Medication Administration Practices Research Articles

Improving the quality of medication administration practices in a tertiary Australian hospital: a best practice implementation project.

Medication safety is an important health priority that focuses on preventing harm from medication-related events. Unsafe medication administration practices can lead to errors, which can cause avoidable injury (or harm) to patients. This paper reports on an evidence implementation project conducted in a large tertiary hospital in Australia to improve nursing compliance with best practice recommendations for medication administration. The project was guided by JBI's seven-phase approach to evidence implementation, using audit and feedback and a structured framework to identify barriers, enablers, and implementation strategies. The project resulted in improved compliance with best practice recommendations. This was achieved through multimodal strategies, including education, improved access to resources, and targeted feedback and discussion sessions to encourage culture and behavior change. The project improved nurses' medication administration practices, specifically in performing independent second checks. Collaborative efforts of the project leads facilitated the review of medication administration policy and the development of staff education resources. Patient engagement remains an area for improvement, along with the potential need for further ongoing medication education. http://links.lww.com/IJEBH/A237.

Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study.

Medication administration errors significantly impact patient safety, potentially leading to severe harm or fatality. Reporting such errors through active systems improves medication administration, thereby enhancing patient safety and the quality of care. However, in the context of Saudi Arabia, little is understood about the causes of medication administration errors and the obstacles hindering their reporting. This study aimed to explore nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. The study employed a qualitative descriptive design, conducting face-to-face semi-structured interviews with 43 nurses from three hospitals in Taif Governorate, Saudi Arabia, between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis. The following themes emerged regarding the causes of medication administration errors: order deficiencies, high workloads and staff shortages, and malpractice. Regarding the barriers to reporting errors, the emerging themes were fear of punishment and lack of support, lack of knowledge and awareness about reporting, and lack of feedback. This study reveals nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. Recognizing and addressing these causes and barriers are essential for patient safety and the improvement of the healthcare environment. Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions. Additionally, supportive mechanisms, such as feedback systems and resources for professional development, should be implemented to empower nurses to actively participate in error reporting and contribute to continuous improvement in medication administration practices.

Central and Peripheral Medication Administration Practices in Pediatric Patients.

Central and Peripheral Medication Administration Practices in Pediatric Patients.

Registered nurses' knowledge and practice of preoperative fasting and medication administration.

Knowledge of fasting or Nil Per Os (NPO) guidelines is an essential component of nursing care in the preoperative period. To describe registered nurses' (RNs) knowledge and management of the preoperative NPO period. Selected surgical wards in a tertiary hospital in the Western Cape, South Africa. Quantitative descriptive, cross-sectional study utilising a structured questionnaire. The population consisted of RNs working in selected surgical wards. Convenience sampling was used and adequate knowledge was determined as ≥ 90%. The response rate was 100%. Of the 68 participants, 48 (70.6%) held a diploma and 20 (29.4%) held a degree as the highest academic qualification achieved. Sixty-one (89.7%) participants knew the correct reason for keeping patients NPO. Sixty-five (95.6%) knew the correct answer for the NPO time for solids while only 27 (39.7%) knew the correct answer for clear fluids. Only 30 (44.1%), 26 (38.2%) and 33 (48.5%) participants, respectively, answered the questions about oral analgesia, oral antibiotics and chronic medication administration during the NPO period correctly. Significantly more degree participants knew the correct answer for the fasting time for non-human milk (p = 0.005) and more diploma participants would administer chronic medication during the NPO period (p = 0.037). Inadequate knowledge of NPO times for various fluids and unsatisfactory practice of medication administration for oral and chronic medication require attention. This study highlights the importance that ongoing education is needed to ensure that patients receive the most up-to-date evidence-based care during the NPO period.

Medication errors by caregivers in the homes of children discharged from a pediatric department in Ghana.

