Rights Of Medication Administration Research Articles

THE IMPLEMENTATION OF ELECTRONIC-BASED SYSTEM IN REDUCTION OF MEDICATION ERROR: A LITERATURE REVIEW

Medication errors have been a persistent issue in healthcare, often overshadowing nurses' ability to focus on patient care. Traditionally, nurses have devoted considerable time to calculating medications—dosages, routes, and frequencies—at the expense of other caregiving duties. This literature review explores the adoption of electronic-based systems to reduce medication errors and associated risks in healthcare settings. The research involved examining databases such as Clinical-key-nursing, Science Direct, ProQuest, Embase, and academic articles, using keywords like "medication error" and "electronic-based system." The findings suggest that electronic systems can mitigate harms linked to medication errors by ensuring compliance with the "10 rights of medication administration," which include the right patient, drug, dose, time, route, documentation, assessment, approach, drug interaction, and information. The review analyzed 19 articles, but only ten met the inclusion criteria. The results indicate a positive correlation between the use of electronic systems and a decrease in medication errors, highlighting the potential benefits of technology in enhancing patient safety and care efficiency.

Exposición laboral a citostáticos en el equipo de enfermería de atención primaria

IntroductionCytostatic drugs are classified as potentially dangerous to health when handled. Methotrexate is a cytostatic and immunosuppressive drug increasingly used in primary care for the treatment of various rheumatological and dermatological problems. Therefore, those workers, such as nurses, who may be exposed to these risks, as a consequence of their professional work must be observed. ObjectivesDescribe the management and exposure of methotrexate in the primary care nursing team of Orihuela Health Department, Spain. MethodologyIt corresponds to a descriptive observational study, carried out in the period from April 1 to 25, 2023. An observation guide was applied during a direct visit with nursing and following the recommendations of the current protocols for the management and exposure to cytostatics. Sampling was non-probabilistic for convenience. The sample size was calculated based on the nursing staff by estimating a proportion considering 7 health care areas and 31 auxiliary offices. As an inclusion criterion, a minimum of one year's experience in the administration of medication in the units under study was taken into account. ResultsOf a total of 124 nurses who provide services in primary care at the Orihuela Health Department, a total of 66 nurses participated. The mean age was 37.34 (SD 12.66). Two groups of nurses were created according to basic health zones with inhabitants of more than 25,000 or less than 25,000. It was considered that the Health Planning of the Territory in the autonomous communities of the Information System defined by Royal Decree 137/1984 of 22, on basic health structures for the improvement of Primary Care. In the observation guide, the lowest values were obtained in the evaluation/information of the patient regarding the management and exposure of methotrexate in the nurses. All nurses in both groups successfully applied the 5 rights of medication administration (route, dose, time, patient, and medication) for the safe management of methotrexate. ConclusionThe results obtained in our research highlight the need to describe the management and exposure of methotrexate in the nursing team and the relevance of seeking methods to improve knowledge and skills. In this sense, this study could, through the observation guide used, improve the management and exposure to methotrexate in the primary care nursing team and avoid unnecessary risks that can have serious consequences for nurses and patients.

Unveiling the Complexity of Medication Errors: A Nursing Perspective on Contributing Factors to Medication Errors

Context: Medication errors have long been associated with poor medical care quality, lengthy hospital stays, substantially increased medical costs, and a decline in patient confidence in the hospital's ability to provide quality care. Additionally, it is imperative to acknowledge that nurses serve as the final defense in mitigating medication errors and ensuring patient safety.
 Aim: To identify the factors contributing to King Abdullah Medical City's medication errors.
 Methods: A descriptive cross-sectional study was conducted in King Abdullah Medical City from January 2023 till March 2023. A total number of 262 nurses were included in this study. Data were collected through an online questionnaire of 28 questions, including nurses' demographics, work-related characteristics, and factors contributing to medication errors from nursing perspectives.
 Results: It was observed that overworked or exhausted healthcare professionals had the highest responses, with a mean score of 4.46±0.78, followed by insufficient staffing, with a mean score of 4.43±0.88. Regarding patient-related factors, the complexity of the clinical case, including multiple health conditions, polypharmacy, and high-risk medications, had the highest responses with a mean score of 4.20±0.83. Concerning work environment contributing factors for medication errors, it was found that the highest responses were to workload and time pressure factors, with a mean score of 4.50±0.71.
 Conclusion: Based on the results of this study, the main contributory factors to medication errors were overworked or exhausted healthcare professionals, insufficient staffing, violation of the eight rights of medication administration by nurses, inadequate drug knowledge and experience, nurses' failure to record the administered drug on the patient's record, and inadequate communication between healthcare providers and patients.

