Rights Of Medication Administration Research Articles

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.

Types and Frequency of Infusion Pump Alarms and Infusion-Interruption to Infusion-Recovery Times for Critical Short Half-Life Infusions: Retrospective Data Analysis.

BackgroundAlarm fatigue commonly leads to a reduced response to alarms. Appropriate and timely response to intravenous pump alarms is crucial to infusion continuity. The difficulty of filtering out critical short half-life infusion alarms from nonurgent alarms is a key challenge for risk management for clinicians. Critical care areas provide ample opportunities for intravenous medication error with the frequent administration of high-alert, critical short half-life infusions that require rigorous maintenance for continuity of delivery. Most serious medication errors in critical care occur during the execution of treatment, with performance-level failures outweighing rule-based or knowledge-based mistakes.ObjectiveOne objective of this study was to establish baseline data for the types and frequency of alarms that critical care clinicians are exposed to from a variety of infusion devices, including both large volume pumps and syringe drivers. Another objective was to identify the volume of these alarms that specifically relate to critical short half-life infusions and to evaluate user response times to alarms from infusion devices delivering these particular infusions.MethodsThe event logs of 1183 infusion pumps used in critical care environments and in general care areas within the European region were mined for a range of alarm states. The study then focused on a selection of infusion alarms from devices delivering critical short half-life infusions that would warrant rapid attention from clinicians in order to avoid potentially harmful prolonged infusion interruption. The reaction time of clinicians to infusion-interruption states and alarms for the selected critical short half-life infusions was then calculated.ResultsInitial analysis showed a mean average of 4.50 alarms per infusion in the general critical care pump population as opposed to the whole hospital rate of 1.39. In the pediatric intensive care unit (PICU) group, the alarms per infusion value was significantly above the mean average for all critical care areas, with 8.61 alarms per infusion. Infusion-interruption of critical short half-life infusions was found to be a significant problem in all areas of the general critical care pump population, with a significant number of downstream (ie, vein and access) occlusion events noted. While the mean and median response times to critical short half-life infusion interruptions were generally within the half-lives of the selected medications, there was a high prevalence of outliers in terms of reaction times for all the critical short half-life infusions studied.ConclusionsThis study gives an indication of what might be expected in critical care environments in terms of the volume of general infusion alarms and critical short half-life infusion alarms, as well as for clinician reaction times to critical short half-life infusion-interruption events. This study also identifies potentially problematic areas of the hospital for alarm fatigue and for particular issues of infusion and infusion-line management. Application of the proposed protocols can help create benchmarks for pump alarm management and clinician reaction times. These protocols can be applied to studies on the impact of alarm fatigue and for the evaluation of protocols, infusion-monitoring strategies, and infusion pump-based medication safety software aimed at reducing alarm fatigue and ensuring the maintenance of critical short half-life infusions. Given the frequency of infusion alarms seen in this study, the risk of alarm fatigue due to the white noise of pump alarms present in critical care, to which clinicians are constantly exposed, is very high. Furthermore, the added difficulties of maintaining critical short half-life infusions, and other infusions in specialist areas, are made clear by the high ratio of downstream occlusion to infusion starts in the neonatal intensive care unit (NICU). The ability to quantitatively track the volume of alarms and clinician reaction times contributes to a greater understanding of the issues of alarm fatigue in intensive care units. This can be applied to clinical audit, can allow for targeted training to reduce nuisance alarms, and can aid in planning for improvement in the key area of maintenance of steady-state plasma levels of critical short half-life infusions. One clear conclusion is that the medication administration rights should be extended to include right maintenance and ensured delivery continuity of critical short half-life infusions.

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

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

Quality Improvement Project to Evaluate Discharge Prescriptions in Children With Cystic Fibrosis.

