The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review: Medication errors and Theory of Planned Behaviour

The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review

Medication errors and Theory of Planned Behaviour


  • Sara Dionisi a:1:{s:5:"en_US";s:97:"1. RN, MSN, PhDs, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy";}
  • Emanuele Di Simone Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
  • Valeria Franzoso Policlinico Umberto I of Rome, Sapienza University of Rome, Italy
  • Elena Caldarola Policlinico Umberto I of Rome, Sapienza University of Rome, Italy
  • Rosaria Cappadona Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
  • Flavio Di Muzio Azienda Sanitaria Locale Roma 4, Rome, Italy
  • Noemi Giannetta Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
  • Marco Di Muzio Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy


medication errors, medicine error, medicament error, drug error, near miss, theory of planned behaviour


Background and aim of the work: A safer drug therapy is a relevant aspect of nursing care and an essential component of the clinical governance function. Nurses are key players in the identification and prevention of medication errors that could occur in the drug management process. In the literature there is a particular interest to environmental and organizational factors, while, as we know, the subjective components are little considered. In psychology, the theory that prefers individual factor, at the expense of the environmental one, is Theory of Planned Behavior (TPB), although it has been  little applied in the health field. The aim is to search the existing literature on the medication errors and the TPB to predict the intentions that foreshadow risk behaviours of nursing interns. Methods: This scoping review is grounded by Arksey and O’Malley’s framework. Results: Attitude is the most determining predictor of intention. For many students reporting an error would lead to a loss of trust in the nursing profession and this could prevent the report. Nevertheless, some of them affirmed to be positively judged when they did it. It was then observed that a better education on safety raised the level of self-confidence and the sense of responsibility of the students, making them more inclined to the drug therapy management.Conclusions: The Theory of planned behaviour  is essential to forerun the behavioural intention of students on the pharmacological safety and the collaborative practice through predictive factors, as attitude, subjective norms and perceived behavioural control.


National Institute of Medicine. To err is human: building a safer health system. Washington (DC); 2000.

Joint Commission. Preventing pediatric medication errors. Sentinel Event Alert, Issue 39; April 11, 2008.

Di Simone E, Giannetta N, Auddino F, Cicotto A, Grilli D, Di Muzio M. Medication errors in the emergency department: Knowledge, attitude, behavior, and training needs of nurses. Indian J Crit Care Med 2018a; 22(5), 346–352.

Cleary-Holdforth J, Leufer T. The strategic role of education in the prevention of medication errors in nursing: Part 2. Nurse Educ Pract 2013; 13(3), 217-220. Doi: 10.1016/j.nepr.2013.01.012.

Di Muzio M, Tartaglini D, De Vito C, La Torre G. Validation of a questionnaire for ICU nurses to assess knowledge, attitudes and behaviours towards medication errors. Ann Ig 2016a; 28(2), 113–21.

Reid‐ Searl K, Moxham L, Happell B. Enhancing patient safety: the importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing students. Int J Nurs Pract 2010; 16(3), 225-23. Doi: 10.1111/j.1440-172X.2010.01820.x.

Armitage G, Knapman H. Adverse events in drug administration: a literature review. J Nurs Manag 2003; 11(2), 130-14. PMID: 12581401.

Westbrook JI, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BMC Health Serv Res 2011; 11(1), 319. Doi: 10.1186/1472-6963-11-319.

Di Muzio M, Reda F, Diella G, Di Simone E, Novelli L, D’Atri A, Giannini A, De Gennaro L. Not only a problem of fatigue and sleepiness: Changes in psychomotor performance in Italian nurses across 8-h rapidly rotating shifts. J Clin Med 2019a; 8(1), e47.

Camiré E, Moyen E, Stelfox HT. Medication errors in critical care: risk factors, prevention and disclosure. CMAJ 2009; 180(9), 936-943. Doi: 10.1503/cmaj.080869.

Di Simone E, Giannetta N, Spada E, Bruno I, Dionisi S, Chiarini M, … Di Muzio M. Prevention of medication errors during intravenous drug administration in intensive care units: A literature review. Recenti Prog Med 2018b; 109(2), 103–107.

Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S. Drug-related problems in hospitals. Drug Saf 2007; 30(5), 379-407. Doi: 10.2165/00002018-200730050-00003.

