ORIGINAL ARTICLE Barriers to the medication error reporting process within the Irish National Ambulance Service, a focus group study Eamonn Byrne 1,2 & Gerard Bury 2 Received: 15 June 2017 /Accepted: 11 January 2018 # Royal Academy of Medicine in Ireland 2018 Abstract Background Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy. Aims To identify, investigate and document the barriers to medication error reporting within the NAS. Methods An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis. Results Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological. Conclusion Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted. Keywords Errors . Medication . Paramedics . Pre-hospital . Qualitative research . Reporting Introduction Medication error has been defined as BA failure in the treat- ment process that leads to, or has the potential to lead to, harm to the patient^ [1]. Pre-hospital care in Ireland is undergoing a period of continued change with medication authorisation, pro- tocols and equipment regularly updated. The literature suggests that 79–89% of medication errors pre-hospital are self-identified by the practitioner [2, 3], and although some reporting of medication errors is occurring within the National Ambulance Service (NAS), levels appear to be well below what might be expected [ 4]. In 2016, the NAS responded to over 300,000 emergency calls, of which 100,000 were designated as potentially life-threatening [5]. For that year, with approximately 1700 staff, there were a total of 11 medication incident reports nationally. All were recorded as no harm or near miss events [NIMS report run 20/04/2017]. The National Ambulance Service (NAS) is the statutory provider of pre-hospital emergency and intermediate care across Ireland, and the Clinical Indemnity Scheme (CIS) has a responsibility for risk management and insurance cover for the NAS as well as the wider public health service. The CIS is a subsection of the State Claims Agency (SCA) [6]. The SCA hosts the national electronic reporting system or National Incident Management System (NIMS) [7]. All patient safety or adverse events which did or could have resulted in harm to * Eamonn Byrne Eamonn.byrne@hse.ie Gerard Bury Gerard.bury@ucd.ie 1 National Ambulance Service, Mallow, Cork, Ireland 2 University College Dublin, Centre for Emegency Medical Science, School of Medicine, Belfield, Dublin 4, Ireland Irish Journal of Medical Science (1971 -) https://doi.org/10.1007/s11845-018-1745-x