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The belief that medical errors can be avoided by using sanction and punishment implements a neglect of the importance of developing safety systems. The culture within the health services will be of vital importance if the successful prevention of medical errors is to be achieved. This work based on four focus groups including 22 nurses from emergency wards in a hospital has given information how the organizational culture will affect the occurrence and reporting of medication errors. Individual perspective and personal responsibility is well incorporated and deeply rooted in the nursing culture, while understanding of the importance of systems and routines for patient safety in general may be improved. The understanding of incident reports as a preventive measure was underdeveloped. Self-reproach was a general response by the nurses if they had contributed to a medication error. Criticism of the system is more adequate than criticism of individuals since self-reproach only create defensiveness and blaming. Incident reporting systems should be free from negative consequences for those who report. The health services would be improved by developing security systems and changing the culture from blame to safety.

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