Márquez-Hernández VV, Fuentes-Colmenero AL, Cañadas-Nuñez F, Di Muzio M, Giannetta N, Gutiérrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PLoS One 2019; 14(7): e0220001.

Di Simone E, Tartaglini D, Fiorini S, Petriglieri S, Plocco C, Di Muzio M. Medication errors in intensive care units: nurses’ training needs. Emergency Nurse 2016; 24(4), 24-29. Doi:10.7748/en.2016.1.1577.

Di Simone E, Di Muzio M, Dionisi S, Giannetta N, Di Muzio F, De Gennaro L, Orsi GB, Fabbian F. Infodemiological patterns in searching medication errors: relationship with risk management and shift work. Eur Rev Med Pharmacol Sci 2019; 23(12), 5522–5529.

Ajzen I. The Theory of planned behaviour. Organizational Behaviour and Human Decision Processes 1991; 50, 179-221. Doi: 10.1016/0749-5978(91)90020-T.

Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall 1980.

Ajzen I, Fishbein M. Attitudinal and normative variables as predictors of specific behavior. Journal of personality and social psychology 1973; 27(1), 41-57. Doi: 10.1037/h0034440.

Astrom AN, Rise J. Young adults’ intentions to eat healthy good: Extending the theory of planned behaviour. Psychol Health 2007; 16, 223-237. Doi: 10.1080/08870440108405501.

Fishbein M. Introduction. In D. J. Terry, C. Gallois, & M. McCamish (Eds.), The theory of reasorzed action: Its application to AIDS-preventive behaviour (pp. xv-xxv). Oxford, UK: Pergamo 1993.

Murnaghan D, Blanchard CM, Rodgers WM, LaRosa JN, MacQuarrie CR, MacLellan DL, Gray BJ. Predictors of physical activity, healthy eating and being smoke-free in teens: a theory of planned behaviour approach. Psychology & Health 2010. 25(8), 925-941. Doi: 10.1080/08870440902866894.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8(1), 19 - 32. Doi: 10.1080/1364557032000119616.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J 2009; 26(2), 91-108.

Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation Science 2010; 5, 69. Doi: 10.1186/1748-5908-5-69.

Lapkin S, Levett-Jones T, Gilligan C. Using the Theory of Planned Behaviour to examine health professional students’ behavioural intentions in relation to medication safety and collaborative practice. Nurse Educ Today 2015; 35(8), 935-940. Doi: 10.1016/j.nedt.2015.03.018.

Natan MB, Sharon I, Mahajna M, Mahajna S. Factors affecting nursing students’ intention to report medication errors: An application of the theory of planned behaviour. Nurse Educ Today 2017; 58, 38-42. Doi: 10.1016/j.nedt.2017.07.017.

Omura M, Levett-Jones T, Stone TE, Maguire J, Lapkin S. Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behaviour Medication Safety Questionnaire. Nursing and Health Sciences 2015; 17(4), 500-506. Doi: 10.1111/nhs.12224.

Di Muzio M, Marzuillo C, De Vito C, La Torre G, Tartaglini D. Knowledge, attitudes, behaviour and training needs of ICU nurses on medication errors in the use of IV drugs: a pilot study. Signa Vitae 2016b; 11(1), 182-206.

Di Muzio M, Dionisi S, Di Simone E, Cianfrocca C, Di Muzio F, Fabbian F, Barbiero G, Tartaglini D, Giannetta N. Can nurses’ shift work jeopardize the patient safety? A systematic review. Eur Rev Med Pharmacol Sci 2019b; 23(10), 4507–4519.

Di Muzio M, De Vito C, Tartaglini D, Villari P. Knowledge, behaviours, training and attitudes of nurses during preparation and administration of intravenous medications in intensive care units (ICU). A multicenter Italian study. Appl Nurs Res 2017; 38, 129–133.



How to Cite

Dionisi S, Di Simone E, Franzoso V, Caldarola E, Cappadona R, Di Muzio F, et al. The application of the Theory of Planned Behaviour to prevent medication errors: a scoping review: Medication errors and Theory of Planned Behaviour. Acta Biomed [Internet]. 2020 Jun. 20 [cited 2024 Jul. 15];91(6-S):28-37. Available from: