Medication Administration Process Research Articles

A Microlearning-Based Self-directed Learning Chatbot on Medication Administration for New Nurses: A Feasibility Study.

New nurses must acquire accurate knowledge of medication administration, as it directly affects patient safety. This study aimed to develop a microlearning-based self-directed learning chatbot on medication administration for novice nurses. Furthermore, the study had the objective of evaluating the chatbot feasibility. The chatbot covered two main topics: medication administration processes and drug-specific management, along with 21 subtopics. Fifty-eight newly hired nurses on standby were asked to use the chatbot over a 2-week period. Moreover, we evaluated the chatbot's feasibility through a survey that gauged changes in their confidence in medication administration knowledge, intrinsic learning motivation, satisfaction with the chatbot's learning content, and usability. After using the chatbot, participants' confidence in medication administration knowledge significantly improved in all topics (P < .001) except "Understanding a concept of 5Right" (P = .077). Their intrinsic learning motivation, satisfaction with the learning content, and usability scored above 5 out of 7 in all subdomains, except for pressure/tension (mean, 2.12; median, 1.90). They scored highest on ease of learning (mean, 6.69; median, 7.00). A microlearning-based chatbot can help new nurses improve their knowledge of medication administration through self-directed learning.

Medication administration errors in the selected Czech hospitals: an observational study

Abstract Aim. The study aimed to identify the occurrence of medication administration errors in clinical practice. Material and methods. This was a direct observational study. The study included observing the medication administration process over three years in four hospitals in the Czech Republic. STROBE was used as a checklist. Results. A total of 18,370 medication administrations to hospitalized patients were observed and recorded, including morning, noon, and evening administrations. The most common MAE was substituting a prescribed medication without the doctor’s consent, especially among nurses aged 35-44 (p &lt; 0.001). These MAEs involved giving a medication of diff erent strength than prescribed (p &lt; 0.001), giving the wrong medication (p &lt; 0.001), and giving a diff erent dose (p &lt; 0.001). Substitutions of MAEs occurred most often during morning medication administration (p &lt; 0.001). Conclusions. A critical fi nding of this study was the substitution of medications without a doctor’s consent. It has been found that MAEs were not uncommon in clinical practice, and factors such as the nurse’s age, overall length of clinical practice, education, and workplace interruptions played a role.

Knowledge, Attitude, and Behavior toward Medication Error in Saudi Arabia

Medication errors are a significant cause of adverse events, with knowledge, attitudes, and behavior (KAB) being key factors. Nurses play a crucial role in the medication administration process and should be proactive in preventing medication errors. This article is based on the author's dissertation research on the influence of nurses' knowledge, attitude, and behavior toward medication errors on medication errors reported. In this article, the author focuses on the comparison of the mean ranks of KAB scores towards medication errors in relation to nurses' socio-demographic and professional characteristics. The researchers utilized a descriptive correlational design with a cross-sectional survey to examine the relationship between variables. Knowledge scores towards medication errors in relation to nurses' socio-demographic and professional characteristics show that there is no significant difference found in the mean ranks of knowledge scores across any of these characteristics. However, both attitude and behavior scores towards medication errors were significantly higher among female nurses, non-Saudi nurses, nurses with education in intravenous drug administration, and nurses of more than 40 years of age in attitude score. Knowledge influences attitude, as nurses who have a deep understanding of the subject matter are more likely to have positive attitudes towards their patients, their colleagues, and their work. Attitude, on the other hand, influences behavior. It is understood that nurses who have positive attitudes are more likely to behave in a professional and ethical manner.

Medication administration competency for clinical preparedness: Comparing testing modalities and test anxiety in undergraduate nursing students

BackgroundAdverse drug events, which occur at various stages of the medication preparation and administration process, cause over half a million injuries or deaths yearly. Upon graduation, prelicensure nursing students lack the skill and competency required for safe medication administration. Therefore, it is essential to ascertain their medication administration proficiency throughout their curriculum prior to participation in clinical experiences. Historically, this has been a deeply embedded process of high-stakes testing. Aligned is cognitive test anxiety which can severely limit a student's performance. Thus, nursing student competency and control appraisal in medication administration can be linked to the Control Value Theory framework. ObjectivesThe purpose of the research was to determine whether an e-simulated high-stakes medication administration test was associated with less anxiety than a standard high-stakes medication math assessment within and between two nursing tracks over three semesters to capture sequencing of medical-surgical clinical courses. DesignThe prospective, quantitative, longitudinal study received Institutional Review Board approval. Participants/settingStudents were recruited from a traditional BSN track and an online LPN-to-BSN track per course level over three semesters. MethodsParticipants completed the State-Trait Anxiety Inventory prior to their course level high-stakes assessment modality. ResultsFor both tracks, testing anxiety remained a factor with no significant difference in the anxiety level between assessment modalities. There was a trend for anxiety scores to slightly decrease over time with each testing modality, but results were non-significant. There was a trend for traditional BSN students (n = 435) to have slightly lower anxiety scores than the LPN-to-BSN (n = 246) students. ConclusionsResearchers must continue investigating teaching, learning, and testing modalities in medication calculation/administration that maintain rigor, enhance student self-efficacy, and provide accurate assessment. These can be aligned with research regarding study skills training and cognitive-behavioral interventions to help mitigate the challenge of cognitive test anxiety.

