Medication Administration In Hospital Research Articles

Medication Administration Practices Among Nurses: An Observational Study from Oman

Safe medication administration is vital in ensuring patients’ safety and enhancing their quality of life. This study aimed to observe nurses' practice in medication administration in Hospitals and primary healthcare institutions to identify and examine the different steps of the medication administration process for quality assurance and safe drug administration. The methodology of the study employed a cross-sectional design using quantitative descriptive data within health institutions at South Sharqiyah Governorate. Data from the direct observation of 99 nurses (once at a time) were observed while they were preparing and administering medications using the disguised observation method (DDM). The data was recorded via Microsoft Access using a descriptive approach (frequencies and percentages) for analysis. The areas of concern in the study were: the five rights of medication administration, documentation, the use of patient’s identifiers, double checking and drug labeling. The trained observer completed the checklist after observing the nurses’ medication administration. Data were collected from 99 observations for analysis. Data analysis was conducted using descriptive and inferential statistics in the SPSS software version 26. The quantitative data illustrates that only 34.3% of nurses performed an independent double check by another nurse, only 56.6% performed appropriate labeling, and 62.6% confirmed the patient’s identity using at least two patient identifiers. Most medication administrations meet the “Five Rights” criteria (right patient =92.9%; right medication=98%; right dose=97%; right route=98%; and right time=97%). A statistically significant association was found between the participant's age and right time (p=0.013); and between years of experience and right medication (p=0.005), right dose (p=0.019) and right route (p=0.004). In this study, the nurses' poor areas of practice in medication administration were identified as double-checking of medication, labeling, and use of patient identifiers. Checking the right of medication administration and documentation post the procedure was the most followed by nurses in the medication administration process. The relevance of the study to clinical practice is the continuing education and clinical audits for nurses regarding basic pharmacology, medication administration policy, factors contributing to medication errors, and strategies preventing medication errors should be a priority.

Establishing a framework for quality of inpatient care for Parkinson's disease: A study on inpatient medication administration

BackgroundThe complexity of antiparkinsonian medications makes patients vulnerable to medication deviations. This study examines the frequency and outcomes of deviations between outpatient and inpatient medication administrations in patients with Parkinson's disease (PD). MethodsWe included hospital admissions of patients with PD during a 12-month period at the Cleveland Clinic Main and Fairview campuses. Outpatient regimens were compared with hospital medication administration records to establish rates of deviations in terms of levodopa equivalent daily dose (LEDD) difference, timing deviations/omissions of time-critical medications, substitution of levodopa compounds, and administration of antidopaminergic medications. Logistic regression analyses were used to investigate associations with length of stay (LOS), readmission rates, and mortality. ResultsThe study included 492 patients with 725 admissions. Of those on time-critical medications, 43% had a LEDD deviation and 19% had levodopa formulation substitutions. Of the admission days with known outpatient timing regimens, 47% had an average deviation of more than 30 min and 22% had at least one missed levodopa dose. LOS was longer with each additional day of over-dose (4%), under-dose (14%), missed dose (21%), timing deviation (15%) and substitution (19%), (all p < 0.0001). Administration of antidopaminergic medications (9.9% of admissions) was associated with increased 30-day readmission/death (OR 1.85, p = 0.041), 90-day mortality (OR 2.2, p = 0.018), and LOS (7.6 vs. 3.8 days, p < 0.0001). LEDD underdose was associated with 30-day readmission/death (OR 1.78, p = 0.025) and 90-day mortality (OR 1.14, CI 1.05–1.24, p = 0.002). ConclusionsDeviations between outpatient and hospital regimens, and administration of antidopaminergic medications, were associated with poor outcomes.

