Table 1 Characteristics and summary findings of articles included in the review

1.

Abdalla et al. 2020 [45], Sudan

To explore the causes and reporting of medication errors.

-Cross-sectional descriptive

-N = 191 Nurses

Enabling factors included knowledge of medication errors and reporting procedures. Barriers included fear of manager or coworker reactions, fear of disciplinary action or job loss, and the belief that errors were not serious enough to report.

2.

Alemu et al. 2017 [46], Ethiopia

To quantify medication error reporting rates and contributing factors.

-Cross-sectional analytical

-N = 141 Nurses.

Barriers to reporting medication error were fear and absence of reporting system.

3.

Asfa et al. 2021 [47], Ethiopia

To assess medication error reporting rates and associated factors.

-Cross-sectional analytical

-N = 224 Nurses

Facilitators of reporting medication errors included extensive experience and higher education. Barriers involved unclear error definitions, unrealistic managerial expectations, fear of consequences, blame-focused management, belief that errors should not be reported, and high patient loads.

4.

Bifftu et al. 2016 [48], Ethiopia

To assess medication administration error reporting rates and associated factors.

-Cross-sectional analytical

-N = 282 Nurses

Educational status of bachelor’s degree and above were enablers of medication administration error reporting while disagreement over time and error definition, fear and administrative reasons were barriers to reporting.

5.

Elasrag & Abusnieneh 2020 [49], Egypt

To assess factors contributing to medication errors and barriers to reporting.

-Cross-sectional descriptive

-N = 146 Nurses

Barriers to reporting medication errors included fear of blame, legal consequences, negative reactions, physician reprimands, lack of feedback, focus on individual fault, unclear error definitions, and time-consuming reporting processes.

6.

Kiguba et al. 2015 [50], Uganda

To assess attitudes towards medication error reporting and patient involvement in reporting.

-Cross-sectional analytical

-N = 1345 Healthcare professionals

Facilitating factors to medication error reporting included adopting a non-punitive approach, fostering organisational leadership, and support. Barriers to effective reporting includes, the fear of being identified, a blame-oriented culture, and time constraints.

7.

Ndamayape et al. 2023 [51], Tanzania

To explore types, causes, and barriers to medication error reporting.

-Cross-sectional descriptive

-N = 75 Nurses

Barriers to reporting medication administration errors included unclear error definitions, unrecognised errors, time-consuming forms, lack of reporting protocols, and fears of blame, incompetence, or negative reactions from colleagues, patients, and families.

8.

Blignaut et al. 2022 [52], South Africa

To identify factors influencing medication errors and to explore their proposed solutions.

-Mixed-method

-N = 295 Nurses

Fear of administrative response and blame, concern that individuals implicated for error than system, the fear that patient and family might develop negative attitude toward staff involved in error reporting were identified as barriers to medication administration error reporting.

9.

Ogunleye et al. 2016 [53], Nigeria

To determine medication error prevalence and develop strategies to enhance safety.

-Cross-sectional descriptive

-N = 2386 Nurses, Physicians, and Pharmacists

Barriers to medication error reporting included a belief that reporting was unnecessary, fear of being accused of incompetence, fear of disciplinary actions, fear of litigation, and a desire to protect one’s ego.

10.

Oshikoya et al. 2013 [54], Nigeria

To assess experiences of medication administration errors.

-Cross-sectional descriptive

-N = 50 Nurses

Factors such as fear of intimidation, and punishment, as well as a lack of policies in place to report medication administration error were identified as barriers.

11.

Elshoura & Mosallam [55], Egypt

To assess knowledge, attitudes, and practices toward medication errors reporting.

-Cross-sectional analytical

-N = 112 Pharmacists

A positive attitude toward reporting encouraged medication error reporting. Barriers included fear of blame or legal consequences, physician reprimand, lack of time and feedback, unclear responsibility, belief that errors were minor and focus on individual rather than system issues.

12.

Brotobor et al. 2021 [56], Nigeria

To assess the barriers to voluntary reporting of medication errors.

-Cross-sectional descriptive

-N = 416 Nurses

Fear of blame, fear of patient and family attitude, fear of being seen as incompetent by peers, fear of litigation, lack of clear policy on medication error reporting, lack of positive feedback, and focus on individual staff member than system gaps were identified as barriers to reporting.

13.

Aly et al. 2013 [57], Egypt

To assess perceptions of safety climate and barriers to medication error reporting.

