Running head: EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 1

Effects of Sleep Deprivation on Medication Errors by Nurses in the Hospital Setting

Hannah Fitzpatrick, Kayla Kilfeather, Jessica Chan, Madyson Carrie, Rachel Keithley

James Madison University

EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 2

Effects of Sleep Deprivation on Medication Errors by Nurses in the Hospital Setting

Abstract

Sleep is a fundamental aspect of functional cognitive behavior in humans. Research data

was gathered to answer the question: In nurses in the hospital setting, does inadequate sleep

increase the frequency of medication errors compared to nurses who are not sleep deprived?

Various commonalities and inconsistencies exist among the articles. The most significant

commonality is the finding of a significant correlation between sleep deprivation and increased

frequency in medication errors. Limitations of the studies are acknowledged and include small

sample sizes, single studies, use of subjective data, and the need for further research.

Recommendations for further practice include shortening the number of nurses’ shift hours and

reducing nurse-patient ratios. Finally, there are several potential improvements for further

research. Use of larger sample sizes and a clear definition of “sleep deprivation” can enhance

the validity of research. A potential topic for further research is one that studies the prevalence

in medication errors in eight-hour shifts versus twelve-hour shifts. Additionally, future studies

could compare the number of medication errors in places with smaller nurse-patient ratios

compared to those with larger ratios.

Introduction

Sleep is a fundamental aspect of functional cognitive behavior in humans. In the nursing

career particularly, the importance of meticulous critical thinking as well as a clear and

concentrated mind are pertinent to successful practice. Although medication administration may

become a monotonous task for nurses, it requires careful thought and technique. The effects of

incorrect medication administration may be costly to patient outcomes. This poses the question:
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 3

In nurses in the hospital setting, does inadequate sleep increase the frequency of medication

errors compared to nurses who are not sleep deprived?

Commonalities

Throughout each of our reviewed studies, we found multiple commonalities. Several

studies focused specifically on the occurrence of medication errors within nursing practice. A

prevalent theme in these studies showed that as hours of sleep among nurses decreased, the

occurrence of medical errors significantly increased (Ferris, 2015; Saleh, Aswadalla, El-masri, &

Sleem, 2014; Ramadan & Al-Saleh, 2014). Data in multiple articles also confirmed that long

hours and night shifts resulted in decreased cognitive function and nursing fatigue, leading to

medication errors (Ferris, 2015; Scott, Arslanian-Engoren & Engoren, 2014; Seelye, Mattek,

Howieson, Riley, Wild, & Kaye, 2014; Shohani & Tavan, 2018; Soletti, Bailey, Smith &

Hirvela, 2014). These findings are indicative of the cognitive effects that sleep deprivation may

have on the brain. Findings also conveyed that error occurred during medication administration,

and accuracy was heavily influenced by outside distractions (Hayes, Jackson, Davidson, &

Power, 2015; Saleh et al., 2014). Multiple studies concluded that inadequate sleep does not

allow the brain to restore to its full potential, as it causes memory loss, mind wandering, and

limited information-processing abilities (Angel, Cortez, Juarez, Guerrero, Garcia, Ramirez, &

Valdez, 2015; Ramadan & Al-Saleh, 2014; Schwarz, Gerhardsson, Lekander, Fischer, Axelsson,

Kecklund, & Ackerstedt, 2017).

Inconsistencies

One of the main inconsistencies among the studies was that the definition of sleep

deprivation is not made clear, there were inconsistencies between studies in the method they

used to define sleep deprivation. For example, in one study participants had four hours of sleep
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 4

each night for five nights (Angel et al., 2015), and in another study, sleep deprivation was

defined as less than five hours of sleep the previous night (Ramadan & Al-Saleh, 2014). Another

inconsistency found was the types of tools used to gather data. Some of the tools used include

questionnaires, self-report inventories, scales, demographic data sheets, and exams such as the

Mini Mental Status Exam. Finally, inconsistencies were found among the populations used in

the studies. Participants ranged from members of the American Association of Critical Care

Nurses to undergraduate nursing students.

Limitations

The most prevalent limitation seen throughout each study was small sample sizes. This

poses a threat to validity because it allows large generalizations to be made about the effects of

sleep deprivation for all nurses. Furthermore, multiple studies were confined to a single setting

or population (Ferris, 2015; Ramadan & Al-Saleh, 2014; Shohani & Tavan, 2018). This

threatens validity as well by making the generalization that data restricted to few

areas/specialties can be applied to all nurses. Certain studies solely relied on questionnaires and

sleep diaries to gather data, limits objective measurements of sleep (Angel et al., 2015; Saleh et

al, 2014; Shohani & Tavan, 2018). This threatens validity due to the fact that questionnaires are

based on opinion and may be swayed by personal experience rather than objective sleep studies.

In two studies, further research is necessary to produce more accurate conclusions because the

current studies are not enough to prove its legitimacy and cannot yet be applied to all populations

of nurses (Seelye et al., 2014; Soletti et al., 2014).

Recommendations and Suggestions

There are several recommended changes for nursing practice. First, one study showed

that nurses who do not get enough sleep, experience fatigue, or do not have enough time to
EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 5

recover in between shifts also reported more decision regret (Scott et al., 2014). A solution

would be to shorten work shifts to eight to ten hours, instead of twelve. This would enable

nurses to get adequate sleep so that they are rested and alert for their next shift. Second, one of

the main causes of medication errors is due to an interruption while the nurse is administering

medications. Eighty-five percent of these interruptions result in error (Hayes et al., 2015).

Reducing the nurse-patient ratio would allow the nurse to focus on giving the medication

correctly without several other patients needing their assistance. Third, in order to avoid the

same medication error from occurring again, each hospital should support a positive learning

environment when errors are made (Soletti et al., 2014).

Topics for Future Research

Many improvements to further research can be made. First, using larger sample sizes

would enhance the studies’ validity. Second, samples from a variety of population settings could

be used to decrease bias. Furthermore, strict monitoring of sleep schedules along with a clear,

quantitative definition of “sleep deprivation” rather than the use of sleep diaries, questionnaires,

and self-report inventories would enhance the validity of the studies. A topic for further research

could compare the number of medication errors made by nurses who work an eight-hour shift

versus the number of errors made by nurses working a twelve-hour shift. Additionally, future

studies could compare the number of medication errors in places with smaller nurse-patient

ratios compared to those with larger ratios.

EFFECTS OF SLEEP DEPRIVATION ON MEDICATION 6

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