Understanding complexity in a safety critical setting: A systems approach to medication administration

‘Medication errors’ are a significant concern and are associated with a higher incidence of adverse events and unintentional patient harm than any other aspect of healthcare. While much research has focused on adverse medication errors, limited studies have specifically examined ‘normal’ medication delivery performance and the interactions between tasks, agents, and information within the medication administration system. This article describes a study that applied the Event Analysis of Systemic Teamwork (EAST) model to study the hospital medication administration system to identify opportunities to optimise performance and patient safety. Key findings of this study demonstrate that this is a highly complex system, comprising many social agents and a relatively closely linked series of tasks and information. However, most of the workload relies on a small proportion of healthcare professionals. Significantly, the patient has a minimal role in the medication administration system during their hospital stay. The research has shown that this approach enables mapping networks and their interdependencies to optimise the system as a whole rather than its parts in isolation.

Eliciting willingness-to-pay to prevent hospital medication administration errors in the UK: a contingent valuation survey

Medication errors are common in hospitals. These errors can result in adverse drug events (ADEs), which can reduce the health and well-being of patients’, and their relatives and caregivers. Interventions...

Nurses’ Self-Reported Practices and Perceived Barriers of Medication Administration Safety in State Hospitals in Northern Nigeria

Introduction:Administering medication is a vital aspect of patients’ treatment and nurses play an essential role in it, with the responsibility of safety during the procedure. Nurse administrators are showing concern about patient safety, and one of the first steps to reduce medication administration errors is assessing the factors contributing to those errors.Materials and Methods: The study was descriptive and adopted cross-sectional design. The Medication Administration Safety Assessment Tool and instrument for assessing barriers to medication administration safety were used for data collection. Proportionate and systematic samplings were used in selecting the respondents. Data collected were analysed using SPSS version 26. Chi-square and ANOVA statistical tools were used for inferential analysis.Results: The majority (40.7%) of the respondents were having Good medication administration safety practices, but 19.1% had poor medication administration safety practices. Majority (41.6%) of the respondents had very low perceived barriers to medication administration safety. There was no significant association between hospital working experience and medication administration safety practices, P>0.05. The professional qualification of the respondents was associated with perceived barriers to medication administration safety, P<0.05.Conclusion:The medication administration safety practices range from good to very good practices, and there was a considerable number of respondents with poor practices. Moreover, a significant number of respondents perceived the barriers to medication administration safety practices as moderate, high or very high. These call for the need for frequent knowledge update through conferences, workshops and educational forums among nurses. Frequent investigation and mitigation of factors aggravating hospitals’ medication administration errors should be given more emphasis.

Variation in Hospitalist-Specific Antibiotic Prescribing at Four Hospitals: A Novel Tool for Antibiotic Stewardship

Background: Hospitalists play a critical role in antimicrobial stewardship as the primary antibiotic prescriber for many inpatients. We sought to describe antibiotic prescribing variation among hospitalists within a healthcare system. Methods: We created a novel metric of hospitalist-specific antibiotic prescribing by linking hospitalist billing data to hospital medication administration records in 4 hospitals (two 500-bed academic (AMC1 and AMC2), one 400-bed community (CH1), and one 100-bed community (CH2)) from January 2016 to December 2018. We attributed dates that a hospitalist electronically billed for a given patient as billed patient days (bPD) and mapped an antibiotic day of therapy (DOT) to a bPD. Each DOT was classified according to National Healthcare Safety Network antibiotic categories: broad-spectrum hospital-onset (BS-HO), broad-spectrum community-onset (BS-CO), anti-MRSA, and highest risk for Clostridioides difficile infection (CDI). DOT and bPD were pooled to calculate hospitalist-specific DOT per 1,000 bPD. Best subsets regression was performed to assess model fit and generate hospital and antibiotic category-specific models adjusting for patient-level factors (eg, age ≥65, ICD-10 codes for comorbidities and infections). The models were used to calculate predicted hospitalist-specific DOT and observed-to-expected ratios (O:E) for each antibiotic category. Kruskal-Wallis tests and pairwise Wilcoxon rank-sum tests were used to determine significant differences between median DOT per 1,000 bPD and O:E between hospitals for each antibiotic category. Results: During the study period, 116 hospitalists across 4 hospitals contributed a total of 437,303 bPD. Median DOT per 1,000 bPD varied between hospitals (BS-HO range, 46.7–84.2; BS-CO range, 63.3–100; anti-MRSA range, 48.4–65.4; CDI range, 82.0–129.4). CH2 had a significantly higher median DOT per 1,000 bPD compared to the academic hospitals (all antibiotic categories P &lt; .001) and CH1 (BS-HO, P = .01; anti-MRSA, P = .02) (Fig. 1A). The 4 antibiotic groups at 4 hospitals resulted in 16 models, with good model fit for CH2 (R2 &gt; 0.55 for all models), modest model fit for AMC2 (R2 = 0.46–0.55), fair model fit for CH1 (R2 = 0.19–0.35), and poor model fit for AMC1 (R2 &lt; 0.12 for all models). Variation in hospitalist-specific O:E was moderate (IQR, 0.9–1.1). AMC1 showed greater variation than other hospitals, but we detected no significant differences in median O:E between hospitals (all antibiotic categories P &gt; .10) (Fig. 1B). Conclusions: Adjusting for patient-level factors significantly reduced much of the variation in hospitalist-specific DOT per 1,000 bPD in some but not all hospitals, suggesting that unmeasured factors may drive antibiotic prescribing. This metric may represent a target for stewardship intervention, such as hospitalist-specific feedback of antibiotic prescribing practices.Funding: NoneDisclosures: Scott Fridkin, consulting fee - vaccine industry (various) (spouse)

