Medication errors and medication error reporting practices in Ghana: a systematic review

Abstract

Background:

Medication errors (MEs) and their underreporting compromise patient safety in Ghana, but the landscape of error types, reporting systems, and barriers has not been comprehensively synthesized.

Objective:

This systematic review aims to map existing literature on MEs in Ghana and assess the functionality and utilization of reporting systems across healthcare settings.

Design:

Systematic review conducted in accordance with PRISMA 2020 guidelines.

Data sources and methods:

PubMed, PubMed Central, Scopus, ScienceDirect, and Google Scholar were searched for studies published between 1 January 2000 and 30 May 2025, with a final update search performed in August 2025 prior to data analysis. Eligible studies were conducted in Ghana and published in English, addressing MEs or medication-error reporting practices across any study design. Study selection, data extraction, and methodological quality appraisal were performed independently by two reviewers, and findings were synthesized narratively due to heterogeneity in study designs and outcome definitions.

Results:

Reported medication-error prevalence varied widely across included studies (47%–68.4%), reflecting differences in study designs, populations, clinical settings, and definitions of MEs. Omission errors were frequently identified as the most common type, accounting for up to 77.6% of documented errors in some studies. Contributing factors included inadequate training (91.6%), poor supervision (92.3%), and illegible prescriptions (63.7%), with severe underreporting highly evident. Reporting practices were often informal, with many errors conveyed verbally or not documented. Common barriers included fear of blame or disciplinary action, low confidence in reporting systems, insufficient anonymity, lack of standardized forms, limited training, and minimal mentorship.

Conclusion:

MEs remain a substantial patient-safety concern in Ghana, compounded by informal reporting systems and persistent organizational and cultural barriers. These findings underscore the urgent need to implement structured, non-punitive reporting systems, enhance staff training, and foster a culture of openness to support medication safety.

Plain language summary

Medication mistakes in Ghana’s healthcare and how often they are reported: a review of existing studies

Medication mistakes during the medication use process are a big problem in Ghana’s healthcare system, yet they often go unreported. We looked at all the research done in Ghana from January 2000 to August 2025 to understand exactly what kind of mistakes happen, how they are reported, and whether they are reported in official systems. We found that almost half to more than two-thirds of patients experience some kind of medication error, with omission errors (when a drug is not given) being the most common. Key reasons behind these errors include lack of training, poor supervision, and hard-to-read prescriptions. On top of that, many errors are never formally documented, as most reports are done verbally or not at all. People often do not report errors because they fear blame, do not trust the systems in place, worry about privacy, or lack proper reporting forms and training. These findings show that Ghana really needs clear, non-punitive reporting systems, better training for healthcare workers, and a system that supports speaking up about mistakes. By improving these areas, there can be a significant strengthening of patients’ safety in the healthcare environment.

Keywords

Ghana incident reporting medication errors patient safety pharmacovigilance quality of healthcare

Introduction

Medication errors (MEs) significantly threaten global patient safety, and the burden is especially high in low- and middle-income countries (LMICs), where systemic constraints can exacerbate risk.¹ MEs are preventable events that may occur at any stage of the medication-use process, including prescribing, dispensing, administration, and monitoring, and they are associated with increased morbidity, mortality, and healthcare costs worldwide. Previous studies highlight that these errors often arise from multifactorial causes such as human factors, communication failures, and system-level weaknesses, underscoring the need for coordinated safety strategies across healthcare systems.² While several reviews have examined medication safety across LMICs or African settings, these studies typically aggregate data across multiple countries, potentially obscuring country-specific system challenges, reporting structures, and policy contexts.

Despite a significant stride in healthcare development, Ghana faces unique challenges in ensuring medication safety across its healthcare system.³ The issue of medication safety remains a critical concern requiring comprehensive examination and targeted interventions. These errors, which encompass prescribing, dispensing, administering, and monitoring mistakes, are particularly concerning in LMICs, where healthcare systems often face resource limitations and weak pharmacovigilance structures.⁴ However, to date, evidence on MEs and reporting practices in Ghana has remained scattered across individual facility-based studies, with no comprehensive synthesis focusing exclusively on the Ghanaian context.

Ghana, like many other LMICs, continues to grapple with the challenges of detecting, documenting, and reporting MEs within both hospital settings and national pharmacovigilance systems.⁵ Several systemic challenges, including a lack of awareness or training among healthcare workers, the absence of standardized error classification tools, fear of punitive consequences, and resource constraints within health facilities, may undermine effective reporting.^6–8 Consequently, policymakers and stakeholders lack comprehensive data to inform targeted interventions, regulatory actions, and safety improvements across all levels of the healthcare system.