Evaluation of nurses' knowledge and performance regarding preparation and injection of intravenous drugs in pediatric wards in Iran

BackgroundA error in intravenous injection in pediatric wards can cause irreparable injuries. This study aimed to determine the level of knowledge and performance of nurses in terms of preparation and injection of intravenous drugs in pediatric wards of hospitals affiliated to Isfahan University of Medical Sciences.MethodsThis cross-sectional study was conducted in 2022 on 156 nurses working in pediatric wards. The data was collected with demographic information questionnaire and the knowledge and performance of the participants were determined using a researcher-made questionnaire, including the five rights of medication administration (preparation and injection, medication error, drug side effects, family empowerment, and documentation) using self-reporting and observation methods. Formal and content validity was calculated using the opinions of 10 experts and Cronbach's alpha with 40 samples.ResultsThe mean and standard deviation of total nurses' knowledge and performance scores were 58.31 + 10.1 and 66.1 + 14.4, respectively. Moreover, the mean and standard deviation of nurses' knowledge scores were 63.55 + 14.3 for documentation, 46.1 + 7.9 for preparation and injection, 73.9 + 12.3 for drug side effects, 58.4 + 10.2 for medication error, and 69.4 + 9.4 for family empowerment. Besides, the mean performance was 69.1 + 17.6 for documentation, 61.3 ± 9.9 for preparation and injection, 78.21 + 12 for drug side effects, 58.6 + 15 for medication error, and 65.4 + 17.7 for family empowerment.ConclusionThe results showed that the mean knowledge and pharmacological performance of nurses working in pediatric wards in different areas of the principles of medicine were not at the desired level, and this can affect children adversely.

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.

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.

Nursing Student Errors and Near Misses: Three Years of Data.

Understanding the magnitude of errors and near misses in all health care situations is crucial to preventing them from occurring in the future. However, little research is available on the type or extent of nursing student errors in the United States. Nursing student error and near miss data were submitted by more than 200 participating prelicensure nursing programs via a secured online repository. Medication errors represented more than half (58.8%, n = 613) of the total error and near-miss data (n = 1,042) submitted. Errors and near misses were attributed to students not adhering to three major patient safety procedures: checking the patient's identification, checking the patient's allergy status, and following the rights of medication administration. Results indicate collecting data on nursing students' errors and near misses can help nursing programs identify system issues, promote transparency, and make quality improvements. [J Nurs Educ. 2023;62(1):12-19.].

Seven Rights of Medication Administration: Nurses' Knowledge, Attitude, and Compliance

Medication error becomes one of the main concerns in ensuring patient safety. In 2020, X Hospital reported medication error incidents. Although categorized near miss, the incidents should have been prevented. One of the methods to prevent medication errors is by applying the seven rights of medication administration. This study aimed to identify the inhibiting factors in the implementation of the seven rights of medication administration in X Hospital and obtain alternative solutions to those obstacles. This study used an analytic observational design with a cross-sectional design. Data were collected from observations and a survey. Observations and a survey through questionnaires to 20 nurses at X Hospital were made to see the implementation of the procedure. At the end of the data collection, interviews were conducted to find out the obstacles in the inpatient installation in applying the seven rights of medication administration. The results show that the main root causes of medication administration errors were the standard operating procedure (SOP) that has not been standardized and nurses' non-compliance behavior on the seven rights procedure. To resolve medication administration errors, the hospital manager should revise the SOP, conduct internal workshops, and perform scheduled supervision to the nurses.

Reducing Near Miss Medication Events Using an Evidence-Based Approach.

Near miss medication events are pervasive without patient harm, mostly because of coincidence. Dynamic clinical environments challenge nurse compliance with medication administration rights and proper use of electronic technology. All nurses are educated in appropriate medication management, but our unit's barcoded medication administration scanning and electronic patient identification practices fell below the 97% benchmarks, representing hundreds of near miss medication events each month. Transformative leadership guided frontline staff to identify gaps in care processes and determined root causes for unsanctioned medication administration practices using a FOCUS (Find-Organize-Clarify-Understand-Select)-PDSA (Plan-Do-Study-Act) methodology. An interdisciplinary team committed to zero events of preventable harm overcame challenges to improve care delivery. Medication management scores exceeded organizational benchmarks, with sustainable gains over 2 years. A rapid-cycle, evidence-based approach engaged staff to reduce near miss medication events. Workable solutions driven by transparent communication and interpersonal collaboration influenced positive safety behaviors.