“On time ‐ every time” A new strategy for dosing levodopa in hospital

AbstractMost Parkinson’s Disease (PD) patients are hospitalised for reasons other than their PD. Their PD symptoms are usually under control before admission, however, too many seem to experience medication‐related problems in hospital. Hospitalised PD patients should receive their levodopa within 30 min of the scheduled time (“on time”) and not miss doses (“every time”). Hospital staff should avoid prescribing and administering contraindicated dopamine antagonists to PD patients in their care. Multiple studies have shown the failure to deliver levodopa “on time” to PD patients, with less than 50% of doses being “on time” and an average 0.7 of doses missed each day. The evidence points to hospital medication administration systems (HMAS) as the likely cause of late and missed levodopa doses. PD medication administration guidelines were reviewed to find strategies that reduced late and missed doses. An integrated “on time – every time” medication administration approach is proposed. PD patients should be encouraged to self‐administer their medication in hospital. More PD nurse navigators will be needed to facilitate PD patient care in Australian hospitals.

Factors associated with workarounds in barcode-assisted medication administration in hospitals.

Aims and objectivesTo identify that workarounds (defined as “informal temporary practices for handling exceptions to normal procedures or workflow”) by nurses using information technology potentially compromise medication safety. Therefore, we aimed to identify potential risk factors associated with workarounds performed by nurses in Barcode‐assisted Medication Administration in hospitals.BackgroundMedication errors occur during the prescribing, distribution and administration of medication. Errors could harm patients and be a tragedy for both nurses and medical doctors involved. Interventions to prevent errors have been developed, including those based on information technology. To cope with shortcomings in information technology‐based interventions as Barcode‐assisted Medication Administration, nurses perform workarounds. Identification of workarounds in information technology is essential to implement better‐designed software and processes which fit the nurse workflow.DesignWe used the data from our previous prospective observational study, performed in four general hospitals in the Netherlands using Barcode techniques, to administer medication to inpatients.MethodsData were collected from 2014–2016. The disguised observation was used to gather information on potential risk factors and workarounds. The outcome was a medication administration with one or more workarounds. Logistic mixed models were used to determine the association between potential risk factors and workarounds. The STROBE checklist was used for reporting our data.ResultsWe included 5,793 medication administrations among 1,230 patients given by 272 nurses. In 3,633 (62.7%) of the administrations, one or more workarounds were observed. In the multivariate analysis, factors significantly associated with workarounds were the medication round at 02 p.m.–06 p.m. (adjusted odds ratio [OR]: 1.60, 95% CI: 1.05–2.45) and 06 p.m.–10 p.m. (adjusted OR: 3.60, 95% CI: 2.11–6.14) versus the morning shift 06 a.m.–10 a.m., the workdays Monday (adjusted OR: 2.59, 95% CI: 1.51–4.44), Wednesday (adjusted OR: 1.92, 95% CI: 1.2–3.07) and Saturday (adjusted OR: 2.24, 95% CI: 1.31–3.84) versus Sunday, the route of medication, nonoral (adjusted OR: 1.28, 95% CI: 1.05–1.57) versus the oral route of drug administration, the Anatomic Therapeutic Chemical classification‐coded medication “other” (consisting of the irregularly used Anatomic Therapeutic Chemical classes [D, G, H, L, P, V, Y, Z]) (adjusted OR: 1.49, 95% CI: 1.05–2.11) versus Anatomic Therapeutic Chemical class A (alimentary tract and metabolism), and the patient–nurse ratio ≥6–1 (adjusted OR: 5.61, 95% CI: 2.9–10.83) versus ≤5–1.ConclusionsWe identified several potential risk factors associated with workarounds performed by nurses that could be used to target future improvement efforts in Barcode‐assisted Medication Administration.Relevance to clinical practiceNurses administering medication in hospitals using Barcode‐assisted Medication Administration frequently perform workarounds, which may compromise medication safety. In particular, nurse workload and the patient–nurse ratio could be the focus for improvement measures as these are the most clearly modifiable factors identified in this study.