-Cross-sectional descriptive

-N = 204 Nurses

Disagreement over definition of medication error, fear of punishment, negative response from administration, efforts required for reporting, the desire to save face for coworkers, and existence of blame culture were identified as barriers to medication error reporting.

14.

Jember et al. 2018 [58], Ethiopia

To assess the proportion of medication error reporting and to explore contributing factors.

-Cross-sectional analytical

-N = 397 Nurses

In terms of likelihood to report, females were more likely to report medication errors. Married nurses were less likely to report errors, while nurses with no experiences of making medication errors were more likely to report.

15.

Ilesanmi et al. 2016 [59], Nigeria

To examine methods of reporting medication administration error.

-Cross-sectional descriptive

-N = 250 Nurses

Facilitators of medication error reporting included anonymity and acceptance of human error. Barriers included fear of punishment, job loss, legal issues, unclear policies, lack of knowledge, and focus on individual errors.

16.

Udi et al. 2019 [60], Nigeria

To assess perceptions about medication error reporting.

-Cross-sectional descriptive

-N = 259 Nurses

Facilitating factors included past experiences with medication errors, relationships with colleagues, and whether medication error reporting was a routine practice in their facility.

17.

Tsegaye et al. 2020 [61], Ethiopia

To assess medication administration error and associated factors.

-Cross-sectional analytical

-N = 414 Nurses

Barriers to medication administration error reporting were fear of blame and high workload.

18.

Manal & Hanan 2012 [62], Egypt

To examine medication errors, causes, and reporting behaviours.

-Cross-sectional descriptive

-N- 186 Nurses

Barriers to medication error reporting were fear of negative reaction from nurse manager and peer, subject to disciplinary action or job loss, and did not think error was serious to warrant reporting.

19.

Fathallah et al. 2023 [63], Egypt

To explore causes of medication errors and barriers to reporting.

-Cross-sectional descriptive

-N = 60 Nurses

Barriers to reporting included fear of negative consequences, unclear error definitions, lack of managerial support, inappropriate reactions, and absence of constructive feedback

20.

Nkurunziza et al. 2018 [64], Rwanda

To explore factors contributing to medication errors and barriers to reporting them.

-Cross-sectional descriptive

-N = 149 Nurses

Barriers to reporting medication errors included fear of blame, legal consequences, negative family attitudes, focus on individual blame, inadequate administrative responses, use of errors to measure care quality, lack of feedback, and disagreements over error definitions.

21.

Ojerinde & Adejumo et al. 2014 [65], Nigeria

To determine the causes and factors contributing to medication errors.

-Cross-sectional descriptive

-N = 333 Nurses and Pharmacist.

Barrier to medication errors reporting were fear of reprimand from authorities and fear of being recognised as incompetent.

22.

Balogun et al. 2019 [66], Nigeria

To assess perception of medical errors, recognition skills, and factors influencing the error disclosure.

-Cross-sectional analytical

-N = 92 Medical speciality trainee

Facilitating factors were being senior resident, having good knowledge of medical error disclosure. The barriers involved poor perception and a belief of self-reporting of an error as an admission of guilt, previous harsh reprimand and not well disposed for reporting medical errors.

23.

Afolalu et al. 2021 [67], Nigeria

To compare doctors’ and nurses’ perceptions of factors influencing medical error reporting.

-Cross sectional descriptive

-N = 230 Nurses and Physicians

Facilitators of medical error reporting included clear guidelines, feedback, legal protection, confidentiality, education, and trust. Barriers included blame culture, lack of confidentiality, poor supervisor responses, loss of patient trust, complex reporting, and ineffective reminders.

24.

Mauti & Githae 2019 [68], Uganda

To identify medical error reporting systems, types of errors, and influencing factors.

-Cross-sectional descriptive

-N = 77 Nurses and Physicians

Facilitators included not punishing reporters, training, an error alert system, and providing error information sheets. Barriers included lack of legal protection, leading to prosecution or punishment of reporters.

25.

Eldesouky et al. 2018 [69], Egypt

To determine the prevalence and factor contributing to medical error reporting.

-Cross-sectional analytical

-N = 257 Nurses

Facilitators included a confidential, non-punitive system with transparent feedback. Barriers involved unclear error definitions, fear of legal issues, complex reporting mechanisms, lack of awareness, poor management, lack of support, and forgetfulness in reporting.

26.

Derese & Agegnehu 2022 [70], Ethiopia

To identify the challenges of medical error reporting for organisational learning and quality improvement.