Medication errors (MEs) by caregivers at home are a cause of morbidity and mortality, shortly after discharge from the hospital. The objective of this study was to determine the rate and types of MEs at the homes of children discharged from a hospital in Ghana and to explore the factors associated with these errors. This was a cross-sectional study of infants and children discharged from the hospital to review medication administration practices. Caregivers of children discharged from the hospital after at least 24 hours of admission were interviewed at their homes about medication administration practices. The study assessed potential harm associated with MEs made by caregivers using the Harm Associated with Medication Error Classification tool. The Least Absolute Shrinkage and Selection Operator regression were used to identify the variables associated with MEs. A total of 95 children (mean age: 28.6 months, 52.6% female) and their caregivers were included. Overall, 65 (68.4%) children experienced one or more MEs. Out of a total of 232 medications reviewed, 102 (44.0%) (95% CI: 37.6-50.4) were associated with a ME. The top two errors, wrong time errors and errors in the frequency of dosing were, 45.1% and 21.6%, respectively. Understanding the information on the disease condition being treated and the medicines dispensed was associated with committing fewer MEs. The number of medicines prescribed was associated with a higher likelihood of MEs. Out of 102 MEs, 48 (47.1%) were assessed as posing potentially no harm, 26 (25.5%) minor harm, 15 (14.7%) moderate harm, and 13 (12.8%) serious harm to the patients. Importantly, none of the MEs were assessed as posing potentially severe or life-threatening harm to the patients. MEs in children following discharge are high, and systems should be developed to prevent these errors.

Life cycle assessment of pharmaceutical and clinical packaging required for medication administration practices

PurposeDigital closed-loop medication administration (CLMA) is a prime example of how digitalization in healthcare can reduce time and costs while simultaneously increasing patient safety. However, in contrast to its social and economic benefits, associated environmental impacts have never been investigated. Since the required amount of packaging material is seen as a major subject of criticism, we assess associated environmental burdens using life cycle assessment (LCA) methodology to identify hotspots and provide adaptation recommendations.MethodsDigital, as well as conventional paper-based medication management (PBMM), involve two types of packaging: pharmaceutical packaging (blisters or bottles), containing purchased medication, and clinical packaging (unit doses or medical dispensers) for medication dispensation. Therefore, a cradle-to-grave life cycle model was established comparing impacts at pharmaceutical packaging level, clinical packaging level, and a combined level. While PBMM requires small, blistered boxes, CLMA requires large, bottled packages. Therefore, the functional unit allows to compare different box sizes but inhibits comparing medication from different manufacturers. Primary data is obtained from University Medical Centre Hamburg-Eppendorf which practices state-of-the-art CLMA. PBMM data is obtained in three dispenser scenarios, varying the reusability of medical dispensers. The life cycle impact assessment was performed for five impact categories using CML 2001(2016) method.Results and discussionAll compared blistered pharmaceutical packaging options yield higher impacts than their bottled counterparts. Cardboard and package inserts result in up to 40 times higher impacts for blisters than for bottles, which, however, is attributed to the methodology of comparing different box sizes. Yet, this does not influence the required amount of blister laminate. All blister materials were found to result in higher environmental burdens, peaking in nearly 240 times higher ozone depletion impacts for polyvinylchloride/polychlorotrifluoroethylene blisters. In terms of clinical packaging, two of three dispenser scenarios result in higher environmental burdens than the respective unit dose scenario. Only if reused, 7.2 times this trend is reversed. When combining selected impacts from both pharmaceutical and clinical impacts, all three dispenser scenarios perform worse than the unit dose scenario.ConclusionsPackaging impacts are lowest if unit dose dispensation is combined with bottled pharmaceutical packaging. Given a specific pharmaceutical packaging, dispensation via medical dispensers may perform better, if they are comprehensively reused. With this study, the authors disproved that packaging impacts are generally higher for CLMA than for PBMM. However, both systems certainly comprise other processes and materials like consumed paper or energy to run required digital infrastructure, which should be subject to future studies.

Implementing a medication lubricant for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles

BackgroundPill dysphagia, the difficulty in swallowing solid oral medications, is a common problem that can affect medication adherence and increase pill modifications. Current practices of crushing medications or using food...

Knowledge, attitudes, and practices toward over-the-counter antipyretics among fever patients: a cross-sectional study in the context of a policy change KAP of OTC antipyretics.