Assessment of Medication Administration Error Reporting Among Hospital Nurses in Indonesia

Introduction: Nurses play a vital role in the maintenance and promotion of patient safety, as well as medication administration in hospitals. In one small state government-owned hospital in South Jakarta, medication errors were the most reported type of patient safety incidents accounting for 52.5% of incidents which occurred within 2016 to September 2018. Nonetheless, only a small percentage (9.25%) of those reports was presented by nurses. The present study aimed to determine the factors associated with medication administration error (MAE) reporting among nurses. Materials and Methods: A cross-sectional study, followed by qualitative research, was conducted at a state government-owned hospital in Jakarta Indonesia within November 2018-April 2019. Total sampling was used to obtain the 44 clinical nurses included in the quantitative study. The qualitative study used focus group discussion and in-depth interviews of selected informants. Results: Consequences of reporting was found to be correlated with MAE reporting among nurses (P=0.013). There was no statistically significant organizational factor or socio-demographic characteristic associated with medication administration error reporting. Through qualitative measures, the factors that most influenced and inhibited error reporting included administrative response and the consequences of reporting. Moreover, managers’ support, understanding and self- awareness of the importance of reporting, and a non-blaming culture were recognized as the factors which support error reporting. Conclusion: As evidenced by the obtained results, medication administration error reporting is still low. Reporting incidents can be improved by fostering a non-blaming safety culture. Further studies are recommended to investigate the occurrence of medication errors, as well as reported errors.

285 Inpatient Management of Medications for Parkinson’s Disease

Abstract Background Medication errors during unplanned hospital admissions are common in Parkinson’s Disease, often involving late or missed doses. These errors can result in serious complications and loss of function in these patients. Several Parkinson’s Disease networks and associations have run campaigns aiming to improve medication administration in hospital. Methods We reviewed the medical notes and medication charts of 20 patients with Parkinson’s Disease admitted through the Emergency Department. Medication charts were reviewed to assess for levo-dopa containing medications. We assessed whether medication dosing and timing was accurately recorded, if medications were administered on time, and if self-management of medication was considered if the patient was capable during the first 48 hours of admission. We measured our findings against standards from NICE guidelines and Parkinson’s UK. Results Only 9 of 20 cases had the times and doses accurately documented on admission. An average of 2.7 doses/patient were missed or delayed in the 48 hour period. Of 152 total doses, 54 (35%) were missed or late. Only 3 out of 20 patients received all their medications on time. Only one out of 20 patients had a documented order to be allowed to self-manage their medication. Conclusion Medication errors and omissions during unplanned hospital admissions in patients with Parkinson’s Disease are unsurprisingly common. Many doctors are unaware of the need to provide alternative routes of delivering levo-dopa for patients with Parkinson’s Disease who are fasting or unable to swallow. Patients with Parkinson’s Disease are not being empowered to manage their own medication during hospital admission. Educating doctors on the importance of reducing these medication errors, and the existence of the OPTIMAL Calculator to convert the patients’ usual medications to alternative preparations, is imperative to improve inpatient management of patients with Parkinson’s Disease.