Given the paucity and scattered nature of the available literature and the absence of a Ghana-focused synthesis, a systematic review is warranted to systematically consolidate the existing evidence on MEs and medication error–reporting practices in Ghana. This review aims to identify commonly reported error types, affected settings, existing reporting mechanisms, and gaps in practice or policy that hinder effective medication-safety surveillance. By synthesizing available evidence, this study seeks to inform healthcare practice, guide regulatory strengthening, and support national strategies to enhance pharmacovigilance and patient safety in Ghana while also identifying priorities for future research.

Methods

Protocol registration

This systematic review was conducted in accordance with the PRISMA 2020 statement, and the completed PRISMA checklist is provided in Supplemental File S2.⁹ A protocol was registered on the Open Science Framework (OSF) with registration number: https://osf.io/7c3ua). Although the review aimed to comprehensively map the available evidence, it was conducted as a systematic review because it included a structured search strategy, predefined eligibility criteria, duplicate screening, formal methodological quality appraisal, and structured evidence synthesis. The review was conducted largely according to the registered protocol. Minor methodological refinements, such as clarification of eligibility criteria/search updates, were made during the review process; these changes did not affect the overall objectives or synthesis approach.

Eligibility criteria

We framed our eligibility criteria using the PICO (Population, Intervention/Exposure, Comparator, Outcome) framework. Specifically, the population comprised studies conducted in Ghana, or involving Ghanaian settings or participants; the exposure of interest included MEs (such as prescribing, dispensing, and administration) and/or practices around reporting those errors; the design was unrestricted and allowed for any empirical study (quantitative, qualitative, or mixed-methods); outcomes included error rates, types of errors, and reporting behaviors. We limited our review to papers published in English between 2000 and 2025.

Inclusion criteria and exclusion criteria

We included empirical studies involving quantitative, qualitative, or mixed methods, conducted in Ghana (Ghanaian settings or participants), published in English between 2000 and 2025, which specifically addressed MEs or medication error–reporting practices, and we also included reports presenting primary data (not purely opinion pieces). We excluded studies that were not based in Ghana or did not involve Ghanaian contexts, those not written in English, and those that focused solely on adverse drug reactions without examining MEs or error-reporting behavior.

Information sources and search strategy

A comprehensive search of PubMed, PMC, Scopus, ScienceDirect, and Google Scholar was performed from January 1, 2000 to May 30, 2025, with a final update search conducted between August 1–5, 2025 to ensure inclusion of recently indexed records prior to screening and analysis. For Google Scholar, the first 200 results sorted by relevance were screened, consistent with recommended practice to ensure reproducibility while minimizing selection bias. Search terms included MeSH and free-text keywords (e.g., “medication error*,” “drug error,” “error reporting,” “administration error,” “Ghana,” “Ghanaian”). Full database-specific search strategies (including Boolean operators, limits, and filters) are provided in Supplemental File S1. In addition to database searches, we hand-searched reference lists of included studies and relevant reviews.

Study selection

Two independent reviewers (SMA and TDA) screened titles and abstracts for eligibility. Discrepancies were resolved by discussion; if consensus could not be reached, a third reviewer (ITH) adjudicated. Formal inter-rater agreement was not quantified, but discrepancies were infrequent and resolved through consensus. Full texts of potentially eligible studies were retrieved and assessed independently by the same two reviewers. The selection process is summarized in a PRISMA flow diagram.

Data extraction

We developed a standardized data extraction form in Microsoft Excel, pilot-tested on five randomly selected studies, and refined it to ensure clarity and completeness. Data items included the following: authors, year, study design, setting, participant characteristics, definition of medication error, outcomes (e.g., error rate, reporting), and barriers/facilitators. Two reviewers (SMA and TDA) independently extracted data; disagreements were resolved by discussion or by consulting a third reviewer.

Quality assessment (risk of bias)

Methodological quality (risk of bias) of the included studies was appraised using design-appropriate instruments, namely the JBI critical appraisal checklists for qualitative and cross-sectional studies,¹⁰ the Newcastle–Ottawa Scale (NOS) for observational designs,¹¹ the CASP tool for relevant case-study reports,¹² and the Mixed Methods Appraisal Tool (MMAT) for mixed-methods studies.¹³ Two independent reviewers performed the assessments, applying predefined thresholds for “low,” “moderate,” and “high” quality for each tool. Predefined thresholds were applied to categorize studies as high, moderate, or low quality based on scoring guidance from the respective appraisal tools and approaches used in previous systematic reviews. For JBI and CASP instruments, studies meeting ⩾70% of applicable criteria were considered high quality, 50–69% moderate quality, and <50% low quality. For the NOS, scores of 7–9 were classified as high quality, 5–6 as moderate quality, and ⩽4 as low quality. For the MMAT, studies meeting all or most criteria were considered high quality, those meeting some criteria were considered moderate quality, and those meeting few criteria were considered low quality.

