Medication Adherence and Factors Affecting Non-Compliance with Administration in the Wards at Mosul City Hospitals

ABSTRACT Background and Objective: Medication adherence is a foundational element of patient safety in clinical settings. In hospital wards, nurses serve as the frontline executors of medication protocols. This study aimed to assess nurses' adherence to medication administration standards in Mosul hospitals, identify factors contributing to non-compliance, and explore associations between adherence and demographic variables. Methodology: A descriptive cross-sectional study was conducted between December 29, 2024, and March 10, 2025, among 100 nurses working in internal medicine and surgical wards across four governmental hospitals in Mosul City. Data were collected using a structured self-administered questionnaire and a direct observation checklist. The instrument examined five domains: demographic characteristics, knowledge, adherence principles, safe administration practices, and contributing factors to non-compliance. Results: The findings indicated a moderate overall adherence level. While nurses showed strong compliance with the “five rights” of medication administration, deficiencies were observed in documentation and verification routines. The most significant barriers included high workload (76%), inadequate initial training (76%), poor supervision (70%), and communication-related issues such as unclear verbal orders and illegible handwriting. Statistically significant associations were found between adherence levels and nurses' educational background, years of experience, and participation in training programs (p < .05). Conclusions: Although nurses in Mosul hospitals demonstrate baseline knowledge of medication safety, systemic and individual-level challenges hinder full compliance. Interventions that combine education, digital tools, clear communication, and administrative support are essential for enhancing medication adherence and reducing clinical risk.