Occurrence Of Medication Administration Errors Research Articles

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 < 0.001). These MAEs involved giving a medication of diff erent strength than prescribed (p < 0.001), giving the wrong medication (p < 0.001), and giving a diff erent dose (p < 0.001). Substitutions of MAEs occurred most often during morning medication administration (p < 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.

Examining the factors that influence medication administration errors and the reporting of these among mental health nurses in the hospital setting: a systematic review

Background/Aims A medication administration error is defined as ‘any difference between what the patient received or was supposed to receive and what the prescriber intended in the original order’. Medication administration errors are associated with increased morbidity and mortality. They occur frequently in the mental health setting and pose a serious risk of patient harm. The factors leading to medication administration errors in the mental health care setting is under researched and the potential for mental health services to prevent harm from medication administration error is unknown. The aim of this study was to understand factors that influence medication administration errors, and the reporting of these, among mental health nurses in the mental health hospital setting. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (2015) checklist. A total of 3625 studies were identified, nine of which were included for final review. The CINAHL, Cochrane, EMBASE, Medline, Medline Ovid, Psych Info and PubMed databases were searched, as well as grey literature. Results Medication administration errors and their reporting are complex, multifaceted and show organisational and individual overlap. Heavy workload, staffing shortages, differing levels of experience, ward dynamics, lack of knowledge, interruptions, communication and patient interaction contributed to the occurrence of medication administration errors. Key factors included rationale on why not to report an error, lack of knowledge regarding how to report, what to report, as well as fear and stigma. Conclusions Many factors lead to the occurrence of a medication administration error or why they are not reported. More education is needed to help reduce medication administration errors. Further research may understand the behavioural patterns of mental health nurses and at-risk behaviour. This may help identify adequate interventions to reduce the risk of medication administration errors in this setting.

Medication administration error prevention among nurses working in intensive care units: A secondary analysis.

The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs. To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables. This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups. The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study. The findings show a difference between knowledge and attitudes in relation to cultural background. Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU.

Medication administration errors in the domain of infusion therapy in intensive care units: a survey study among nurses

BackgroundDespite extensive research carried out on medication administration errors (MAEs) in the domain of infusion therapy, there is limited knowledge on nurse’s perceptions on the occurrence of MAEs during infusion therapy. Since nurses are responsible for medication preparation and administration in Dutch hospitals, it is vital to understand their perspectives on the risk factors for MAEs.AimThe purpose of this study is to investigate the perception of nurses, working in adult ICUs, on the occurrence of MAEs during continuous infusion therapies.MethodsA digital web-based survey was distributed among 373 ICU nurses working in Dutch hospitals. The survey investigated nurses’ perceptions on the frequency, severity of consequences and preventability of MAEs, factors for the occurrence of MAEs, and infusion pump and smart infusion safety technology.ResultsA total of 300 nurses started to fill out the survey but only 91 of them (30.3%) fully completed it and were included in analyses. Medication-related factors and Care professional-related factors were perceived as the two most important risk categories for the occurrence of MAEs. Important risk factors contributing to the occurrence of MAEs included high patient-nurse ratio, problems in communication between caregivers, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on labels. Drug library was reported as the most important infusion pump feature and both Bar Code Medication Administration (BCMA) and medical device connectivity as the two most important smart infusion safety technologies. Nurses perceived the majority of MAEs as preventable.ConclusionsBased on ICU nurses' perceptions, the present study suggests that strategies to reduce MAEs in these units should focus on, among other factors, the high patient-to-nurse ratio, problems in communication between nurses, frequent staff changes and transfers of care, and no/incorrect dosage/concentration on drug labels.

Medication administration errors: A concept analysis.

To provide an analysis of the concept of medication errors that occur during the nursing task of medication administration. Medication errors occurring during medication administration have an increased risk for an adverse patient outcome. Many terms are associated with medication errors, with limited clarification for a medication administration error at the point of care delivery. Twenty-seven sources were chosen from database searches of PubMed, CINAHL, EMBASE, and Scopus. Key search terms used to narrow the search consist of the following terminology: ("bedside" OR "point-of-care" OR "nursing care*") AND "medication administration errors" AND ("acute care"). Rodger's evolutionary method of concept analysis was used to clarify the concept of medication administration error. The concept analysis identified three attributes of a medication administration error: nurse-provided care, administration, and point of care. Antecedents identified in the analysis are organizational factors and nurse factors. Consequences identified in the analysis are patient, nurse and organizational themes. The continued occurrence of medication administration errors warrants the need for an investigation into existing safety measures. Using this concept analysis may help guide the study of the healthcare environment and determine empirical measures to assess the impact that a medication administration error has.