Identification of Potential Causes for Increased Central Line Associated Bloodstream Infection Rates in the NICU

The University of Utah Newborn Intensive Care Unit (UUNICU) has seen a recent increase in rate of Central Line Associated Bloodstream Infection (CLABSI) after an extended period of 965 days with no CLABSI’s. Unfortunately, in the last three years, infection rate has been on average 2.6 CLABSI per year. The goal of this study was to identify potential contributing factors leading to this substantial increase. To conceptualize these factors, we focused on the emergence of safety conflicts during the intravenous medication administration process. A safety conflict was defined as an interference between two separate pathways designed to protect the integrity of patient care (a ‘safety pathway’). A total of 30 structured health care worker observations of the intravenous medication administration process were conducted. Data analysis shows a notable increase in safety conflict frequency, and necessary LCs as the number of medications per administration event increases. Conversely, the average duration of a single vs. two medication administration events does not significantly increase, which indicates substantial batching of tasks. This batching increases the likelihood of safety conflicts, negatively affecting patient safety.

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.

The prevalence and perceived effectiveness of using a medication-swallowing lubricant in aged care facilities across Australia.

To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that "it is effective method to facilitate medication swallowing in residents." The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)-approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.

Prescribing Practices at a Residential Treatment Center – from Paper to Plastic (Computers)

ABSTRACT Medication prescription procedures were reviewed at psychiatric residential treatment centers (RTC), and a quality improvement project was conducted in order to implement integrated electronic medical records (EMR) and computerized provider order entry (CPOE). To assess the impact of preexisting prescribing practices on RTCs, surveys were sent anonymously to current and past providers of regional and local RTCs. The surveys assessed the impact of the prescribing protocol on workflow, the frequency of medication errors, the impact such errors had on patient care, the overall provider satisfaction, and the discrepancies between electronic and paper charts. Current providers were then re-surveyed after implementing the integrated CPOE system in May 2020, during the COVID-19 pandemic. The first round of provider survey results revealed that the majority of staff (n = 10, 70%) observed frequent medication errors and were largely dissatisfied with the current medication ordering and administration process (n = 10; 70%). Incident Response Improvement System (IRIS) reports revealed the most common medication errors were omissions, incorrect dosing, and incorrect medications administered. After the initiation and implementation of the CPOE, staff satisfaction increased with the process (n = 14; 50%) noting that medication errors were less frequent than before (n = 14; 50%).

Implementation of barcode medication administration (BMCA) technology on infusion pumps in the operating rooms

BackgroundMedication administration errors (MAEs) are a major cause of morbidity and mortality. An updated barcode medication administration (BCMA) technology on infusion pumps is implemented in the operating rooms to automate...

Effects of workload on medication administration errors in nursing: an analysis based on system dynamics modeling

Medication administration errors account for a relatively high proportion of medical errors, with more than 50% occurring at the nursing administration stage. Nursing is characterized by a large amount of work, rigid working hours, high information cognitive intensity, and frequent information updates. The high workload of nurses is a significant cause of medication administration errors. In this study, a literature analysis was used to determine the elements of the system dynamics model, and the causal loop diagram was used to draw the relationship framework among the elements. Vensim personal learning edition and interview surveys were then used for model validation and simulation. First, 302 case analyses of medication administration errors collected from the three metropolitan area hospitals were used to construct the causal loop diagram, the stock and flow map of the medication administration error system, and the dynamics model; second, the model was tested from theoretical and historical data simulation perspectives; finally, the system dynamics model proposed in this study was used to simulate a medical institution from overtime and policy perspectives. Through system dynamics modeling, the inducing mechanism of workload on medication administration errors in nursing operations was elucidated, and corresponding suggestions for prevention were provided. In addition, ideas and basis for optimizing the medication administration process, improving workload, and preventing medication administration errors considering workload were provided.

Residual Infusion Performance Evaluation (RIPE): A Single-Center Evaluation of Residual Volume Post-Intravenous Eravacycline Infusion.