On January 8, 2023, a change in the control policy for COVID-19 was implemented in China, whereby patient self-management of fever typically entails the utilization of over-the-counter fever-reducing medications. This study aimed to investigate the knowledge, attitudes, and practices (KAP) toward over-the-counter (OTC) antipyretics among fever patients. This cross-sectional study was conducted between October 2022 and February 2023 at author's hospital in Wuhan, China, among fever patients on OTC antipyretics, using a self-administered questionnaire. A total of 481 valid questionnaires were collected, with the age of 36.05 ± 12.10 years, including 240 (49.90%) males, and 209 (43.45%) collected before policy change. The knowledge, attitudes, precautions for medication administration and decision-making practices scores were 6.86 ± 3.30 (possible range: 0-12), 16.67 ± 2.46 (possible range: 7-35), 29.98 ± 5.41 (possible range: 7-35) and 27.87 ± 1.28 (possible range: 8-40), respectively. The multivariable logistic regression analysis showed that knowledge (OR = 0.83, 95%CI: 0.81-0.92, p < 0.001) was independently associated with positive attitude. Knowledge (OR = 1.41, 95%CI: 1.28-1.56, p < 0.001), attitude (OR = 0.87, 95%CI: 0.79-0.95, p = 0.004), suburban (OR = 0.45, 95%CI: 0.23-0.88, p = 0.019) were independently associated with proactive precautions for medication administration practices. Knowledge (OR = 1.14, 95%CI: 1.07-1.22, p < 0.001), attitude (OR = 0.90, 95%CI: 0.82-0.98, p = 0.018), responding after policy change, 2023 (OR = 1.70, 95%CI: 1.10-2.63, p = 0.016) were independently associated with proactive decision making practices. Fever patients had moderate knowledge, negative attitude, proactive precautions for medication administration practices, moderate decision-making practices. After the policy change, there was a significant increase in knowledge regarding medication administration precautions and decision-making.

Barriers and enablers for safe medication administration in adult and neonatal intensive care units mapped to the behaviour change wheel.

Intensive care settings have high rates of medication administration errors. Medications are often administered by nurses and midwives using a specified process (the '5 rights'). Understanding where medication errors occur, the contributing factors and how best practice is delivered may assist in developing interventions to improve medication safety. To identify medication administration errors and context specific barriers and enablers for best practice in an adult and a neonatal intensive care unit. Secondary aims were to identify intervention functions (through the Behaviour Change Wheel). A dual methods exploratory descriptive study was conducted (May to June 2021) in a mixed 56-bedded adult intensive care unit and a 6-bedded neonatal intensive care unit in Sydney, Australia. Incident monitoring data were examined. Direct semi-covert observational medication administration audits using the 5 rights (n = 39) were conducted. Brief interviews with patients, parents and nurses were conducted. Data were mapped to the Behaviour Change Wheel. No medication administration incidents were recorded. Audits (n = 3) for the neonatal intensive care unit revealed no areas for improvement. Adult intensive care unit nurses (n = 36) performed checks for the right medication 35 times (97%) and patient identity 25 times (69%). Sixteen administrations (44%) were interrupted. Four themes were synthesized from the interview data: Trust in the nursing profession; Availability of policies and procedures; Adherence to the '5 rights' and departmental culture; and Adequate staffing. The interventional functions most likely to bring about behaviour change were environmental restructuring, enablement, restrictions, education, persuasion and modelling. This study reveals insights about the medication administration practices of nurses in intensive care. Although there were areas for improvement there was widespread awareness among nurses regarding their responsibilities to safely administer medications. Interview data indicated high levels of trust among patients and parents in the nurses. This novel study indicated that nurses in intensive care are aware of their responsibilities to safely administer medications. Mapping of contextual data to the Behaviour Change Wheel resulted in the identification of Intervention functions most likely to change medication administration practices in the adult intensive care setting that is environmental restructuring, enablement, restrictions, education, persuasion and modelling.

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.

Competence and Stress of Medication Administration Practices for School Nurses in K-12 Taiwan Schools.

We investigated school nurses' experiences, perceived government support, school nurses' acceptance of responsibility for medication administration, perceived stress, and perceived competence of medication administration and analyzed factors associated with perceived competence. In this cross-sectional study, from February to April 2023, we conducted an online survey of 269 school nurses serving at K-12 schools in Taiwan. The results revealed that although 71% of the participants had prior experience with medication administration, they reported low competence and high stress in areas such as drug interactions, adverse drug effects, and referrals. The school nurses' disagreement with responsibilities for medication administration emerged as the only factor to be significantly associated with perceived medication administration competence, accounting for 22.8% of the variance. We recommend implementing continuing training programs to provide school nurses with up-to-date medication information. Additionally, the development of practice guidelines is suggested as a means of enhancing nurses' competence and reducing their stress levels for the administration of medications.