Study quality was considered during the synthesis and interpretation of findings. No studies were excluded solely based on methodological quality; however, greater emphasis was placed on findings from higher-quality studies when drawing conclusions. Where inconsistencies were observed, methodological limitations were examined as a potential explanation, and conclusions were interpreted with caution when primarily supported by lower-quality evidence. Any disagreements between assessors were resolved by consensus or, if needed, by consultation with a third reviewer.

Data synthesis

Due to substantial heterogeneity in study designs, settings, definitions of MEs, denominators, and outcome measurement approaches, a meta-analysis was not considered appropriate. We therefore conducted a narrative synthesis. No formal sensitivity analyses were conducted because the review employed a narrative synthesis and did not include quantitative pooling of results. Also, no statistical imputation or effect-size conversion was required because meta-analysis was not undertaken. Studies were grouped by healthcare setting (e.g., hospital vs community), type of medication error, and reporting behavior. Quantitative findings, including prevalence estimates, were summarized descriptively in tables without statistical pooling or calculation of aggregate estimates. Where ranges of prevalence were reported, these were presented to illustrate variability rather than to imply direct comparability across studies.

Subgroup comparisons were undertaken cautiously and interpreted considering methodological differences between studies. Qualitative findings were synthesized using thematic coding to identify common barriers, facilitators, and contextual factors influencing medication error reporting. This approach aligns with guidance for systematic reviews where statistical pooling is not appropriate due to heterogeneity.

Certainty/confidence in evidence

We assessed the certainty of evidence for key outcomes (e.g., error prevalence, reporting barriers) by considering methodological quality, consistency across studies, and relevance to Ghana’s context.

Data management

We managed bibliographic records and study selection in Mendeley, and all data extraction and synthesis in Excel. Quality assessment results were linked to extracted data for transparency. Extracted data were standardized descriptively across studies.

Results

A total of 1778 records were identified through database searches. After removal of 695 duplicates, 1083 records remained and were screened by title and abstract, of which 1063 were excluded. Twenty articles were assessed for full-text eligibility, and eight were excluded for the following reasons: non–peer-reviewed sources (n = 2), duplicate (n = 2), and studies outside the scope of the review (n = 4). Twelve studies met the inclusion criteria and were included in the final review. The search results and screening process are presented in Figure 1. The relatively small number of eligible studies reflects the limited volume of empirical research on MEs conducted in Ghana rather than overly restrictive eligibility criteria.

Figure 1.

A PRISMA flow chart indicating search outcome and screening process.

Summary of study characteristics

Table 1 shows the methodological and geographic landscape of medication error research studies in Ghana. The research approach was predominantly cross-sectional studies (66.7%), indicating snapshot views rather than longitudinal tracking. There was balanced healthcare distribution across hospital levels (tertiary, regional, district, each at 25%), showing system-wide investigation. Geographically, Greater Accra leads research activity (33.3%), with Ashanti following (25%), suggesting an urban-centered research focus. Because the number of studies included was relatively small (n = 12), percentages should be interpreted cautiously, as small absolute differences may result in large proportional changes.

Table 1.

Summary of included study characteristics (N = 12).

Characteristic	Category	Number (n)	Percentage (%)
Study design	Cross-sectional	8	66.7
	Observational	2	16.7
	Qualitative	1	8.3
	Mixed methods	1	8.3
Study setting	Tertiary hospital	3	25
	Regional hospital	3	25
	District hospital	3	25
	Mission hospital	1	8.3
	Multiple facilities/regions	1	8.3
	Outside healthcare facilities	1	8.3
Geographic distribution	Greater Accra	4	33.3
	Ashanti	3	25
	Northern	2	16.7
	Central	1	8.3
	Volta	1	8.3
	Eastern	1	8.3

Characteristics of studies included and key findings

The characteristics and key findings of the studies included are presented in Tables 2 and 3. To improve clarity, studies were grouped according to their primary focus: those reporting medication error outcomes (e.g., prevalence, incidence, types, and interventions) are summarized in Table 2, while studies examining perceptions, contributing factors, and reporting practices are presented in Table 3.

Table 2.

Characteristics and key findings of studies reporting medication error outcomes in Ghana.