The Influence of Nurses’ Characteristics on Medication Administration Errors: An Integrative Review

BackgroundMedication administration errors (MAEs) are a frequent cause of morbidity and mortality in acute care settings and can result in a prolonged hospital stay. The WHO estimated that medication errors cost up to $42 billion globally per a year. Therefore, MAEs was among the most common medical errors to occur in acute care settings. Studies of medication error usually focus on system factors, thus creating a gap between what researchers know about the causes of MAEs, and what frontline nurses actually do in the clinical setting. The purpose of this review is to fill a gap in the existing literature by focusing on the relationship between nurses’ characteristics and MAEs.MethodsOnline databases were accessed, including CINAHL, PsycINFO, PubMed, Scopus, and Google Scholar from 2007–2020 period. This review was guided by the methods described by Whittemore and Knafl. Studies that addressed the occurrence of medication errors based on RN demographics were included in this review. The included studies were reviewed and analyzed by the two authors.ResultsOf the 1141 publications retrieved, 19 studies met inclusion criteria. The result provided strong evidence that nurses’ level of education, length of experience, and attendance at training courses, are directly associated with the occurrence of MAEs. There is weak evidence of MAEs being influenced by the age and gender of nurses. Other nurse characteristics, such as cognitive load, frustration with technology, negligence, lack of attentiveness, and nurse ethnicity, are not adequately examined across the reviewed studies necessitates further research.ConclusionFocusing on nurses’ characteristics might facilitate other researchers to suggest appropriate interventions that may reduce the incidence of MAEs. Interventional studies may provide convincing evidence as to whether one variable has a causal effect on another variable, and control the influence of confounding variables to enhance the generalizability of the findings.

Perceived Occurrence of Medication Administration Errors among Nursing Students at a Higher Education Institution in Western Cape, South Africa

The aim of the study was to determine awareness and perception of trends in the occurrence of medication administration errors (MAEs) among nursing students. A descriptive quantitative design was employed on two consecutive days and a self-administrative questionnaire was used to collect data. The validity and reliability of this instrument were tested and established by a pilot study. Responses were collected from 291 nursing students at a higher education institution (HEI) in Western Cape, South Africa. Non-probability proportional quota sampling was used and the data was analysed with IBM SPSS® software. The data was presented in graphs, percentages, means and standard deviation, while inferential statistics was applied. The findings of the study revealed that 85.2% of the respondents were aware of MAE occurrence. There was no significant difference between the respondents’ awareness of MAE occurrence and their year of the study. The significant (p-value < 0.05) subscale for the causes of MAE occurrence was the physician communication subscale (p-value < 0.001). Moreover, the respondents perceived the top item to be using abbreviations instead of writing out the prescription orders completely (p-value < 0.001, mean = 4.85). The respondents disagreed that the pharmacy related subscale and its items were causes of MAE occurrence. In conclusion, the nursing students who participated in the study were aware of MAE occurrence during their practice time. The causes of these errors as indicated by the respondents are mentioned in the article. Therefore, the healthcare institutions as well as HEIs must focus on treating these causes in order to reduce MAE occurrence and enhance patient safety.

Perception and contributing factors to medication administration errors among nurses in Nigeria

PurposeThe study assessed perception and contributing factors to medication administration errors among nurses. DesignA quantitative descriptive design was adopted. Three hundred nurses participated in the study during the month of July 2015. A self-administered questionnaire was used to obtain information on registered nurses characteristics, knowledge and perceived causes of medication admiration errors. Descriptive analysis and inferential statistics were done using Statistical Package for Social Sciences. ResultsThe findings of the study revealed that Nurses have good knowledge and perception of medication administration errors. Confusion of drugs with different names and increase patient to nurse staffing ratio constitute the major contributing factors for the occurrence of medication administration error among them. Furthermore, majority of the nurses are aware of guidelines and methods to follow to prevent the occurrence of medication administration errors. ConclusionIn this regards, identification of the main factors contributing to medication administration errors allows nurses and system to eliminate situations such as nurse staffing, medication transcribing issues, poor physician communication, problem with medication packaging and poor reporting system as well as incorporating changes that minimize them. Also, nursing supervisors should create an enabling environment which allows incidence of medication administration errors to be reported not on the basis of being punished but to initiate actions to prevent future occurrences. This will improve and enhance patient safety environment in the hospital.

Nurses’ Medication Administration Errors at Medical Surgical Units

Medication administration errors (MAEs) are among the key concepts of patient safety in clinical care settings that have long been the focus of study and exploration because they contribute directly to patient injury, death and health care costs. Medication errors are recurrent and expected to be a prolonged problem in the health care system. The administration of medication is predominantly an important part of nursing practice that has a dimension of quality of care and organizational performance. The study sought to assess nurses’ medication administration errors at the general medical and surgical units. A descriptive cross sectional study design was used where stratified random sampling using the medical and surgical units as strata was used to proportionately recruit 100 Nurses. Each nurse was further observed twice during medication administration process making a total of 200 observations included in the study. Two tools were used to collect data for the current study. The interviewer administered medication administration errors questionnaire and a concealed medication administration observation checklist. Data was collected for a period of four months and analyzed using descriptive and inferential statistics to check for relations between variables. The study findings imply that the wrong rate of administration, the wrong time of administration and medication being administered after the order to discontinue was written were the highly perceived MAEs reported respectively as occurring ‘most of the time’ by 27%, 23% and 15% of the studied nurses. For observed MAEs, the wrong time error type had the highest estimated error rate of 51%, followed by the documentation error at 29% and technique error at 27.5%. There was statistical significant difference between the pharmacy reasons subscale of causes of MAEs and the age (F= 5.465, p=0.006), clinical experience (F=3.922, p=0.011) and type of shift (F=2.507, p=0.035) the nurse works most. Further, there was statistically significant mean differences between the medical and surgical units with regard to the medication packaging subscale (t=4.160, p=0.044). The findings also revealed negative significant correlation between the observed MAEs scores and the nurses’ reported scores on types of IV & non-IV MAEs (r_s=-0.266, p=0.007) and the pharmacy reasons subscale (r_s=-0.266, p=0.046). Updating, developing, disseminating and implementing medication administration guidelines and protocols in the hospital settings is required. Nurses have to embrace the occurrence of MAEs as a patient safety indicator that should be viewed as an opportunity to learn and prevent MAEs through rationalized medication management protocols and guidelines.