Introduction:Cystic Fibrosis (CF) requires multiple pharmaceutical treatments, elevating the risk of medication errors (ME), which may compromise patient safety. This study aimed to improve the quality of discharge prescriptions (DPs) using indicators following admissions for IV antibiotics in pediatric CF patients.Methods:This project involved a longitudinal observational retrospective descriptive study followed by a longitudinal quasi-experimental prospective phase between January 2013 and December 2016 in CF patients admitted to a London Children’s Hospital. The CF pharmacist reviewed DPs. Six rights of medication administration were defined (6R): dose, drug, frequency, duration of treatment, pharmaceutical form, and route of administration. We classified ME according to 6R, including subtype of error: committed/omitted. We calculated quality indicators by dividing the number of each correct parameter defined by 6R by number of DPs. Retrospective results were used prospectively to describe and implement improvement strategies and safety actions.Results:The retrospective study phase included 42 CF children (100 hospital admissions and 1,343 drugs). The prospective phase included thirty-five children (55 admissions and 822 drugs). The total number of ME identified was 148 (78 committed; 70 omitted) in retrospective phase and 135 (19 committed; 116 omitted) in prospective phase. Quality indicators for drug and dose showed significant improvement after implementing safety strategies. The global quality indicator increased from 22% (retrospective) to 41.82% (prospective), but we did not achieve the previously defined quality standard value (50%).Conclusions:A retrospective review of DP by a CF Pharmacist identified failures in DP quality. Implementing improvement strategies improved prescribing. Integrating pharmacist within multidisciplinary team improves DP reducing errors.

Medication Errors in the Context of Hematopoietic Stem Cell Transplantation: A Systematic Review.

There have been numerous efforts by health institutions and professionals to prevent and reduce medication errors. The aim of this study was to identify in the literature the incidence, related factors, consequences, and prevention mechanisms of medication errors in the context of hematopoietic stem cell transplantation. This is a systematic review carried out in the databases LILACS, PubMed, PMC, EMBASE, and CINAHL databases, from January 11 to 13, 2017. Eleven studies were included in this review and presented in 4 categories of analysis. (1) occurrence-most of the medication errors were related to administration and prescription; (2) related factors-multicausal, highlighting issues including polypharmacy, lack of double checking, and similarity between the medications' names; (3) consequences-the main ones were associated with adverse reactions, with prolonged hospitalization time as outcome; (4) preventive measures-related to safe practices in pharmacotherapy, such as double check and application of the 10 rights of medication administration. Medication administration is an activity of great responsibility for nursing; however, in order to achieve a decrease in medication errors, prevention strategies are necessary for the whole health team. Practice improvements are needed including establishing institutional drug administration protocols and keeping them updated, using a computerized prescription system, and promoting patient safety with staff.

Application of “Six Rights” on Medication Administration by Nurse and Patient Satisfaction

Introduction: Giving the medications, nurse should pay attention to the principles of “six of rights", namely: right of patient, right medication, right dose, right way, right time, and right documentation. There are more than a half of nurses in a ward who are not provide medications in accordance with the Standard Operational Procedure (SOP). The purpose of this study was to determine of the relationship between applications of Standard Operational Procedure (SOP) six rights of medication administration by nurses and patient satisfaction. Methods: This study was using cross sectional design.There were 30 respondents taken by accidental sampling. This research was conducted in February 2017. Data collection used questionnaires and observation. Chi-Square test was used to analyze data. It can be known from 30 respondents who had six right in application of medication administration was performed good (50%) then respondents were satisfied (50%). Results: The results showed the significant relationship between the six rights of medication administration by nurse and the level of patient satisfaction (p = 0.003).Conclusion: It can be inferred that the higher interaction that occurs between nurse and patient in applying the principles of medication administration, it will higher patient satisfaction. Nurses suggested applying the six rights during medication administration.

Nurses' rights of medication administration: Including authority with accountability and responsibility.

Medication errors continue to occur too frequently in the United States. Although the five rights of medication administration have expanded to include several others, evidence that the number of errors has decreased is missing. This study suggests that medication rights for nurses as they administer medications are needed. The historical marginalization of the voice of nurses has been perpetuated with detrimental impacts to nurses and patients. In recent years, a focus on the creation of a just culture, with a balance of accountability and responsibility, has sought to bring a fairer and safer construct to the healthcare environment. This paper proposes that in order for a truly just culture to exist, the balance must also include nurses' authority. Only when a triumvirate of responsibility, accountability, and authority exists can an environment that supports reduced medication errors flourish. Through identification and implementation of Nurses Rights of Medication Administration, nurses' authority to control the administration process is both formalized and legitimized. Further study is needed to identify these rights and how to fully implement them.