Author (Ref)	Year	Setting	Study focus	Design	Sample size (n)	Key findings
Wuni et al.¹⁶	2024	Upper East	Medication error incidence	Cross-sectional	399	Medication administration error rate was 65.9%, with the intravenous route commonly involved.
Cofie et al.²²	2021	Greater Accra	Medication error prevalence	Observational	NR	Medication dosing errors occurred in 47% of cases.
Acheampong et al.¹⁸	2016	Greater Accra	Error interventions	Observational	24	Warfarin was the most frequently reported drug with errors; regimen change was the most accepted intervention.
Sabblah et al.¹⁵	2024	Greater Accra	Medication errors by caregivers at home	Cross-sectional	95	68.4% of children experienced ⩾1 medication error; wrong timing and dosing frequency were most common.
Boye et al.²⁰	2024	Central	Drug education and prescription clarity	Cross-sectional	286	Inadequate pharmacist education; illegible handwriting (63.7%), and unconventional prescription notations (78.0%).
Acheampong et al.¹⁷	2016	Greater Accra	Medication administration errors in the emergency department	Cross-sectional	387	Most frequent errors were omissions (77.6%) and wrong timing (16%).
Obeng et al.⁸	2024	Ashanti	Medication errors at the diabetes management center	Mixed methods	264	Wrong drug formulation most prevalent (39.6%); 47.8% resulted in adverse drug events.

NR, not reported.

Table 3.

Characteristics and key findings of studies reporting perceptions and medication error reporting practices in Ghana.

Author (Ref)	Year	Setting	Study focus	Design	Sample size (n)	Key findings
Tuvor et al.⁵	2025	Volta	Medication error reporting among nurses	Qualitative	20	Nurses were aware of errors, but underreporting occurred due to staffing shortages, fatigue, and calculation difficulties.
Nukpezah et al.⁷	2024	Northern	Pediatric nurses’ perception of medication errors	Cross-sectional	143	Contributing factors included inadequate training (91.6%), misunderstanding abbreviations (88.8%), and poor supervision (92.3%).
Bam et al.¹⁹	2021	Ashanti	Nursing students’ perception of medication errors	Cross-sectional	200	Negligence was perceived as the most common cause (80.5%); nurses and doctors were viewed as frequent contributors (84.5%).
Opoku-Danso et al.²¹	2024	Eastern	Medication administration errors among nurses and midwives	Cross-sectional	231	Unfavorable institutional reporting protocols were identified as barriers.
Boakye et al.¹⁴	2024	Ashanti	Nurses’ refusal to report medication errors	Cross-sectional	153	Lack of reporting protocols (62%) and fear of consequences were key barriers to reporting.

Outcome-focused studies (Table 2) were conducted across multiple healthcare settings, including tertiary and regional hospitals, emergency departments, and community or home-based care. Reported medication error prevalence varied widely across studies, ranging approximately from 47% to 68.4%, reflecting differences in study populations, measurement approaches, and definitions of MEs; therefore, these estimates should not be interpreted as directly comparable. Errors occurred across the medication use process, from prescribing to administration. Commonly reported error types included omissions, wrong timing of medication administration, dosing errors, and incorrect drug formulations. Some studies also highlighted prescription-related challenges, such as illegible handwriting and unconventional prescription notations, which contributed to medication safety risks.

Studies focusing on perceptions and reporting practices (Table 3) identified multiple human and system-related factors influencing MEs and underreporting. Contributing factors included inadequate training, heavy workload, poor supervision, and challenges related to medication dosage calculations and interpretation of medical abbreviations. Organizational barriers were also prominent, including lack of standardized reporting protocols, fear of blame or litigation, and staffing shortages. These findings indicate that both individual and institutional factors play important roles in shaping medication safety practices in Ghana.

Overall, the evidence suggests that MEs in Ghana arise from a complex interaction of human, organizational, and system-level factors. However, due to methodological heterogeneity across studies, findings were synthesized narratively without statistical pooling, and conclusions should be interpreted with appropriate caution.

Study quality assessment

The JBI was applied to eight cross-sectional studies. The findings revealed that the majority of these studies were of moderate to high methodological quality, particularly in terms of clearly defined inclusion criteria, detailed description of study setting and participants, valid measurement of exposures and outcomes, and appropriate statistical analysis (Table 4). Two observational studies were assessed using NOS. One study met high-quality standards (eight out of nine points), while the other was rated as moderate quality (5–6 out of 9), mainly due to limited control for confounding factors. One qualitative study was evaluated using the CASP checklist and demonstrated high quality, with clearly defined aims, an appropriate methodology, and rigorous thematic analysis. However, minor limitations were noted in the lack of discussion on researcher reflexivity. The mixed-method study assessed using the MMAT showed moderate quality.

