# Medication administration errors in a Norwegian ambulance service: a quasi-experimental study on the impact of a team training program

## TL;DR

A Norwegian ambulance service study found that a team training program did not reduce medication errors, suggesting the need for better systems and procedures.

## Contribution

The study evaluates the effectiveness of TeamSTEPPS training in reducing medication errors in prehospital ambulance settings.

## Key findings

- 30.6% of ambulance missions had at least one medication administration error.
- TeamSTEPPS training did not significantly reduce overall error frequency.
- Wrong drug errors increased significantly after the intervention.

## Abstract

Ambulance professionals operate in dynamic, time-pressured environments where patient safety is paramount, with medication administration errors (MAEs) being a particular concern. While pediatric-focused interventions have addressed dosing errors, few studies have explored strategies to reduce MAEs in prehospital settings. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training program that has demonstrated positive outcomes in various in-hospital contexts. This study aimed to evaluate the impact of a TeamSTEPPS intervention on MAE frequency in ambulance services.

This quasi-experimental, pre-post study was conducted within a Norwegian ambulance service across seven ambulance stations split into two groups as part of the TEAM-AMB project. The intervention consisted of a nine-month TeamSTEPPS team training program. Two independent reviewers assessed randomly selected electronic patient journals from pre- and post-intervention periods for MAEs, defined as deviations from the "five rights" of medication administration according to ambulance service protocols. Statistical analysis included descriptive statistics, Chi-square/Fisher's exact tests, Mann–Whitney U tests, and multivariable logistic regression. Cohen's Kappa evaluated interrater reliability.

Overall, 30.6% of ambulance missions contained at least one MAE, with wrong dose (17.5%) and wrong drug (15.1%) being the most common error subcategories. There was no significant change, combined or for either group, in MAE frequency between pre-intervention (28.9%) and post-intervention (32.2%) periods (p = 0.17). Wrong drug errors significantly increased from 11.2% to 19.1% post-intervention (p < 0.01). The number of different medications administered was the strongest predictor of errors, with each additional medication type increasing error odds by 47% (p < 0.01). Patient and mission characteristics showed no association with MAEs in multivariable analysis.

This Norwegian ambulance service study found MAEs in 30.6% of 1,499 missions. The TeamSTEPPS team training intervention did not reduce overall error frequency. The results suggest that team training alone is not sufficient to address the multifaceted causes of MAEs. Future interventions should focus on organizational improvements, particularly enhanced standard operating procedure adherence and electronic documentation systems, to improve accuracy and enable reliable medication error detection.

ClinicalTrials.gov—ID: NCT05244928.

The online version contains supplementary material available at 10.1186/s13049-026-01560-1.