Nighttime medication administration and patient perception of sleep in the intensive care unit

AbstractIntroductionEnvironmental, patient, disease, and care‐related factors can lead to sleep disruption in the intensive care unit (ICU). Medication administration is a potentially modifiable factor in this setting that has not been well described as a target for sleep improvement.ObjectivesTo determine characteristics of nighttime medication administration practices in the ICU, evaluate the effect on patient perceived sleep, and assess the opportunity for pharmacist‐led nighttime medication administration stewardship.MethodsThis was a multicenter, retrospective, observational cohort study. Patients included for chart review had perceived sleep measured using the Richards‐Campbell Sleep Questionnaire (RCSQ). Data were collected on patient characteristics, ICU exposures, and nighttime medications administered. Four RCSQ groups defined for comparison were RCSQ 0–25 indicating “very poor” sleep, 26–50 “poor” sleep, 51–75 “good” sleep, and 76–100 “very good” sleep.ResultsOverall, 115 patients with RCSQ assessments and 435 nighttime medication administrations were included. Nighttime medications were most commonly cardiovascular (28.9%) and central nervous system (21.4%) agents, administered via intravenous (54.5%) and oral (22.7%) routes. Patient characteristics were comparable between the four groups except for history of head trauma. Patients reporting very poor sleep had a significantly higher median number of nighttime medications administered as compared to patients reporting very good sleep (4.0 [interquartile range (IQR) (2, 6)] vs. 2.5 [IQR 1, 4], adjusted p = 0.048). Approximately three‐quarters of nighttime medications occurred between the hours of 22:00–0:59 and 5:00–5:59. Nearly 40% of nighttime medications could have been retimed for daytime administration.ConclusionsUnnecessary nighttime medication administration is common and associated with poor patient perceived sleep in the ICU. Pharmacists are well‐positioned to evaluate timing of medication administration and cluster medication‐related care for daytime hours, when appropriate. Nighttime medication stewardship optimization by pharmacists is an opportunity to improve patient perceived sleep in the ICU.

Medication administration evaluation and feedback tool: Longitudinal cohort observational intervention

Background Medication administration by nurses is a complex task requiring multiple steps to ensure patient safety. A medication administration evaluation and feedback tool (MAEFT) incorporating self-assessment, direct observation, and feedback has been developed and tested previously for reliability. Aim To describe nurses’ medication administration practice when followed up with self and peer evaluation and feedback using the MAEFT. Methods Four nurse evaluators were trained to use the MAEFT. Twenty-eight nurses participated in the study to be observed administering medications in the clinical setting. The initial observations were conducted over four weeks, with follow-up four months later. The MAEFT contains 22 criteria, against which the nurses were evaluated. For each criterion, an evaluation of whether it was performed (“yes” or “no”) was made. The overall score was calculated as a percentage of the number of criteria performed. Findings There was a high standard of criteria performed, with median overall observer scores of 95% at time 1 and 94% at time 2. Criteria not performed demonstrated 71 potential medication errors at time point 1, with only 33 at time point 2. Discussion There was no difference in nurses’ practice using the MAEFT when followed up, but there was no baseline control to determine the current practice before using the MAEFT. However, there was a reduction in the number of medication errors. Conclusion Nurses’ medication administration practice standards remained high when followed up with self and peer evaluation and feedback using the MAEFT. More criteria were checked during the follow-up evaluation.

Critical Care Nurse’s Practice Regarding Medication Administration Safety in Intensive Care Units at Governmental Hospitals in Gaza Strip

Background: Administration of medications is primarily the nurse’s responsibility. This study aimed to assess intensive care nurses’ practice of safe medication administration in governmental hospitals in the Gaza Strip. Methods: This study utilized descriptive, cross-sectional, analytical design. The sample of the study consisted of 116 ICU nurses from five governmental hospitals (Al Shifa Hospital, Indonesy Hospital, Shohada Al Aqsa hospital, European Gaza Hospital, and Nasser Hospital). For data collection, the researcher used Patient Safety Assessment in Medication Administration Questionnaire and Observation Checklist. A pilot study was conducted on 20 nurses, and reliability of the Patient Safety Assessment in the Medication Administration Questionnaire was 0.908. Results: The results showed that 66.4% of study participants were male nurses and 33.6% were female nurses, mean age was 28.97 years, 85.4% have bachelor degree, mean experience was 4.18 years, mean income was 1431.64 New Shekel, and 67.2% are working mixed shifts (morning, evening, and night). The practice of safety medication administration indicated that the highest score was in right route (93.8%), the right time (91.8%), right patient (90.7%), right way (89.5%), right recording of administered medication (88.9%), right answer (86.7%), right guidance (86.5%), right dose (86%), right medication (85.3%), and the overall score was 88.6%. Also, observation of nurses indicated high practice of safe medication administration with an average score of 83.6%. There were statistically insignificant differences in the practice of safe medication administration related to the hospital, gender, qualification, age, experience, and income. Conclusion: The study concluded that intensive care nurses handling medication safely at a moderate level and more. The authors demonstrated the need to provide adequate number of qualified nurses in Intensive Care Units, and encouraged nurses to participate in training programs about safe medication preparation and administration.