Nurses' satisfaction with barcode medication-administration technology: Results of a cross-sectional study.

Medication administration is a critical task of nurses that, if not done appropriately, can lead to fatal errors. New technologies, including barcode medication administration, are intended to decrease medication errors and enhance verification of medication-administration rights. Therefore, in this study, we examined the effect of introducing barcode medication administration on nurses' satisfaction and identified correlates of nurses' satisfaction with barcode medication administration. A descriptive, cross-sectional design using self-reported questionnaires was utilized to recruit 207 nurses from three public hospitals. Participants reported being moderately satisfied with barcode medication administration, especially with its efficacy and safety aspects. Their satisfaction had a significant negative correlation with their age, nursing experience, and experience using barcode medication administration, and a significant positive correlation with barcode medication-administration training satisfaction, computer competence, comfort with using barcode medication administration, and perceived job productivity using barcode medication administration. This study provides important information about Jordanian nurses' satisfaction with barcode medication-administration technology and provides greater understanding of different clinical correlates to barcode medication-administration satisfaction. It is recommended that effective barcode medication-administration training and computer skills training be provided prior to establishing barcode medication administration in hospitals and that the safety features of barcode medication administration be integrated in clinical education and training.

Electronic prescribing and medication administration in hospital could be linked to error increases, study finds

Electronic prescribing and medication administration in hospital could be linked to error increases, study finds

Drug consumption and futile medication prescribing in the last year of life: an observational study.

the last year of life for many older people is associated with high symptom burden and frequent hospitalizations. Hospital physicians have an opportunity to prioritize essential medications and deprescribe potentially futile medications. to measure medication consumption during hospitalization in the last year of life and the prevalence of potentially inappropriate medications (PIMs) at hospital discharge. retrospective chart review. acute hospital. ≥65 years, hospitalized in the last year of life. medication consumption was determined by examining hospital Medication Administration Records. PIMs were defined using STOPPFrail deprescribing criteria. the study included 410 patients. The mean age of participants was 80.8, 49.3% were female, and 63.7% were severely frail. The median number of days spent in hospital in the last year of life was 32 (interquartile range 15-59). During all hospitalizations, the mean number of individual medications consumed was 23.8 (standard deviation 10.1). One-in-six patients consumed 35 or more medications in their last year. Over 80% of patients were prescribed at least one PIM at discharge and 33% had ≥3 PIMs. Lipid-lowering medications, proton pump inhibitors, anti-psychotics and calcium supplements accounted for 59% of all PIMs. Full implementation of STOPPFrail recommendations would have resulted in one-in-four long-term medications being discontinued. high levels of medication consumption in the last year of life not only reflect high symptom burden experienced by patients but also continued prescribing of futile medications. Physicians assisted by the STOPPFrail tool can reduce medication burden for older people approaching end of life.

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Supervising nursing students in a technology-driven medication administration process in a hospital setting: a systematic review protocol.

The objective of this review is to identify, describe and synthesize the experiences of nurse supervisors and the factors that influence the supervision of pre-graduate nursing students in undertaking technology-driven medication administration in hospital settings.The current review seeks to answer the following questions.

An automated medication system reduces errors in the medication administration process: results from a Danish hospital study

ObjectivesImprovements in a hospital's medication administration process might reduce the prevalence of medication errors and improve patient safety. The objective of this study was to evaluate the success of an...

Systematic literature review of hospital medication administration errors in children.