Errors Associated with the Rights of Medication Administration at Hospital Settings

Errors Associated with the Rights of Medication Administration at Hospital Settings

Impact of a Barcode Medication Administration System on Patient Safety

To determine the impact of barcode medication administration (BCMA) on the incidence of medication administration errors among patients in an onco-hematology day hospital and to identify the characteristics of medication errors in that setting. . 715 patients treated in the onco-hematology day unit at the Príncipe de Asturias University Hospital in Madrid, Spain. . A between-groups, pre-/postintervention study was conducted. Administration errors observed in patients with solid tumors (intervention group) were compared with those in patients with hematologic cancer (control group) before and after the introduction of BCMA. Error incidence, type, and severity were assessed, as was length of stay for treatment. . Use of a BCMA system reduced the incidence and severity of errors in medication administration in the onco-hematology day hospital. . BCMA is a useful technology to check the five rights of medication administration in the onco-hematology day hospital and could help nurses increase the time spent on direct patient care activities. .

Anesthesia Medication Handling Needs a New Vision.

Anesthesia Medication Handling Needs a New Vision.

Reflective writing: Factors that influence the successful transition of nursing students entering into their second semester of a RN-ABSN program

Objective: Identify factors influencing the successful transition of nursing students entering into their second semester of a RN-ABSN program. Background: Newly graduate registered nurses (RNs) are able to enter practice within weeks of graduation as fully licensed RNs. An inadvertent effect of this transition is placing new graduates into an environment that demands safe, effective and quality care. Identifying factors that influence the successful transition of nursing students entering into the second semester of an ABSN (Accelerated Bachelor of Science Nursing) program sets off ones actions, increases awareness and understanding, and promotes the development of personal experiences by means of reflective journaling. Reflective journal rubrics (personal narrative of storytelling) help to fortify the successful transformation to practice by allowing self-reflection and encourage the reconceptualization of the problem situations. Reflective journals illuminate performance expectancies and can diminish misperceptions around role. The reflective journal rubric for assessing RN performance, focused on reflective writing. The tool was developed using the modified version of written exercises by Freshwater, Taylor and Sherwood for active learning concepts used in the classroom. Reflective journaling incorporates the application of concepts and leads to increase mastery and retention of content. Additionally, it identifies important themes and offers opportunities for students to discuss essential topics for a smooth transition into their first and second semester. Methodology: A group of seventeen ABSN students in the second semester medical surgical clinical were required to participate in the reflective journaling at the beginning and end of their experiences in training as a part of their preparation for a clinical rotation. Nurse educators, read the reflective journals to gain insight into the participants’ experience and then coded to highlighted themes. The journals were evaluated with the reflective practices of Freshwater, Taylor and Sherwood who have proposed the use of the term “art” pertinent in the context of reflective journaling in nursing. Qualitative content analysis was deemed complete when agreement was reached regarding major themes. Dependability was achieved by the researchers using the participants’ own words to support the themes and conclusions. Data Collection: IRB approval was obtained. 17 students participated in the study and identifying themes from approximately 17 students over the past 2 years. The self-reflection rubric contained open-ended, short write-in items. Responses were anonymous. No names, email addresses, nor computer IP addresses were collected. Results: Seventeen journals were analyzed. Students are using critical reflection to improve practice, especially with respect to Freshwaters statement ‘thinking about thinking’. The key outcomes indicated that reflective journals assist students to focus on their clinical learning during the coaching point. These following themes emerged: my preceptor was knowledgeable about nursing practice, therapeutic touch, confidence level, prioritization of patient care, caring, communication, six rights of medication administration, holistic approach and skills. Conclusions: This study heightens most discussions on the use of reflective journals validating previous information defined in the literature with the advantages of utilizing journals in terms of fostering and stimulating reflection type to enhance first-hand learning in the nursing student’s clinical practice.

Medication calculation and administration workshop and hurdle assessment increases student awareness towards the importance of safe practices to decrease medication errors in the future.