Emergency Department Nurses' Perceptions toward Factors Influencing the Occurrence of Medication Administration Errors

Background: Significant efforts have been directed to understand medication errors causes in recent years because it contributes directly to patient morbidity and mortality. This study was conducted to determine the factors influencing the occurrence of medication administration errors, as perceived by nurses in emergency department (ED). Aim: The current study aimed to assess emergency department nurses’ perceptions toward factors influencing the occurrence of medication administration errors. Design: The study followed a cross-sectional descriptive design. Setting: The present study was carried out at ED in teaching Main University Hospital in Alexandria governorate, Egypt. Subjects: 84 nursing staff worked in the previous mentioned setting. Tool: The data gathering tool was Medication Administration Errors (MAEs) Reporting Questionnaire which was developed by Wakefield in 1998 [1]. It contains 16 items regarding reasons why medication errors occur. Results: This study suggested four categories for reasons of why MAEs occur in emergency department and the leading cause of medication errors was due to nurses- physicians' communication. Conclusion: Medication errors are common in emergency department. A wide range of factors perceived as contributing factors of the occurrence of medication administration errors were identified such as nurses- physicians communication, medication packaging, pharmacy processes and nurse staffing. This information could be used to improve the medication system in emergency department in Egypt. Recommendations: This study recommended for provision of safe work environment that encourage good physicians-nurses team work relationship, dissemination of safety guidelines in all hospital department specially nursing and pharmacy, on-going education and training on safe medication administration and supervision of newly hired nursing staff during medication administration process and provision of adequate staffing and fair scheduling for nursing staff working in a highly urgent care departments.

Effect of barcode technology with electronic medication administration record on medication accuracy rates

The effect of barcode-assisted medication administration (BCMA) with electronic medication administration record (eMAR) technology on the occurrence of medication administration errors was evaluated. A pretest-posttest nonequivalent comparison group was used to investigate the effect of BCMA-eMAR on the medication administration accuracy rates at two community-based hospitals. Patient care units included three matched pairs in the two hospitals-two medical-surgical, two telemetry, and two rehabilitation units-plus a medical-surgical intensive care unit, an emergency department, and both an inpatient oncology unit and an outpatient oncology service at one of the hospitals. Medication administration accuracy rates were observed and recorded before (phase 1) and approximately 6 and 12 months after (phases 2 and 3, respectively) the implementation of BCMA-eMAR. The overall accuracy rate at hospital 1 increased significantly from phase 1 (89%) to phase 3 (90%) (p = 0.0015); if wrong-time errors are excluded, the accuracy rate improved from 92% in phase 1 to 96% in phase 3 (p = 0.000008). The overall accuracy rate did not change significantly from phase 1 to phase 3 at hospital 2; when wrong-time errors were excluded from consideration, the accuracy rate improved from 93% in phase 1 to 96% in phase 3 (p = 0.015). Implementation of BCMA-eMAR in two hospitals was associated with significant increases in total medication accuracy rates in most study units and did not introduce new types of error into the medication administration process. Accuracy rates further improved when wrong-time errors were excluded from analysis. The frequency of errors preventable by BCMA-eMAR decreased significantly in both hospitals after implementation of that technology. BCMA-eMAR and direct observation were more effective than voluntary reporting programs at intercepting and recording errors and preventing them from reaching patients.

Factores del entorno de trabajo que influyen en la ocurrencia de errores de administración de medicación

The incidence of medication administration errors (MAE) is high and costly for patients and health institutions. Human factors and factors relating to the work context intervene in their occurrence. The aim of this article is to identify the role of factors in the work setting related to occurrence of MAEs in the hospital field.A narrative review of the literature. Eight articles were included following a review of MEDLINE, CINAHL and COCHRANE LIBRARY databases for the 2002-2012 period.Distractions and interruptions, work overload, design of units and characteristics of the material stood out amongst the work context factors intervening in the occurrence of medication administration errors.The creation of organizational artefacts to reduce interruptions; patient involvement in medication administration; the introduction of new technologies and improving the labelling of medications can help reduce the incidence of medication administration errors. To advance in identifying and managing factors that are precursors of medication administration errors, we recommend the carrying out of studies or reviews of prospective cohorts.