Table 4.

Quality assessment of included studies.

Study (author, year)	Design type	Tool used	Overall quality	Key strengths	Main limitations
Nukpezah et al.(2024)⁷	Cross-sectional	JBI	Moderate (6/8)	Reliable instrument, clear inclusion	No confounder adjustment
Boakye et al. (2024)¹⁴	Cross-sectional	JBI	High (7/8)	Validated tool, regression analysis	Self-report bias
Sabblah et al. (2024)¹⁵	Cross-sectional	JBI	High (8/8)	Direct observation, LASSO regression	Recall bias
Wuni et al. (2024)¹⁶	Cross-sectional	JBI	High (7/8)	Direct observation, confounder control	Convenience sampling
Acheampong et al. (2016)¹⁷	Cross-sectional	JBI	High (7/8)	Correct use of descriptive and inferential statistics	Did not control for all possible contextual variables
Boye et al. (2024)²⁰	Cross-sectional	JBI	Moderate (5/8)	Objective prescription analysis	No multivariate adjustment
Bam et al. (2021)¹⁹	Cross-sectional	JBI	High (8/8)	Validated survey, regression	Single site
Opoku-Danso et al. (2024)²¹	Cross-sectional	JBI	Moderate (5–6/8)	Large sample, ethics compliance	Self-report, descriptive only
Acheampong et al. (2016)¹⁸	Observational	NOS	High (8/9)	Objective observation, adjusted analysis	Single hospital
Cofie et al. (2021)²²	Observational	NOS	Moderate (6/9)	Retrospective 5-year data, clear outcomes	Limited confounder control
Tuvor et al. (2025)⁵	Qualitative	CASP	High (9/10)	Rigorous thematic analysis, strong ethical conduct	Reflexivity not discussed
Obeng et al. (2024)⁸	Mixed Methods	MMAT	Moderate (3/5)	Qualitative explains context	Single-center study

Thus, seven of the studies (58.3%) were rated as high quality, meeting most or all of the respective appraisal criteria. These comprised.^5,14–19 The remaining five studies (41.7%) were rated as moderate quality.^7,8,20–22

Overall, the included studies were largely of high quality, with moderate risk of bias across most domains, supporting the reliability of the findings synthesized in this review. While many studies meet key quality criteria, the certainty of evidence should be considered moderate due to the predominance of cross-sectional designs and reliance on self-reported data.

Mediums of medication error reporting

According to the studies reviewed, the most common medium for reporting MEs was verbal communication, either to immediate supervisors or among colleagues (Table 5). In formal healthcare settings such as public hospitals,²⁰ paper-based incident report forms were used, although their utilization was inconsistent. In lower-tier facilities like community pharmacies³ and municipal hospitals,¹⁴ formal reporting tools were either absent or rarely used, with most error disclosures made verbally or not at all. In the study by Tuvor et al,⁵ fear and distrust further discouraged the use of structured reporting, resulting in errors being either undocumented or underreported.

Table 5.

Mediums for reporting medication errors.

Study (author, year)	Setting	Reported medium(s)
Boye et al (2024)²⁰	Public hospitals (Central Region)	Paper-based forms and internal incident logs
Sabblah et al (2022)³	Community pharmacies (Volta Region)	Mostly verbal; formal error forms were absent in 84% of facilities
Boakye et al (2024)¹⁴	Municipal hospitals (Ashanti Region)	Verbal reporting to supervisors; no routine written documentation
Tuvor (2025)⁵	District Catholic Hospital (Upper West)	Mostly verbal or undocumented; fear discouraged formal reporting

Barriers to medication error reporting

Several recurrent barriers to reporting MEs were identified across studies, as shown in Table 6. The most prominent was fear of blame, punishment, or disciplinary action, which discouraged staff from formally disclosing errors.^5,14,23 This was compounded by unclear reporting policies, lack of anonymity, and low confidence in the usefulness of reporting systems. In some settings, such as community pharmacies, the absence of formal reporting tools and limited staff training further hindered error disclosure.³ Among student and junior nurses,¹⁹ inexperience and fear of legal consequences were cited as key barriers, emphasizing the role of mentorship and organizational support in creating a safe reporting culture.

Table 6.

Barriers to reporting medication errors.