Intravenous (IV) drugs are administered through infusion pumps and IV administration sets for patients who are seen in healthcare settings. There are multiple areas of the medication administration process that can influence the amount of a drug a patient receives. For example, IV administration sets that deliver a drug from an infusion bag to a patient vary in terms of length and bore. In addition, fluid manufacturers report that the total acceptable volume range for a 250 mL bag of normal saline can be anywhere from 265 to 285 mL. At the institution chosen for our study, each 50 mg vial of eravacycline is reconstituted using 5 mL of diluent, and the total dose is administered as a 250 mL admixture. This single-center, retrospective, quasi-experimental study evaluated the residual medication volume after the completion of an IV eravacycline infusion in patients admitted during the pre-intervention study period compared to those in the post-intervention study period. The primary outcome of the study was to compare the residual antibiotic volume remaining in the bags following IV infusions of eravacycline before and after the implementation of interventions. The secondary outcomes included the following: comparing the amount of the drug lost in the pre- and post-intervention periods, determining whether the amount of residual volume was affected by nursing shifts (day versus night), and lastly assessing the cost of facility drug waste. On average, approximately 15% of the total bag volume was not infused during the pre-intervention period, which was reduced to less than 5% in the post-intervention period. Clinically, the average estimated amount of eravacycline discarded decreased from 13.5 mg to 4.7 mg in the pre- and post-intervention periods, respectively. Following the statistically significant results of this study, the interventions were expanded at this facility to include all admixed antimicrobials. Further studies are needed to determine the potential clinical impact when patients do not receive complete antibiotic infusions.

Medication errors and associated factors among pediatric inpatients in public hospitals of gamo zone, southern Ethiopia

BackgroundMedication errors are the most common medical errors in the world. In particular, pediatric patients are more susceptible to severe injuries and death. Despite their multidimensional impact, medication errors are not recognized well in developing nations, including Ethiopia. Thus, this study aimed to assess the prevalence of medication errors and associated factors among pediatric inpatients in public hospitals of Gamo zone, southern Ethiopia. MethodsA facility-based cross-sectional study was conducted among 416 pediatric inpatients from August 1, 2020, to February 30, 2021. Open data kit tools and Stata version 16.0 were used for data collection and analysis, respectively. Bivariable and multivariable analyses were performed to identify factors associated with medication errors. An adjusted odds ratio with a 95% confidence interval was computed and a P-value of <0.05 in the multivariable analysis was set to declare statistical significance. ResultsOverall, 69.5% (95% CI: 64.80, 73.86) of pediatric inpatients experienced medication errors. Unsuitable working environment (aOR: 2.40, 95% CI: 1.48, 3.91), child weight <5 Kg (aOR: 3.72, 95% CI: 1.79, 7.73), medication administered by diploma professionals (aOR: 2.10, 95% CI: 1.31, 3.36), parent involvement (aOR: 0.55, 95% CI: 0.33, 0.95), non-adherence with medication administration rights (aOR: 2.68, 95% CI: 1.32, 5.44) and hospital stay for >5 days (aOR: 1.83, 95% CI: 1.15, 2.93) were significantly associated with medication errors. ConclusionMedication errors were high among pediatric inpatients as compared to previous national studies. To reduce the occurrences of medication errors, it is critical to create a suitable working environment, arrange education and training opportunities for providers, involve families in the medication administration process, and strictly adhere to medication administration rights.

Addressing anesthesia medication errors for improved quality care

Medication errors in anesthesia can have serious consequences for patients, including morbidity and mortality. These errors can occur at any stage of the medication administration process, from prescribing and preparation to administration and monitoring. Learning from medication errors is essential to improving patient safety in anesthesia. To address medication errors in anesthesia, various strategies have been developed, including the use of checklists, protocols, and simulation training. The implementation of technology, such as barcode scanning and automated dispensing systems, has also been effective in reducing medication errors. Learning from medication errors involves identifying the root causes of the error, analyzing the factors that contributed to the error, and implementing strategies to prevent similar errors from occurring in the future. A culture of safety that encourages reporting and analysis of errors is crucial for learning from medication errors. Improving patient safety in anesthesia requires a collaborative effort among healthcare professionals, including anesthesiologists, nurses, and pharmacists, as well as a commitment to continuous improvement through learning from errors.

Using objective structured clinical examination to teach medication rights in undergraduate nursing education.

Clinical partner feedback identified insubstantial student preparation and limited understanding of safe medication administration process. Faculty initiated a new teaching and evaluation approach to prepare students for safe medication administration processes in the practice setting. The teaching method is a synthesis of situated cognition learning theory that emphasizes use of deliberate practice case scenarios in low fidelity simulation. Objective Structured Clinical Examination (OSCE) evaluates student critical thinking and application of the medication rights administration process. Data collection includes first and second attempt OSCE pass rates, occurrence of incorrect answers, and student feedback regarding the testing experience. Findings include a greater than 90% pass rate on first attempt, 100% pass rate on second attempt, and positive testing experience. Faculty now use situated cognition learning methods and OSCE in one course within the curriculum.