Pharmacists' Approach to Optimise Safe Medication Use in Paediatric Patients.

Paediatric patients are unique, yet challenging patients to care for by pharmacists. Paediatric medicine use requires special consideration. Pharmacists play an important role in educating and counselling patients, carers, and healthcare workers. Further, pharmacists have the necessary knowledge and skills to optimise safe medicine use in paediatric patients. This article provides basic principles for safe practices in paediatric medicine by following the nine rights of medication administration.

Improving Safe Medication Administration in New RNs Using Simulation.

This study describes the use of simulation to increase medication administration knowledge and skill in new RNs enrolled in a residency program. The study sample consisted of 54 new RNs with less than 1 year of nursing experience who were enrolled in a nurse residency program, and it compared medication administration knowledge posttest scores between groups. The medication administration posttest scores for the simulation group were not significantly higher than the scores of the classroom-only group (p = .056), but the simulation group scored significantly higher on questions regarding timing and the rights of medication administration. Participants were also asked their perceptions of medication errors and why they think they occur. Simulation supported improved medication administration knowledge of some concepts; simulation participants were more satisfied with their learning experience; and the use of simulation helped to identify a consistent knowledge gap within the study sample. New RNs also desire earlier medication administration education in their career. [J Contin Educ Nurs. 2021;52(1):30-33.].

Web-Based Virtual Learning Environment for Medicine Administration in Pediatrics and Neonatology: Content Evaluation.

BackgroundWorldwide, patient safety has been a widely discussed topic and has currently become one of the greatest challenges for health institutions. This concern is heightened when referring to children.ObjectiveThe goal of this study was to develop a virtual learning environment for medication administration, as a tool to facilitate the training process of undergraduate nursing students.MethodsDescriptive research and methodological development with a quantitative and qualitative approach were used with stages of design-based research as methodological strategies. For the development of the virtual environment, 5 themes were selected: rights of medication administration, medication administration steps, medication administration routes, medication calculation, and nonpharmacological actions for pain relief. After development, 2 groups—expert judges in the field of pediatrics and neonatology for environment validation and undergraduate nursing students for the assessment—were used to assess the virtual learning environment. For the validation of the virtual learning environment by expert judges, the content validity index was used, and for the evaluation of the students, the percentage of agreement was calculated.ResultsThe study included 13 experts who positively validated the virtual environment with a content validity index of 0.97, and 26 students who considered the content suitable for nursing students, although some adjustments are necessary.ConclusionsThe results show the benefit of the virtual learning environment to the training of nursing students and professional nurses who work in health care. It is an effective educational tool for teaching medication administration in pediatrics and neonatology and converges with the conjectures of active methodologies.

The workshop increased knowledge, motivation and nursing attitude about five right drug administration

To determine the effect of workshops on nurses' knowledge, motivation, and attitudes toward the five right drug administration. A quasi-experiment, pre-post without control group design, was performed in a hospital with 140 inpatient nurses as the subject. As the intervention, a workshop with lecturing sessions, video presentation, and discussion was carried out. The measurement was three time (before, one and four week after intervention) using a questionare consisting of 10 (knowledge), 17 (motivation) and 20 (attitude) item. Analysis using the Friedman test. Results indicated a low mean of knowledge but a high mean of motivations and attitudes. Friedman's test revealed significant differences in knowledge (p=0.000), motivation (p=0.000), and attitudes (p=0.000) about five rights of medication administration before, one, and four weeks after the workshop. The workshop increases nurses' knowledge, motivations, and attitudes toward five rights of medication administration.

