allergy labels: A quality improvement report.

Over 3 months, we provided monthly education to internal medicine residents and distributed resources regarding penicillin-allergy history taking. Allergy information in the electronic record was updated more often during the intervention compared to the period before the intervention (16.1% vs 10.9%; P = .02). Education and interdepartmental collaboration have the potential to affect provider behavior.

153. Development of a Pathway for Removal of Inappropriate Penicillin Allergy Labels in Hospitalized Patients

BackgroundMore than 90% of reported penicillin allergies are found inaccurate when formally assessed. These allergy labels lead to decreased utilization of first-line beta-lactam antibiotics, and adverse clinical outcomes. The objective of this study was to develop a multi-disciplinary approach to decrease inaccurate labeling among hospitalized patients with documented penicillin allergy.MethodsA team of clinicians, pharmacists, and nurses utilized the DMAIC quality strategy to improve accuracy of penicillin allergy labeling. Allergic reactions were stratified to develop a penicillin allergy de-labeling algorithm (Figure 1). Admission to the intensive care unit (ICU) for anaphylaxis was defined as a balancing measure. We reviewed baseline data from patients with a documented penicillin allergy admitted to a single inpatient floor at Mayo Clinic, Rochester between June and October 2019. A cause and effect diagram was used to conduct a root cause analysis. The intervention was then applied to patients who reported penicillin allergy admitted to the same floor from November 2019 to January 2020. Study data were collected and basic descriptive statistics generated.Figure 1: Penicillin allergy delabeling algorithm Results96 patients were included in the control group with mean age of 71 years (range 65–84 years) and 55% females. Breakdown of documented allergic reactions are represented in Figure 2. 58 (60%) received an antibiotic for a median duration of 1.5 days (IQR: 0 – 6). Of these, 7(12%) received penicillin-class antibiotics, and 41 (70.6%) received non-beta-lactam antibiotics. 2 (2%) of these patients were de-labeled without any penicillin skin tests. Detailed metrics of each PDSA cycle are shown in Table 1. During PDSA cycle 2, inaccurate penicillin documentation was removed in 9/19 (47.4%) of hospitalized patients. There were no ICU admissions for anaphylaxis.Figure 2: Graphic representation of proportion of type of documented allergic reactions to penicillin Table 1: Metrics and outcomes at baseline and during successive PDSA cycles ConclusionVarious factors contribute to penicillin allergy mislabeling. Our comprehensive algorithm addresses nuances of penicillin allergic reactions and increased accurate penicillin allergy labeling in 47.4% of the cases. Beta-lactam use also increased to 37% through our pilot project while maintaining patient safety. A multi-disciplinary and patient-centered approach aligned with institutional workflows is necessary to improve patient outcomes.Disclosures All Authors: No reported disclosures

The Nurse Leader’s Role:: A Conduit for Professional Identity Formation and Sustainability

The development of professional identity in nursing (PIN) is essential to the education, advancement, and brand image of nursing, and to demonstrate the impact on patients’ health and well-being. Unfortunately, the construct of PIN has not been well-established. To further shape and distinguish the concept, 3 think tanks were held between 2018 and 2020, resulting in the recognition that nursing leadership is a primary conduit to influence PIN. How leaders role model, improve practice environments, and foster lifelong learning greatly contributes to the formation and sustainability of the professional identity of nurses and the next generation of leaders.

Medication errors in outpatient pharmacies: comparison of an electronic and a paper-based prescription system

Abstract Objectives Medication errors are among the most common medical errors. They can result in mortality, morbidity and additional healthcare costs. Surveillance of medication errors is encouraged to identify gaps in the healthcare system and work on them. This study aimed to compare medication errors in outpatient prescriptions in two hospitals in Jordan: one with a paper-based and one with an electronic prescription system. Methods This was a cross-sectional observational study in two large hospitals in Jordan over a three-month period. Prescribing and dispensing of medicines were screened for medication errors in both centres: 2500 prescriptions were screened in each hospital. Key findings In the hospital with electronic prescriptions, of the 2500 prescriptions screened, 631 medication errors were detected: 231 (36.6%) prescription errors and 400 (63.4%) dispensing errors. In the hospital with paper-based prescriptions, 3714 medication errors were found: 288 (7.8%) prescription errors and 3426 (92.2%) dispensing errors. The most common prescription and dispensing errors in electronic prescriptions were, respectively, prescription of drugs that could have a drug–drug interaction, and omitting to dispense a drug on the prescription. In the paper prescriptions, the most common prescription and dispensing errors were, respectively, inappropriate dose/quantity/frequency or route of administration, and inappropriate and/or inadequate labelling of medication when dispensed, of which there were a large number (2496 (67.2%)). Conclusion This study highlights the effect of the prescription system used by hospitals. Fewer medication errors were found in the electronic system. Healthcare policymakers, professionals and administrators are encouraged to invest in electronic systems to minimize medication errors.