Study (author, year)	Reported barriers
Boakye et al (2024)¹⁴	Fear of blame or punishment; lack of anonymity; unclear policy
Tuvor et al (2025)⁵	Fear of negative consequences; perceived ineffectiveness of reporting
Sabblah et al (2022)³	Absence of reporting tools; lack of training; low motivation
Bam et al (2021)¹⁹	Inexperience; fear of legal implications; inadequate mentorship

Discussion

Magnitude of MEs in Ghana’s healthcare system

This systematic review reveals an alarming prevalence of MEs across Ghana’s healthcare system, with error rates ranging from 47% to 68.4% across different studies and settings.^15,16,22 These figures are substantially higher than the global average of approximately 6.5 per 100 admissions reported in acute hospital settings,²⁴ positioning Ghana among countries with critically high medication error rates. The consistently elevated error rates across different regions, healthcare levels, and study periods suggest a systemic rather than isolated problem within Ghana’s healthcare infrastructure.

The predominance of omission errors (77.6%) identified by Acheampong et al. is particularly concerning, as these were primarily attributed to drug unavailability rather than clinical decision-making errors.¹⁷ This finding aligns with broader healthcare challenges in LMICs where pharmaceutical supply chain disruptions significantly impact patient care outcomes. The high prevalence of timing errors (16%) and dosing errors (47%) further indicates fundamental gaps in medication administration protocols and healthcare worker competency.^17,18,22 The wide variation in reported prevalence should, however, be interpreted cautiously, as methodological heterogeneity across studies limits direct comparability.

Reporting practices and barriers

This review highlights persistent verbal reporting practices in Ghanaian healthcare settings, especially where formal systems are weak or absent. For instance, in Central Region public hospitals, MEs were documented through paper-based incident forms and internal logs, although their actual usage remained sporadic.²⁰ By contrast, community pharmacies in the Volta Region—lacking reporting forms in 84% of facilities—relied almost entirely on verbal disclosure.³ Similarly, in Ashanti Region municipal hospitals and a Catholic district hospital in the Upper West, error reporting was primarily informal and verbal, with minimal documentation, often deterred by fear of reprimand.^5,14

These practices coincide with widespread underreporting driven by structural and cultural barriers. Fear of blame or disciplinary action emerged as a universal deterrent.^5,14 Participants also reported a lack of anonymity and poorly defined reporting protocols, which exacerbated reluctance to report errors. In addition, Sabblah et al.³ emphasize the absence of reporting forms and limited staff training as key impediments in community settings. Junior nursing staff cited inexperience, fear of legal repercussions, and lack of mentorship as further obstacles to error reporting.¹⁹

These findings echo with broader evidence from across Africa, where weak healthcare systems, limited staff capacity, and a punitive organizational culture inhibit spontaneous reporting, even in countries with pharmacovigilance frameworks.^3,15 The predominance of verbal, undocumented reporting not only restricts opportunities for organizational learning but also perpetuates a culture of silence, where errors are hidden rather than addressed constructively.

Contributing factors: A multi-level analysis

Individual-level factors

The review identified critical knowledge and skill deficits among healthcare workers that contribute to MEs. The findings highlight the critical role of healthcare worker competencies in medication safety. Evidence from a study by Nukpezah et al. indicates that deficiencies in professional preparation and communication skills may substantially contribute to medication administration errors, with a large proportion of pediatric nurses identifying inadequate training and misunderstanding of medical abbreviations as key factors.⁷ These observations align with global literature emphasizing that workforce competency and clarity of clinical communication are central to preventing MEs.⁴ The difficulty in calculating drug dosages reported in other studies particularly highlights the need for enhanced mathematical and clinical skills training in nursing education curricula.⁵ The review highlights substantial risks among pediatric populations, with one study reporting that 68.4% of children experienced MEs at home.¹⁵ This finding underscores that medication safety risks extend beyond healthcare facilities into home-based care, where dosing errors, misunderstanding of instructions, and caregiver administration practices may contribute to harm. Pediatric patients are particularly susceptible due to weight-based dosing requirements and limited availability of child-appropriate formulations.

Organizational factors

Organizational weaknesses in supervision and clinical communication appear to play an important role in MEs. The widespread reporting of inadequate oversight among nurses suggests that insufficient supervisory support may limit adherence to safe medication practices and reduce opportunities for real-time error detection.^21,25 In addition, the persistence of illegible handwriting and unconventional prescription notations reported by Boye et al. points to broader system-level communication failures within healthcare teams, which may increase the likelihood of misinterpretation and administration errors.²⁰ These findings suggest that organizational culture and communication protocols require substantial reform to ensure medication safety.