-Qualitative explorative

-N = 21Healthcare professionals

Barriers to reporting medical errors included fear of patient reactions, concerns for reputation, fear of punishment, lack of confidentiality, avoidance of error learning, poor patient involvement, low health literacy, media exposure, weak team dynamics, scapegoating, a ‘perfect’ attitude, and lack of malpractice insurance.

27.

Simon et al. 2015 [71], Uganda

To explore the common medical errors and available error reporting mechanisms.

-Mixed method

-N = 200 Healthcare professionals

Healthcare professionals were hesitant to report serious errors but more likely to report colleagues’ mistakes, especially if it benefited them. Promoting a positive attitude, establishing a formal reporting system, and regular discussions helped improve reporting. Barriers included fear of punishment, job loss, legal issues, poor teamwork, high turnover, and lack of feedback.

28.

Eltaybani et al. 2019 [72], Egypt

To identify the nature of nursing errors and their contributing factors.

-Qualitative descriptive

-N = 112 Nurses

Outlined that the less significance of induced patient harm, the less frequency of reporting error.

29.

Abuosi et al. 2022 [73], Ghana

To assess adverse event reporting rates and patient safety culture.

-Cross-sectional analytical

-N = 1651 Healthcare professionals

Facilitating factors included teamwork, non-punitive response to error, supervisor support for patient safety, communication about error, adequate staffing, hands off and information exchange.

30.

Samson et al. 2022 [74], Ghana

To assess the managerial patient safety practices that influence adverse event reporting.

-Analytical cross-sectional

-N = 210 Nurses

Facilitating factors included having over 6 years of work experience, nurses and midwives working in obstetrics and gynaecology unit, a non-punitive response, feedback, open communication, management support and positive response.

31.

Gqaleni & Bhengu 2018 [75], South Africa

To explore adverse event reporting experiences, barriers, current practices, and propose solutions.

-Qualitative descriptive

-N = 5 Nurses

Facilitators included anonymous reporting and encouragement. Barriers included fear of litigation, victimisation, punishment, peer ridicule, focus on individual blame, misinterpretation of reports, misunderstandings, staff shortages, and lack of feedback and support.

32.

Zoghby et al. 2021 [76], South Africa

To describe the frequency of adverse events and rate of formal reporting.

-Cross-sectional descriptive

-N = 100 Nurses and Physicians

Nurses were more likely report adverse events than a physician. However, perceiving the adverse event as minor or harmless hindered the reporting practices.

33.

Yalew & Yitayew 2021 [77], Ethiopia

To assess the clinical incident reporting behaviour.

-Mixed method

-N = 291Healthcare professionals

Facilitators of incident reporting included training, benefits acknowledgment, guidelines, a reporting system, and an incident officer. Barriers involved lack of organisational structure, fear of legal consequences, insufficient investigation, and lack of feedback.

34.

Abraham et al. 2022 [78], South Africa

To provide insight on how managerial staff perceive the patient safety culture.

-Qualitative descriptive

-N = 10 Hospital managers

Participants highlighted that adverse event reporting should be a learning opportunity for quality improvement. Facilitators included committees, while barriers included lack of reporting systems, blame culture, fear of punishment, job loss, and litigation.

35.

Alhassan et al. 2019 [79], Ghana

To explore experiences with adverse medical events and barriers to reporting them.

-Cross-sectional descriptive

-N = 221 Healthcare professionals

Barriers to adverse medical events reporting were lack of clear reporting system, available but inaccessible incidence reporting book, lack of workplace support system, and lack of mandatory reporting policy

36.

Aouicha et al. 2022 [80], Tunisia

To explore perception of patient safety culture.

-Mixed method

-N = 297 Healthcare professionals

Barriers to reporting included lack of a reporting system, unresponsiveness, blame culture, fear of punishment, and inadequate risk management. Errors were often seen as skill deficiencies, with a lack of root cause analysis and interventions hindering reporting.

37.

Dorgham & Mohamed 2012 [81], Egypt

To assess preferences in disclosing and reporting incidents.

-Cross-sectional descriptive

-N = 90 Healthcare professionals

Fear, lack of understanding, administrative hurdles and burden of effort required to report were identified as barriers.

38.

El-Sayed et al. 2022 [82], Egypt

To enhance the implementation of the occurrence variance reporting system.

-Quasi-experimental

-N = 100 Physicians and Nurses

Barriers to reporting included a blame culture, lack of corrective actions and feedback, high workload, inadequate education and training, lack of management support, stress, and the perception that reporting was time-consuming or a sign of incompetence.