Pediatric Vaccine Administration: Sustaining an Improved Process in a Primary Care Setting

Background: Pediatric vaccine errors may lead to patient harm, including unknown disease vulnerability requiring costly revaccination. Local Problem: Pediatric vaccine administration errors (expired and wrong vaccine) in a Federally Qualified Health Center prompted a root cause analysis. System and human factors issues were identified including a variable and complex administration process; multiple administering staff (medical assistants, registered nurses, nurse practitioners); competency training gaps; and storage opportunities driving error. Methods: Using Plan-Do-Study-Act cycles, the administration process and storage system were improved. Interventions: A simplified and standardized pediatric vaccine administration process was implemented. Administering staff completed 10 hours of education and competency training. Audits with feedback were conducted to monitor process behaviors linked to achieving the five rights of medication administration. Results: Twenty-four audits were conducted over a six-month period after implementation to monitor steps in the process. Early post-implementation analysis revealed performance variability and additional improvement activities were deployed. Behaviors have improved over time and are nearing consistent performance and no reported vaccine errors. Conclusions: Continuous analysis and improvement are needed to sustain safe practice until behaviors to achieve the five rights are normalized and impact patient outcomes. Keywords: vaccine error, quality improvement, sustainability, patient safety

Nurses' Compliance With Bar-code Medication Administration Technology

Medication administration using bar-code medication administration technology enhances the verification of medication administration rights. Nurses' compliance with bar-code medication administration procedure is essential to maximize the benefits. This study evaluated the current rate of nurses' compliance with bar-code medication administration use through direct observation. A descriptive design was used and 134 RNs were recruited from two public hospitals located in the middle region of Jordan. Compliance with bar-code medication administration was evaluated using an evidence-based checklist of 17 items. Participants' compliance with the bar-code medication administration was 55%, which had a significant positive correlation with their level of comfort using bar-code medication administration, usefulness, and ease of use, perceived job productivity, and overall rating of bar-code medication administration. Stakeholders can benefit from assessing end-user acceptance and perceptions regarding the bar-code medication administration technology to promote acceptance and compliance.

The Magnitude of Medication Administration Errors among Nurses in Ethiopia: a Systematic Review and Meta-analysis.

Introduction: Nurses are the final safety check in the process of medication administration process to prevent errors that adversely affect life; yet death of comprehensive evidences in Ethiopia. The present study aimed to assess the pooled magnitude of MAEs (Medication Administration Errors) in Ethiopia.Methods: Systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar for gray literature were performed until December 3, 2018. The quality of study was assessed using criteria adopted from similar studies. Heterogeneity test and evidence of publication bias were assessed. Moreover, sensitivity analysis was also performed. Pooled prevalence of MAE was calculated using the random effects model.Results: A total of 2142 medication administrations were from observational and 681from self-reported studies were included in this systematic review and meta-analysis. The most prevalent and frequently reported type of MAEs was documentation error (52% to 87.5%) and time error (25.5% to 58.5%) respectively. Overall, the pooled magnitude of MAE was found to be 39.3% (95% CI, 29.1%-49.5%).It has no evidence of significant heterogeneity (I2 = 0%, P = 0.57) and publication bias Egger’s test (P = 0.40).Conclusion: Overall, more than one in four observed/perceived medication administrations had errors. Documentation error is the most prevalent type of error. Nurses are suggested to strengthen their focus on the rights of medication administration guide particularly, documentation of their activities need special attention.

Magnitude and associated factors of medication administration error among nurses working in Amhara Region Referral Hospitals, Northwest Ethiopia

Introduction Medication administration errors (MAEs) are common health problems that threaten patient safety and raise mortality rates, duration of hospital stay, and cost of services. It also influences healthcare professionals performing the procedure and healthcare organizations. Its prevalence in Ethiopia is high ranging from 51.8% to 90.8%. Objective This study aimed to assess the magnitude and associated factors of MAE among nurses at Northwest Amhara Region Referral Hospitals. Methods An institution-based cross-sectional study was conducted from February to March 2019. A simple random sampling technique was employed to select 348 nurses. Structured pretested self-administered questionnaires and an observational checklist were used to collect data. The data were entered in Epi-info version 7, analyzed using SPSS version 20 (SPSS Inc., Chicago, IL), and presented in tables and graphs. Bivariate and multivariable logistic regressions were computed to identify the factors associated with MAEs. p Values <.05 and adjusted odds ratios were used to declare the significance and strength of the association. Results One hundred and seventy-eight (54%) of the respondents made MAEs in the last 12 months. Only 10 (5%) of the 200 observed nurses were administered medications without any breach in any of the six rights of medication administration. Factors like poor knowledge (AOR = 5.98; 95% CI (2.39,14.94)), poor communication (AOR = 2.94; 95% CI (1.34, 6.46)), stress (AOR = 5.41; 95% CI (2.53, 11.57)), interruption during medication administration (AOR = 4.70, 95% CI (2.42, 9.10)), and night shift (AOR = 2.79, 95% CI (1.42, 5.46)) were significantly associated with MAE. Conclusions The magnitude of MAE was high. Poor knowledge, poor communication, stress, night shift, and interruption were significantly associated with MAEs. Strengthening institutional medication administration regulations and guidelines and minimizing interruption during medication administration would help minimize MAEs.