The staffing challenges and fatigue reported by Tuvor et al.⁵ reflect broader human resource constraints in Ghana’s healthcare system, where the doctor-to-patient ratio was 1:10,000 in 2010 and 1:9043 in 2014. Such ratios are well below WHO recommendations and likely contribute to the high error rates observed across studies. Similarly, the high medication-error rates observed in emergency departments^16,26 reflect organizational pressures in high-acuity clinical environments. Emergency settings combine time constraints, heavy workload, and complex decision-making processes, which may increase the likelihood of prescribing and administration errors. These findings suggest the need for targeted organizational interventions such as clinical decision support, standardized protocols, and improved staffing support in high-risk clinical settings.

System-level factors

The review reveals fundamental weaknesses in Ghana’s medication safety infrastructure. The finding that MEs are the most common and preventable cause of patient injury globally makes the systemic failures in Ghana particularly concerning. The reliance on handwritten prescriptions, with 67% being susceptible to errors,⁷ demonstrates the urgent need for electronic prescribing systems and digital health infrastructure development.

The crisis of underreporting

Perhaps the most striking finding of this review is the massive underreporting of MEs to official systems. Despite the high error rates documented across multiple studies, only two MEs from Ghana were reported to the WHO global database between 2001 and 2018.³ This represents a reporting rate that is orders of magnitude below the actual incidence, suggesting a fundamental breakdown in medication error surveillance systems.

The barriers to reporting identified in this review are consistent with global patterns but appear particularly pronounced in Ghana’s context. These findings suggest that medication-error reporting may be constrained by a punitive rather than learning-oriented safety culture. Evidence from Boakye et al. indicates that substantial proportions of healthcare workers cited fear of criticism, litigation, and potential loss of professional licensure as reasons for avoiding reporting, highlighting how perceived personal consequences may discourage transparent disclosure and organizational learning.¹⁴ MEs often prelude guilt and fear in healthcare professionals, thereby resulting in under-reporting and further compromising patient safety, a pattern that appears deeply entrenched in Ghana’s healthcare system.

Comparison with the regional and global context

Across both regional and global contexts, our findings mirror well-documented patterns in medication error reporting systems. In several low- and middle-income countries—including Ethiopia, Uganda, and Tanzania, medication administration errors (MAE) reporting is predominantly verbal and informal, undermined by fear of blame, unclear definitions of error, inadequate reporting systems, and time constraint.²⁶ For instance, in northwest Ethiopia, an MAE reporting rate of 29% was attributed to fear of legal repercussions and limited confidence in reporting mechanisms.²⁷ Similarly, studies across Africa have consistently emphasized punitive cultures, poor feedback loops, and resource constraints as persistent barriers.²⁶

Globally, even countries with established systems face comparable issues. A 16-country survey revealed that blame culture, insufficient time, training deficiencies, and poor system coordination are major global barriers to medication error reporting.²⁸ In Saudi Arabia and South Korea, health professionals cited limited understanding of reporting processes, fear of consequences, and lack of access to feedback as dissuasive factors in formal error reporting.²⁹ Notably, the absence or low utilization of structured reporting tools, prevalent in our Ghana-based studies, is similarly reported internationally, highlighting systems-level gaps.

Together, these analogies illuminate how the phenomena uncovered in Ghana, as verbal reporting norms, fear-driven silence, and systemic priority gaps, are not isolated but reflect universal healthcare challenges. These findings reinforce international recommendations that emphasize strengthening non-punitive safety cultures, improving staff training, standardizing reporting tools, and ensuring functional feedback mechanisms within healthcare systems. Such strategies align with the World Health Organization’s global patient safety agenda, which calls for improved reporting systems, stronger medication-safety governance, and coordinated system-level interventions to reduce preventable medication-related harm.² Comparisons with findings from other countries should therefore be made with caution, as variations in healthcare systems and study methodologies may influence reported rates.

Implications for policy and practice

The findings of this review have significant implications for healthcare policy and practice in Ghana. The WHO’s global initiative to reduce severe, avoidable medication-associated harm in all countries by 50% over the next 5 years provides a framework for addressing Ghana’s medication safety challenges. However, achieving this target will require comprehensive reforms across multiple levels of the healthcare system.

The evidence suggests that Ghana should adopt a multi-pronged strategy with actionable steps. First, no-blame medication-error reporting systems could be strengthened by piloting anonymous or confidential reporting tools within selected regional and teaching hospitals, supported by the Ghana Health Service and linked to the national pharmacovigilance center. Second, healthcare worker training could be enhanced by integrating structured medication-safety modules into pre-service curricula for nurses, pharmacists, and physicians, alongside periodic in-service training and simulation-based workshops at the facility level. Third, digital health infrastructure improvements may begin with the gradual introduction of electronic prescribing or standardized digital medication charts in high-volume hospitals to reduce handwriting-related errors and improve traceability.