Medication errors are the second most frequently reported hospital incident in Australia and are a global concern. A "Medication Calculation and Administration" workshop followed by a "hurdle" assessment (compulsory task mandating a minimum level of performance as a condition of passing the course) was introduced into Year 2 of the James Cook University medical curriculum to decrease dosage calculation and administration errors among graduates. This study evaluates the effectiveness of this educational activity as a long-term strategy to teach medical students' essential skills in calculating and administering medications. This longitudinal study used a pre- and post-test design to determine whether medical students retained their calculation and administration skills over a period of 4 years. The ability to apply basic mathematical skills to medication dose calculation, principles of safe administration (Part 1), and ability to access reference materials to check indications, contraindications, and writing the medication order with correct abbreviations (Part 2) were compared between Year 2 and 6 assessments. Scores for Parts 1, 2 and total scores were nearly identical from Year 2 to Year 6 (P = 0.663, 0.408, and 0.472, respectively), indicating minimal loss of knowledge by students in this period. Most Year 6 students (86%) were able to recall at least 5 of the "6 Rights of Medication Administration" while 84% reported accessing reference material and 91% reported checking their medical calculations. The "Medication Calculation and Administration" workshop with a combined formative and summative assessment - a "hurdle" - promotes long-term retention of essential clinical skills for medical students. These skills and an awareness of the problem are strategies to assist medical graduates in preventing future medication-related adverse events.

Medication Safety Practices: A Patient's Perspective

ABSTRACT Introduction Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. A foundational cornerstone upon which health care providers endeavor to base all care is the medical oath, “Never do harm to anyone” (Hippocrates). Medication use in hospitals is a complex process and depends on successful interaction among health care personnel functioning at different areas, and errors may occur at any stage of prescribing, documenting, dispensing, preparation, or administration. The purpose of this research is to explore the safety practices employed by nurses during medication administration, specifically from the patients’ perspectives. The fundamental objectives are to explore patients’ perceptions, attitudes, and beliefs about the safety practices utilized by nurses when administering medications and to identify opportunities for increasing patient safety. Materials and methods This study was undertaken employing a quantitative survey instrument as the methodology. For collecting data, a pretested, structured questionnaire was given to the sample population after fulfilling the inclusion/exclusion criteria, and consent to enroll in study was taken. This method is convenient and affords the opportunity to generalize responses from the sample population to the population as a whole. Results The mean age of the respondents from Obstetrics and Gynecology was 29.08 ± 6.53. The mean age of the respondents from medicine was 33.4 ± 9.6. The mean age of the respondents from surgery was 33.68 ± 12.2; 23% respondents belonged to medicine unit, 21.5% respondents belonged to surgery unit, and 55.5% respondents belonged to Obstetrics and Gynecology unit. Of the total respondents, 62.75% were females. Moreover, 76 respondents in medicine, 72 respondents in surgery, and 172 respondents in Obstetrics and Gynecology stayed in the hospital for &gt; 7 days. Respondents &lt; 30 years of age responded negatively to three out of six questions compared to respondents &gt; 30 years of age. This is statistically significant (p = 0.008, 0.0001, and 0.008) showing that age does not alter the perception of the quality of health care. The perception of medicine respondents was negative to four out of six questions as compared to surgery respondents. This is statistically significant (p = 0.008, 0.0001, and 0.008), thus unit alters the perception of the quality of health care. The medicine respondents rated care lower as compared to surgical respondents. The patients’ perception varies with gender, and it has been found to be significant in five out of six cases where p value is &lt; 0.05. Females rated the quality of care better and shared the responsibility for health care. The patients’ perception varies with length of stay (LOS): 47.25% respondents feel that the nursing care of the hospital is very safe; 63% respondents feel that their care is a responsibility shared by both doctors as well as themselves more so by the female respondents from surgical units and who stayed longer. Conclusion According to patients’ perceptions reported in this study, there were a number of inconsistencies noted in the seven rights of medication administration delivered by nurses, specifically patient identification, hand washing, allergy assessment, and patient teaching. The perception of medication safety practices do change with the unit they are in, gender, and LOS. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care. How to cite this article Bhalerao K, Ghike S, Bhalerao AV. Medication Safety Practices: A Patient's Perspective. J South Asian Feder Obst Gynae 2016;8(4):271-281.

Teaching medication administration through innovative simulation

Nurse educators are constantly seeking innovative ways to better prepare nursing students for clinical practice in the health care environment. One approach implemented by an associate degree program of nursing in southern Ohio is an automated medication dispensing system in the skills laboratory setting to evaluate first-year students' competency in administering medications. This self-report convenience survey evaluated the perceptions of 51 first semester nursing students following the implementation of a medication dispensing system in the skills laboratory prior to competency evaluation for medication administration. The authors' findings supported the use of the Demo Dose medDISPENSE automated medication dispensing system as a valuable teaching strategy because it reinforces the students' knowledge base of the six rights of medication administration and their confidence level. In addition, the potential for preventing medication errors by nursing students was discovered.