Pharmacy practice in hospital settings in GCC countries: Dispensing and administration

PurposeTo outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries’ hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study. MethodsA modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. ResultsSixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps. ConclusionThe results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.

Improving Nursing Medication Administration Practice in Inpatient Units: A Quality Improvement Project

Background: Nurses play a unique and crucial role in medication administration. In hospital units, the medication administration process is frequently viewed as a series of sequential steps, beginning with prescribing, then dispensing, and finally administering to the patient. Local problem: Data from 2020 indicated improper nursing medication administration practices in the hospital's inpatient units, despite adherence to medication safety standards and policies, so the current project was created to improve nursing medication administration compliance. Methods: A quality improvement project was conducted using the Standards for Quality Improvement Reporting Excellence Revised Publication Guidelines (SQUIRE 2.0). Common quality improvement tools were used, including the fishbone diagram, Focus PDCA, and the General Medication Administration (GMA) instrument. Interventions: Staff audit interviews and observations, as well as engaging and educating processes, were conducted weekly. A final medication administration compliance assessment was performed on the staff. Results: The present project found high medication administration compliance and an excessive enhancement of awareness among nurses related to medication administration. Conclusion: This quality improvement project summarizes the steps of using quality improvement tools to find and treat improper medication administration practices. As is obvious, there has been improvement in nursing compliance.

Analýza podání léčiv ve vztahu k potravě a použitým nápojům u hospitalizovaných pacientů

Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.

Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events.

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

Medication administration errors made among undergraduate nursing students: A need for change in teaching methods.

Systems factors, such as interruptions, contribute to nursing errors. Gaining an understanding of what contributes to nursing student errors can inform educational strategies aimed to improve patient safety. The aims of this study were to investigate: (a) within-subjects differences in error rates among nursing students during interrupted compared to uninterrupted simulated medication administration, (b) types of medication administration errors made by nursing students, and (c) nursing students' perceptions of their ability to independently administer medication. A descriptive comparative within-subjects design was utilized in this two-site study. Data on errors were collected via direct observation. Senior baccalaureate nursing student participants discussed their experience of interrupted and uninterrupted simulated medication administration during individual debriefing sessions. Nearly one-third of participants made errors. Error rates were similar in interrupted (19.4%) and uninterrupted (16.7%) conditions. Near-misses, which were not included in the error rates, were reported by 8% of participants. The most common error types were documentation and dose errors. Students attributed the interruption and lack of independent medication administration practice as causes for errors. Educational programs must adequately prepare nursing students for independent safe medication administration in complex work environments. The inclusion of systems factors in educational modalities is critical.

Intravenous Smart Pumps at the Point of Care: A Descriptive, Observational Study.

ObjectiveThis study was conducted to advance understanding of intravenous (IV) smart pump medication administration practices using the Baxter Spectrum IQ. The primary objective was to observe adherence with manufacturer required IV smart pump system setup at the point of care during actual clinical use.MethodsThe study was conducted in a 285-bed acute care community hospital near Boston, Massachusetts. The study design was observational and noninterventional, and all data were collected by a single observer. Observations included measurement and documentation of adherence with the Baxter Spectrum IQ system setup requirements.ResultsA total of 200 primary and secondary IV medication administration observations were included: 101 in critical care and 99 in medical-surgical. Overall adherence was found to be: 6.5% with IV smart pump position relative to the patient (aim 1); 6.5% with required position of the primary infusion bag (aim 2); and 69.5% adherence with required position of the secondary medication infusion bag (aim 3). Additional exploratory data were also collected.ConclusionsThese results add to the emerging body of knowledge, which support that adherence to required system setup for head-height dependent IV smart pumps is low and difficult to achieve during actual clinical use. Consideration of alternative human factors–designed technology to replace the current manual setup requirements is needed to improve the process of acute care IV medication administration in this very important area of patient safety.