Fourth, pharmaceutical supply chain strengthening could involve reinforcing inventory management systems and pharmacist-led medication reconciliation processes to reduce dispensing substitutions and stock-related risks. Fifth, standardized medication-administration protocols may be implemented through national guidelines accompanied by facility-level checklists and supervisory audits to ensure adherence.

Strengthening integration between hospital reporting structures and the national pharmacovigilance system, through routine submission of medication-error summaries and feedback loops, may further enhance detection, documentation, and utilization of medication-error data for safety improvement.

Strengths and limitations

This systematic review provides the first comprehensive synthesis of medication error research in Ghana, covering diverse geographic regions and healthcare settings. The inclusion of both quantitative and qualitative studies provides a holistic view of the medication safety landscape.

Moreover, the findings of this review are strengthened by the overall high methodological quality of the studies included. Most of these studies demonstrated high quality in terms of study design, participant selection, exposure measurement, and statistical analysis. Collectively, the high quality of the studies included in this review suggests that the synthesized findings are grounded in reliable evidence and reflect a low overall risk of methodological bias.

However, the review is limited by the heterogeneity of study designs, as well as the predominance of cross-sectional studies, which provide snapshots rather than a longitudinal understanding of trends and intervention effectiveness. The reliance on self-reported data in many included studies may introduce social desirability bias, potentially underestimating certain barriers like fear. Moreover, the geographic concentration of studies in urban areas may limit generalizability to rural healthcare settings where resource constraints may be even more pronounced. Finally, only English-language studies were included, as English is the principal language of academic publication in Ghana. While this likely minimized the exclusion of relevant studies, the possibility of language bias cannot be entirely ruled out.

Conclusion

This systematic review reveals a medication safety crisis in Ghana characterized by high error rates, systemic contributing factors, and severe underreporting. The findings call for immediate, coordinated action across policy, practice, and research domains to protect patient safety and improve healthcare quality. The evidence suggests that with proper interventions, Ghana can significantly reduce MEs and align with international safety standards. However, this will require sustained commitment, resources, and systemic changes across all levels of the healthcare system. Future research should prioritize strengthening the national evidence base through well-designed multicenter studies, standardized definitions of MEs, and evaluation of reporting interventions within Ghana. Such efforts will provide the robust local data needed before broader regional comparisons or generalization to other settings are pursued.

Supplemental Material

sj-docx-1-taw-10.1177_20420986261444513 – Supplemental material for Medication errors and medication error reporting practices in Ghana: a systematic review

Supplemental material, sj-docx-1-taw-10.1177_20420986261444513 for Medication errors and medication error reporting practices in Ghana: a systematic review by Stephen Mensah Arhin, Isaac Tabiri Henneh, Theodora Dedo Azu, Joseph Arhin, Kwasi Sobre Nkrumah, Meshack Antwi-Adjei, Ewura Seidu Yahaya, Phylis Elsie Owusu Agyei, Emmanuel Nkrumah, Frank Osei-Poku, James Kojo Prah, Kwesi Boadu Mensah and Martins Ekor in Therapeutic Advances in Drug Safety

Supplemental Material

sj-docx-2-taw-10.1177_20420986261444513 – Supplemental material for Medication errors and medication error reporting practices in Ghana: a systematic review

Supplemental material, sj-docx-2-taw-10.1177_20420986261444513 for Medication errors and medication error reporting practices in Ghana: a systematic review by Stephen Mensah Arhin, Isaac Tabiri Henneh, Theodora Dedo Azu, Joseph Arhin, Kwasi Sobre Nkrumah, Meshack Antwi-Adjei, Ewura Seidu Yahaya, Phylis Elsie Owusu Agyei, Emmanuel Nkrumah, Frank Osei-Poku, James Kojo Prah, Kwesi Boadu Mensah and Martins Ekor in Therapeutic Advances in Drug Safety

Footnotes

Acknowledgements

We acknowledge the support of our colleagues who provided valuable insights during the conceptualization and refinement of the review protocol. Special appreciation goes to the library team for their assistance with database searches and access to full-text articles.

Declarations

ORCID iDs

Stephen Mensah Arhin

Isaac Tabiri Henneh

Theodora Dedo Azu

Joseph Arhin

Kwasi Sobre Nkrumah

Meshack Antwi-Adjei

Ewura Seidu Yahaya

Phylis Elsie Owusu Agyei

Emmanuel Nkrumah

James Kojo Prah

Kwesi Boadu Mensah

Martins Ekor

Supplemental material

Supplemental material for this article is available online.

Patient and public involvement

Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.

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