Voice of the Learning-Disabled Adolescents

The present research aimed to understand the concerns of 20 Learning-Disabled adolescents in their academic and Non-academic areas. This was an exploratory study using interview method, that probed expression of the challenges they face in their school. The sample was selected in a child guidance clinic in Delhi. They were led by directional open-ended questions, leading them to talk about their concerns in academic and non-academic areas. Findings indicated their feelings of dejection and demotivation, inappropriate manner of teaching, choice of subjects, judgements based on marks and feeling unheard. They were restricted for games, library, zero-periods, third language and activity periods and were taught by special educators instead of subject specialised teachers. This added to conflicts, maladjustment, inappropriate labelling, loss of peer group and a feeling of inadequacy. They added that reduced and simplified content, compromised expectations, simpler subjects offered by the boards have made the academic journey easier, but it has also kept their potentials from full bloom.

Sustaining and spreading penicillin allergy delabelling: A narrative review of the challenges for service delivery and patient safety.

Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm. This review assesses an emergent evidence base and trend favouring delabelling using direct oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these direct delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems.

Hypothyroidism and obesity: Is there a bidirectional link? What is the impact on our clinical practice?

It is well established that hypothyroidism causes weight gain, but novel emerging data suggest that obesity may actually lead to hypothyroidism. The interplay between leptin, thyroid hormones (THs), and thyroid autoimmunity in obese patients needs special attention. Clinicians need to be more cautious while interpreting elevated thyroid-stimulating hormone levels in obese individuals to avoid inappropriate labeling of hypothyroidism and unjustified use of TH therapy. It would seem reasonable to measure circulating plasma levels of THs and thyroid autoantibodies in these individuals. Stimulation of brown adipose tissue in adults, specifically through TH-mediated pathways, may seem a promising therapeutic target for obesity; however, the evidence has been inconclusive regarding effectiveness of TH therapy in treating obesity. Moreover, the effect of weight loss on thyroid function has been variable as per different studies. We aim to review the available evidence regarding the possible bidirectional link between hypothyroidism and obesity, explore responsible underlying mechanisms, and discuss the impact of this knowledge on our clinical practice.

1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing

BackgroundWhen considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care.MethodsUsing local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms.ResultsThe smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials.ConclusionScript for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