ObjectiveMedication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child’s weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients.MethodsTwelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria.Key findingsA total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588). It was also identified in a mean of 29% of doses observed (n=8,894). The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration.ConclusionThis review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to the definition and method used to investigate MAEs. The review also illustrated the complexity and multifaceted nature of MAEs. Therefore, there is a need to develop a set of safety measures to tackle these errors in pediatric practice.

Beyond Technology Adoption: An Embeddedness Approach to Reduce Medication Errors

Medication errors are causing harm, and even death, to hospital inpatients. These preventable errors occur at the hands of the same individuals who are charged to protect and provide care to patients—health care professionals. While decision support technologies are available to assist health care providers, patients continue to experience incorrect medications, inaccurate doses/rates of medication, duplicate doses, medication interactions, and other medication errors. This article investigates the reasons that health care professionals in hospital environments underutilize medication administration technologies and argues that a fusion view can provide guidance to increase their use. A Fusion Model is developed using the concept of embeddedness, the Technology Acceptance Model, the Task-Technology-Fit Model, and drawing on ethnographic fieldwork conducted at a modern hospital in the United States. The most important findings of this research are: (1) the concept of embeddedness can be used to study and frame fusion of technology in an environment; (2) four constructs (i.e., task characteristics, technology characteristics, individual use behavior, environmental characteristics) are identified and used to describe system characteristics needed to support medication decisions; and (3) guidance is provided for design and evaluation of decision support technologies for medication administration in hospitals.

Improving medication administration safety: using naïve observation to assess practice and guide improvements in process and outcomes.

To present findings from the Collaborative Alliance for Nursing Outcomes' (CALNOC) hospital medication administration (MA) accuracy assessment in a sample of acute care hospitals. Aims were as follows: (1) to describe the CALNOC MA accuracy assessment, (2) to examine nurse adherence to six safe practices during MA, (3) to examine the prevalence of MA errors in adult acute care, and (4) to explore associations between safe practices and MA accuracy. Using a cross-sectional design, point in time, and convenience sample, direct observation data were collected by 43 hospitals participating in CALNOC's benchmarking registry. Data included 33,425 doses from 333 observation studies on 157 adult acute care units. Results reveal that the most common MA safe practice deviations were distraction/interruption (22.89%), not explaining medication to patients (13.90%), and not checking two forms of ID (12.47%). The most common MA errors were drug not available (0.76%) and wrong dose (0.45%). The overall percentage of safe practice deviations per encounter was 11.40%, whereas the overall percentage of MA errors was 0.32%. Findings predict that for 10,000 MA encounters, 27,630 safe practice deviations and 770 MA errors will occur. A 36% reduction in practice deviation per encounter prevents 4.4% MA errors. Ultimately, reliably performing safe practices improves MA accuracy.

The use of a standard design medication room to promote medication safety: organizational implications

Medication administration is one of the most potentially dangerous tasks in hospitals. In recent years, the medical establishment has gained insight into the importance of environmental and ergonomic factors on patient safety. Limited data are available on how a standard designed medication room (MR) supports safety medication administration. Proactive observations were conducted at a tertiary care facility, the Hadassah University Medical Center, Jerusalem, Israel, to determine if safety principles were being implemented in the medication preparation and storage environment. These observations revealed that no designated MRs existed in the hospitals wards and safety systemic weaknesses in medication preparation. Guidelines for planning and designing MRs, based on safety and human engineering principles, were established to promote safer medication administration in hospital wards. The purpose of the survey was to compare the implementation of safety principles among hospital wards before and after MR renovation and among hospital wards with and without a MR. Structured observations in medication preparation areas and storage were designed. Selected safety indicators were measured (e.g. ordering and labeling; storage of intravenous infusions). Each category was subdivided into indicators that were design dependent only (DD), design and behavior dependent (DBD) and behavior dependent only (BD). Indicators that were both DD and DBD showed significant improvement before and after renovation of MRs. Most of the results were not significant for BD indicators. A similar trend was observed in departments with and without a MR. A trend of improvement could be seen in BD-positive indicators, regardless of the presence or absence of a dedicated MR. A standard design MR can improve environmental aspects of safety medication administration.