Should known allergy status be included as a medication administration 'right'?

This article employs a paediatric case study, involving a 3-year-old child who had an anaphylactic reaction that occurred as a result of the multidisciplinary team's failure to identify and acknowledge the patient's documented 'known allergy' status. It examines and reconsiders the ongoing healthcare dilemma of medication errors and recommends that known allergy status should be considered the second medication administration 'right' before the prescribing, transcribing, dispensing and administration of any drug. Identifying and documenting drug allergy status is particularly important when caring for paediatric patients, because they cannot speak for themselves and must rely on their parents, guardians or health professionals as patient advocates. The literature states that medication errors can be prevented by employing a 'rights of medication administration' format, whether that be the familiar '5 rights' or a more detailed list. However, none of these formats specify known allergy status as a distinct 'right'. The medication safety literature is also found wanting in respect of the known allergy status of the patient. When health professionals employ a medication administration rights format prior to prescribing, transcribing, dispensing or administering a medication, the 'known allergy status' of the patient should be a transparent inclusion.

Characterization of adverse events occurring during nursing clinical rotations: A descriptive study

IntroductionPatient safety is a pillar of quality health care. Nursing students may commit errors during clinical practice, compromising patient safety. ObjectiveAnalyze the adverse events, as well as the factors associated with the errors, reported by students from a private university in Santiago, Chile during nursing clinical rotations. MethodsQuantitative cross-sectional descriptive study. A total of 68 errors by first- through fifth-year nursing students were reported between 2012 and 2018. The data collection instrument was the Adverse Events Notification Form from the School of Nursing. This form documented information about the study as well as about the event. ResultsAfter this reporting system was established in 2012, the number of events reported increased steadily each year. The greatest numbers of reported errors were committed by fifth-year students (73.5%), and the most common type of error was associated with medication administration (94.2%), including incorrect dose (27.9%) and incorrect medication (17.6%). The major factors contributing to errors were failure to review the “10 rights of medication administration” (85.3%) or lack of critical judgment (7.4%). Most of the errors occurred in public institutions (72.1%). ConclusionThe results suggest that it would be beneficial to re-evaluate how safety and quality of care are taught at the school of nursing, with an emphasis on understanding the learning styles of students and teaching strategies of instructors. It is crucial that the academic institution remain actively involved in teaching safety-related skills to future nursing professionals. Furthermore, we suggest modifications to the adverse events reporting system that would avoid the need for personal interpretations of the event by the student.

Incidence of medication administration errors in Ethiopia: A systematic review and meta-analysis of observational studies

Abstract Introduction: In Ethiopia, the overall incidence of medication administration errors (MAEs) has been variously estimated within the range of 16% to 99%; a wide range and difficult to conclude. Thus, this study aimed to assess the pooled incidence of MAEs in Ethiopia. Materials and methods: A systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar were performed. The quality of study was assessed using criteria adopted from similar studies. Heterogeneity test and evidence of publication bias were assessed. Sensitivity test and trim and fill analysis was also performed. Pooled incidence of MAE was calculated using random effects model. Results: A total of nine studies, including a total of 46,426 medication administrations interventions, were included in this systematic review and meta-analysis. The frequently reported MAEs were wrong dose, wrong time, and wrong route. The reported error was ranged from 0.1% for wrong medication to 95.8% for omitted drug error. Overall the pooled incidence of MAE was found to be 37.9% (95% CI, 34%-41.9%). It has no evidence of significant heterogeneity (I2 = 0%, p <0.820) and publication bias from the visual inspection of funnel plot and Egger’s test (P =0.481). Conclusion: The incidence of MAE was high. Wrong dose, wrong time, and wrong route were the frequently reported errors. Omission error was the most incident errors. Authors suggested to give more attentions to the rights of medication administration guide, particularly to prevent omission error.