39.

Eshete et al. 2021 [83], Ethiopia

To identify incident disclosing behaviours and associated factors.

-Cross-sectional analytical

-N = 288 Nurses

Barriers to the incident reporting practice included non-supportive management, a culture of blame and shame, lack of feedback, fear of administrative sanctions, and the potential for legal penalties.

40.

Gqaleni & Bhengu 2020 [84], South Africa

To analyse safety incident reporting and patient outcomes.

-Cross-sectional descriptive

-N = 224 Nurses

Lack of feedback, fear, and busy schedule were identified as barriers to effective reporting.

41.

Iloh et al. 2020 [85], Nigeria

To describe the experience, motivators, barriers, and preventive measures for patient safety incidents.

-Cross-sectional descriptive

-N = 185 Physicians

Facilitators included documentation, patient-centered communication, audits, safety protocols, training, and teamwork. Barriers involved communication breakdowns, lack of feedback, inadequate resources, poor engagement, blame culture, and time constraints.

42.

Labib et al. 2019 [86], Egypt

To implement incident reporting systems and enhancing patient safety practices.

-Quasi-experimental

-N = 73 Nurses and Physicians

There had been persisted perception that only serious errors needed to be reported and a tendency to focus more on personal mistakes rather than systemic issues which hindered incident reporting.

43.

Naome et al. 2020 [87], Uganda

To explore incident reporting practices, barriers, and motivating factors

-Cross-sectional descriptive

-N = 158 Healthcare professionals

Facilitators of incident reporting included a supportive environment, knowledge of processes, training, clear guidelines, and teamwork. Barriers included lack of knowledge, absence of a management team, confidentiality issues, lack of support, fear of punishment, and isolation from staff.

44.

Tenza et al. 2022 [88], Ghana

To explore perspectives on compliance to patient safety culture dimension.

-Qualitative exploratory

-N = 114 Hospital managers

Facilitators included good interpersonal skills and positive staff-manager relationships. Barriers included fear of reporting, a blame culture, unstandardised reporting, selective reporting of critical errors, and punishment or questioning of reporters.

45.

Wami et al. 2016 [89], Ethiopia

To assess patient safety culture and associated factors.

-Mixed method

-N = 596 Healthcare professionals

Encouragement from hospital management facilitated the reporting while blaming hindered it.

46.

Agegnehu et al. 2019 [90], Ethiopia

To assess incident reporting behaviour and associated factors.

-Cross-sectional analytical

-N = 579 Healthcare professionals

Factors that facilitated reporting included feedback, support from hospital management, non-punitive response to error, communication openness, and actions by supervisors that promote safety.

47.

Yali & Nzala 2022 [91], Zambia

To explore concerns related to patient safety receiving clinical care.

-Qualitative exploratory

-N = 33 Healthcare professionals

Barriers to effective reporting included fear of blame and punishment, the absence of a standardised reporting system, and a lack of policy guidelines.

48.

Gqaleni & Mkhize 2023 [92], South Africa

To assess knowledge and implementation of incident reporting and learning guidelines.

-Cross-sectional descriptive

-N = 181 Nurses and Physicians

Working in specialised units and day shifts were associated with good knowledge of patient safety incident reporting and learning guidelines.

49.

Engeda 2016 [93], Ethiopia

To assess incident reporting behaviours and associated factors.

-Cross-sectional analytical

-N = 378 Nurses

Facilitators of incident reporting included training on incident reporting and the motivation to help patients. Barriers were fear of administrative sanctions, legal penalties, and loss of prestige among colleagues.

50.

Mohammed & Mahmoud 2016 [94], Egypt

To assess workplace culture, barriers, and strategies for encouraging medication error reporting.

-Cross-sectional analytical

-N = 300 Nurses

Strategies to enhance medication error reporting included using electronic systems, promoting open communication, and prioritising safety. However, complex reporting, high workloads, lack of support, blame culture, fear of negative consequences, and unclear guidelines were barriers.

51.

Mjadu & Jarvis 2018 [95], South Africa

To assess perceptions to incident reporting prior to improvement intervention in an adult intensive care unit.

-Cross-sectional analytical

-N = 101 Nurses

Facilitators of incident reporting included clear, user-friendly policies, learning from mistakes, and unit-specific feedback. Barriers involved fear of blame, loss of anonymity, and lack of confidentiality.