Knowledge of the administration of medications among undergraduate nursing students in selected clinical sites in Kenya

BACKGROUNDMedication administration is one of the critical competencies in nursing to ensure patient safety. Globally, a lack of competence in medication administration has been associated with high morbidity and mortality rates and poor patient outcomes. This study focused on assessing knowledge of medication administration among undergraduate nursing students.MATERIALS AND METHODSThis descriptive cross-sectional study was conducted between June and August 2021 in two County Referral Hospitals in Kenya. The study aimed to establish the level of knowledge on medication administration among second-year nursing students starting their clinical rotations, mainly in the medical/surgical wards. The census method was used to recruit 147 participants based on the pre-defined inclusion criteria. The data was collected using a pretested interviewer-administered knowledge questionnaire based on the World Health Organization (WHO) training curriculum on medication safety. The data was then cleaned, coded and analysed using SPSS version 26. Descriptive and inferential statistics were used to summarise and compare the results.RESULTSThe average score for the medication administration knowledge was 64.8 %, S.D=5.8. The highest score was 79%, whereas the lowest was 43 %. Poor performance was noted in five of the six categories of medication administration, whereby the total number of participants who passed the knowledge assessment with a score of 70% and above was 43 (29.3%) per the international recommendations. The proportion of those who passed differed significantly from those who failed the knowledge assessment, χ2 (1, n=147) =25.31, p&lt;0.05. The results of one sample chi-square test indicated that most students failed the knowledge assessment in the various categories (p&lt;0.05).CONCLUSION AND RECOMMENDATIONSThe pass mark for high-risk skills such as medication administration is 70%. Therefore, the participants’ knowledge was below the recommended pass mark. Nurse educators must identify the gaps in teaching and consider including the WHO medication safety curriculum guidelines and teaching strategies in the existing institutional undergraduate nursing curriculums to enhance the medication administration process and patient safety.

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.

How do medication errors occur in the nursing communication process? Investigating the relationship between error types and error factors.

Human error types and error factors are two important elements of error analysis. Understanding the relationship between them can contribute to new case analyses, the tendency of error occurrence statistics, error factor identification, and prevention of error recurrence. To provide evidence and guidance for the prevention and improvement of medication communication errors by quantitatively exploring the relationship between error types and error factors. Data were collected on self-reported errors in the medication administration process by nurses in all departments of three cooperative medical institutions, and an error sheet of specified style was adopted. Error types were determined by the systematic human error reduction and prediction approach method and human cognition processes. Error factors were extracted using the root cause analysis combined with Berlo's communication model, and the relationship between error types and error factors was quantitatively studied using the partial least-squares regression method. After a one-by-one analysis of 303 error cases, the communication errors occurring in the nursing medication process could be explained by six error types and 12 error factors. In addition, 20 correlation patterns between the error types and error factors were quantitatively obtained, and their path coefficient distributions ranged from 0.088 to 0.467. The results of this study may provide reference to understand errors and establish countermeasures from the statistics of error occurrence trends, extract error factors related to error types and determine key error factors.

Team training program’s impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol

IntroductionMedication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing...

Barcode Medication Administration Technology to Prevent Medication Errors.

Medication errors cause harm to patients at any point along the medication administration process and can be prevented. Barcoding medication administration (BCMA) is effective as a clinical decision support system (CDSS) to avoid errors. This viewpoint proposes the implementation of BCMA to avoid potential adverse events. The opinion piece gives an overview of BCMA, reviews the current literature on its effectiveness, and sheds light on the associated challenges and how to overcome them. The objective of this article is to increase awareness regarding BCMA and how it can decrease patient morbidity and mortality, enhance safety, and lower overall hospital-associated costs by preventing medication errors. Key Words: Bar-code medication administration, Medication errors, Adverse drug events, Patient safety.

Barcode Medication Administration Technology to Prevent Medication Errors.

Medication errors cause harm to patients at any point along the medication administration process and can be prevented. Barcoding medication administration (BCMA) is effective as a clinical decision support system (CDSS) to avoid errors. This viewpoint proposes the implementation of BCMA to avoid potential adverse events. The opinion piece gives an overview of BCMA, reviews the current literature on its effectiveness, and sheds light on the associated challenges and how to overcome them. The objective of this article is to increase awareness regarding BCMA and how it can decrease patient morbidity and mortality, enhance safety, and lower overall hospital-associated costs by preventing medication errors. Key Words: Bar-code medication administration, Medication errors, Adverse drug events, Patient safety.