Using simulation to assess undergraduate nursing students’ competency with medication administration to a limited- English language proficiency patient

Background/Objectives: Medication errors continue to be an area of concern in health care and are a significant cause of morbidity and mortality in both inpatient and outpatient settings. Little consideration has been given to the role of the patient in the medication process; patients with limited-English language proficiency (LEP) may be at risk for medical errors and drug complications. The purpose of this research study is to assess undergraduate nursing students’ competency with medication administration to a simulated patient with LEP. Methods: A non-experimental quantitative design using the Medication Administration Safety Assessment Tool (MASAT) (Copyright © 2013 Goodstone &amp; Goodstone) for student competency in medication administration perfor- mance was conducted in a simulation environment. Qualitative data was also collected during debriefing for questions specific to safety, medication administration, and barriers related to care. Results: Student scores on the MASAT identified a less than expected probability of success. Students’ performance did not show proficiency in the six rights of medication administration; in addition, students’ were inattentive to the language needs of a LEP patient. Conclusion: Results from this study indicate further experiential learning activities may be necessary to reinforce safety in medication administration. Students were not attentive to the language needs of the simulated patient and may require additional learning opportunities through simulation to assist students in responsive behaviors that support LEP patients.

Use of safety strategies to identify children for drug administration

OBJECTIVE: To understand the use of safety strategies in child identification for drug administration.METHODS: In this cross-sectional study at a pediatric unit, drugs were distributed in a centralized and unique manner. We conducted 373 observations of the process for preparing and distributing drugs carried out by 25 nursing professionals.RESULTS: The pharmacy had distributed 198 (53.1%) medicines without identifying the drugs' label, which, while in storage, was identified with the child's first name handwritten on adhesive tape. At the time of drug preparation, the professional transcribed the drug's name as described in the prescription to the drug label for 173 (90.6%) observations of injectable drug preparation and 161 (88.5%) observations of preparation of oral drugs. Information regarding the five rights of medication administration and preparation, such as the full name of the child, appeared on 10.7% of drug labels.CONCLUSION: No safety strategies to identify children during drug administration were found, nor were any standards for data identification observed.

NFC-based Framework for Checking the Five Rights of Medication Administration

Medication errors that occur during the medication administration stage are a serious issue in healthcare. The most common types of errors in this stage are wrong patient, wrong medication, wrong time, wrong dose, and wrong route. In this paper, we propose a solution that uses NFC technology to help nurses provide the right patient with the right medication in the right dose at the right time and via the right route during the medication administration stage.

Impact of faculty development sessions to increase faculty competency with supervision of medication administration in an associate degree program

To reduce medication administration errors by student nurses, this initiative focused on the education of clinical faculty in key areas of the medication process. Faculty development sessions addressed clinical supervision, Quality and Safety Education in Nursing, the rights of medication administration, and the impact of interruptions during the medication administration process. Outcomes indicate an increase in near-miss medication errors, indicating a need for further monitoring and faculty development.

Bar Coding—Not Just in the Supermarket Anymore

incorporate auto mation into our application of the “5 rights of medication administration” for all of our patients. We need to take advantage of the power of bar codes to see things that our own eyes may miss or our brains re-interpret. In response to this need, the Institute for Safe Medication Practices Canada and the Canadian Patient Safety Institute have spearheaded the Canadian Pharmaceutical Bar Coding Project (see www.ismpcanada.org/barcoding/). This project has identified 2 major concerns with the current medication supply chain, a system based on human identification methods: (1) assurance of medication safety for the patient and (2) efficiency and accuracy of the supply chain. The “Joint Technical Statement on Pharmaceutical Automated Identification and Product Database Requirements”, which was updated and released in February 2012, provides guidance on creating the tools required to improve supply chain efficiency and enhance medication safety. So now I can enjoy my perfectly prepared cup of coffee while contemplating our health region’s complex medicationuse system and considering how bar codes could enhance medication safety and improve the efficiency of providing medications to patients.