Medication safety in emergency departments: a mixed methods study

BACKGROUND: Medication safety competence is a critical component of patient safety, particularly in emergency departments (EDs), where high-acuity conditions and workflow instability increase vulnerability to medication-related errors. Despite extensive research on medication safety, limited attention has been given to how medication safety competence is enacted within emergency department settings. METHODS: A convergent mixed-methods design was employed. Data were collected between July and September 2024 from two large urban tertiary teaching hospitals. Quantitative data were obtained from 122 emergency nurses using the Medication Safety Competence Scale and were analyzed using descriptive statistics, independent t-tests, and one-way analysis of variance. Qualitative data were collected through structured written open-ended questions and analyzed using inductive content analysis. Integration was conducted through joint display analysis of quantitative and qualitative findings. RESULTS: Statistically significant differences were observed only in the patient-centered medication management subdimension, where nurses aged 30-39 years and those with ≥ 5 years of experience reported higher scores (p < .05). No significant differences were identified in the total scale score or other subdimensions. Mean item scores were generally high across all subdimensions, with the highest scores observed in patient-centered medication management, followed by responsibility in nursing. Qualitative analysis generated three themes: (1) self-assessment-based learning and development, (2) developing a medication safety culture, and (3) efficient organizational management. Integration revealed that although self-reported medication safety competence was high, its consistent enactment was influenced by cognitive workload, workflow interruptions, and the prevailing error reporting climate. CONCLUSIONS: Medication safety competence in emergency nursing is not solely an individual attribute but a context-dependent capacity shaped by professional development, collaborative culture, and organizational conditions. Strengthening medication safety competence therefore requires integrated educational and system-level interventions that enable its consistent enactment in emergency clinical practice.