SUN-187 LYSOZYME AMYLOIDOSIS – TWO NOVEL CASES WITH NEWLY DESCRIBED GENETIC MUTATIONS

Amyloidosis is a disorder of protein folding in which proteins are deposited as abnormal insoluble fibrils which disrupt tissue structures and cause disease. Lysozyme is a bacteriolytic enzyme present in secretions synthesised by gastrointestinal cells, macrophages and hepatocytes. Lysozyme amyloidosis is a rare form of hereditary amyloidosis which typically manifests with renal impairment, gastrointestinal symptoms and sicca syndrome. The natural history of lysozyme amyloidosis is felt to be indolent with slow progression of end organ damage associated with the condition. The complexity of diagnosing hereditary forms of amyloidosis likely results in underdiagnosis of the condition or inappropriate labeling of the condition as immunoglobulin associated amyloidosis. Measures utilised to identify immunoglobulin associated amyloidosis, such as serum or urinary protein measurements, are unable to utilised in identifying lysozyme amyloidosis with immunohistochemistry and molecular genetic testing being required for formal identification. We report two cases of patients with lysozyme amyloidosis managed by our service. Case 1 was referred to our service in May 2017. The 44-year-old woman was referred with chronic renal impairment and mild proteinuria (protein/creatinine ratio 22 mg/mmol) on a background of peptic ulcer disease managed with an oral proton pump inhibitor, chronic back pain, cigarette smoking, menorrhagia, dry eyes and bilateral knee osteoarthritis. Screening testing of serum free light chains, paraprotein, antinuclear antibody, complements and renal tract imaging were unremarkable. Renal biopsy identified heavy congo red deposits within glomerular, vascular and interstitial compartments. Transthyretin and amyloid A staining were negative. Further tissue assessment with mass spectrometry was performed identifying high levels of lysozyme consistent with lysozyme amyloidosis. Molecular genetic testing identified heterozygous presence for the c.176G>C variant in the LYZ gene, a variant of uncertain clinical significance. Case 2 was referred to our service in June 2018. The 43-year-old man presented with a creatinine of 251 with no background medical history. Screening testing of serum free light chains, paraprotein, antinuclear antibody, complements and renal tract imaging were unremarkable. Renal biopsy demonstrated diffuse congo red staining within glomerular, vascular and interstitial compartments. Transthyretin and amyloid A staining were negative. Molecular genetic testing identified presence for the c314A>T and c263C>A variant in the LYZ gene. Further testing of an affected parent confirmed the presence of the same LYZ genetic mutations. Lysozyme amyloidosis is a poorly characterised and rarely encountered hereditary form of amyloidosis. We report two cases of lysozyme amyloidosis encountered by our renal service with molecular genetic testing describing two novel genetic mutations. A high index of suspicion must be maintained to ensure appropriate classification of amyloidosis.

Semi-Nondestructive Certification of Crocodilian Leather by LC-MS Detection of Collagen Marker Peptides.

Leather produced from crocodile, alligator, and caiman skin is widely used in the fashion industry. Crocodilian leather is generally more expensive than mammalian leather, and the value greatly differs even between the crocodilian species. However, inappropriate labeling of the animal source on leather products sometimes arises from accidental or fraudulent substitution, which is difficult to unambiguously detect by existing methods. In the present study, animal source identification of crocodilian leather was carried out using type I collagen-derived marker peptides generated after dechroming, heat denaturation, and trypsin digestion. Definitive discrimination between the three crocodilian species and also a related species, lizard, was achieved based on the detection patterns of selected six marker peptides, determined by LC-MS. Furthermore, powdering of the leather samples enabled a reduction in the sample amount required and allowed the elimination of the dechroming step. Approximately 100 μg of powder was taken from commercial leather watch straps by filing, resulting in only slight damage to the undersides of the straps. The animal sources of the crocodilian products and also a crocodile-embossed calf product were successfully identified using a combination of the crocodilian marker peptides and previously established mammalian marker peptides. This semi-nondestructive species identification method is not only useful for certification of leather products but also for monitoring of international trade of leather and skin.

CONTRIBUTING FACTORS TO MEDICATION ERRORS AS PERCEIVED BY NURSING STUDENTS IN ILIGAN CITY, PHILIPPINES

Background: Nursing students are allowed to give medication with clinical supervision to enhance skills in medication administration. However, studies suggest that some students commit medication errors due to knowledge, personal, administrative and environmental factors.
 Objective: This study will identify factors that cause student nurses to commit medication errors and correlate it to the number of perceived medication errors committed.
 Methods: A correlational design was used to correlate the factors contributing to medication administration and the number of medication errors committed by the students. 388 randomly selected nursing students were asked to answer Modified Medication Error Questionnaire which measures the knowledge, administrative, personal and environmental factors which may contribute to medication administration errors. Medication administration errors are measured according to the number of times a student commits as perceived by them.
 Results: Lack of knowledge of the drug and equipment to be used for administration, decrease in confidence, poor clinical assessment of patients’ conditions, and poor follow ups from clinical instructor are identified concerns under knowledge factor. Poor positive feedback, inadequate supervision and belittling ways of clinical instructors are identified under the administrative factor. Fear of administering an injection or giving medications is a common problem under personal factor. Inappropriate labelling of medications, unfavorable room temperature, lack of space, inadequate lighting, disorganized medication administration schedule and noise are problems found under environmental factor. A minority of 17.3% claimed that they have encountered a medication error in any of their clinical duties.
 Conclusion: Knowledge, administrative, personal and environmental factors have no effect towards medication errors. However, the relationship between age and the number of perceived medications errors is established. More in-depth investigation is recommended to determine the type of medication errors committed and its detrimental effects towards patient safety.