Safe Medication Administration Research Articles

Safe Administration of Medication in School: Policy Statement.

Many youth with acute and chronic health conditions require medication to be administered during the school day. This policy statement offers guidance to school physicians, community prescribers, school nurses, other school health professionals, and groups providing oversight to school health activities and ensures patient safety and equity lenses are applied to administration of medications during school and for school-related activities. The American Academy of Pediatrics supports a robust collaborative model that allows all those involved in student health, including the student and family, to communicate, participate in effective medication management, inform delegated medication responsibilities, and promote safe medication storage and administration. School medication administration protocols are developed to help prevent medication administration errors specific to potential risks in the school setting and are responsive to the maturing students' evolving understanding of their health needs, growing autonomy, and responsibility. All protocols involving school nurses, unlicensed assistive personnel, and prescribers must be consistent with state and federal regulations on scope of practice, student privacy laws, and professional nursing organization guidelines. Consistent policies and messaging on safety of the patient and the entire school community enable school health teams to ensure equitable treatment of students prescribed therapeutic agents newly regulated by the US Food and Drug Administration, over-the-counter medications, or products that are currently not regulated by the US Food and Drug Administration.

Pharmacist administered parenteral medications: A descriptive report of an inpatient training program

AbstractIntroductionParenteral medication administration is a crucial aspect of in‐hospital patient care and has been historically managed by nurses and physicians. Despite pharmacists' extensive training in the medication use process, their underutilization in medication administration stems from various factors, including the lack of formalized training, limited awareness by other healthcare professionals, and unclear legal guidance. This report discusses the implementation and outcomes of a pharmacist medication administration program at a large academic medical center.MethodsThe initiative began by revising hospital policies, enabling pharmacists to administer medications during emergencies. Documentation and communication protocols were established. Training included an online module and hands‐on sessions covering various topics with a focus on parenteral medication administration and medication safety. Following completion of the program, competency of pharmacists was assessed by pharmacists experienced in intravenous administration using simulated patient case scenarios. Following implementation, the frequency and characteristics of pharmacist administered medications were captured and described.ResultsThirty pharmacists, including 11 residents, participated. Seven pharmacists administered 349 doses of medications to 284 patients in emergency situations. Administrations by pharmacists included 227 titratable infusions, 72 intermittent or continuous infusions, 49 intravenous pushes, and 1 intranasal naloxone. Classes of medications included high risk products such as vasopressors, sedatives, antiarrhythmics, and thrombolytics. No extravasations or infiltrations were reported.ConclusionImplementation of the pharmacist medication administration program signifies significant progress in strengthening the pharmacists' role in patient care at the bedside specifically highlighting the competency of pharmacists to administer parenteral products during emergency situations. The absence of adverse events highlights the feasibility and safety of integrating pharmacists into the bedside team. As the landscape of health‐system pharmacy evolves, embracing standardized training programs like ours reemphasize pharmacists' essential contributions to the multidisciplinary healthcare teams, ultimately enhancing patient care and safety.

Optimizing the Use of Dose Error Reduction Software on Intravenous Infusion Pumps.

Intravenous infusions have the potential to cause significant harm in patients and are associated with a high rate of adverse drug events and medication errors. Infusion pumps with dose error reduction software (DERS) can be used to reduce errors by establishing safe infusion parameters. In 2019, a quality improvement project was initiated with the aim to increase DERS compliance from 46% to 75% at our specialty institution by October 1, 2022. An interdisciplinary group was tasked with improving compliance with DERS by identifying key drivers, including informed staff, engaged staff, and an accurate smart pump library. We used the Model for Improvement framework to guide this improvement project, and Plan-Do-Study-Act (PDSA) cycles were used to plan for interventions. PDSA cycles included drug library updates, education, and unit-level compliance reporting. Weekly average DERS compliance was monitored as the outcome measure, and weekly pump alerts per 100 infusions were monitored as a balancing measure; statistical process control charts were used to monitor measures from 2018 to 2022. Over the course of 25 months, 8 PDSA cycles resulted in 5 centerline improvements from a baseline mean of 46% to a final mean of 78%. Pump alerts per 100 infusions decreased from 15.9 to 6.4 with the first PDSA cycle and then continued to decrease to 3.9 with subsequent interventions. Although features like DERS can help ensure safe medication administration, continuous improvement efforts to increase DERS compliance without increasing alert burden are needed to ensure that benefits of this technology are optimized.

The impact of healthcare information technology on reducing medication errors: A review of recent advances

This review explores the impact of HIT on reducing medication errors, encompassing recent advances in electronic health records (EHRs), clinical decision support systems (CDSS), bar-coding technology, telemedicine, and mobile health applications. By synthesizing evidence from scholarly literature, case studies, and real-world implementations, this paper delineates the multifaceted benefits, challenges, and future prospects of integrating HIT into medication management processes. Understanding the evolving role of HIT in error reduction is pivotal for healthcare stakeholders to optimize patient outcomes and enhance the quality and safety of medication administration. In the dynamic realm of modern healthcare, medication errors loom as a formidable challenge, imperiling patient safety, compromising care quality, and inflating healthcare expenditures. However, amidst this backdrop of concern, healthcare information technology (HIT) emerges as a beacon of hope, offering potent remedies to counteract these errors. This review embarks on a journey to unravel the profound impact of HIT on ameliorating medication errors, delving into recent strides across various fronts including electronic health records (EHRs), clinical decision support systems (CDSS), bar-coding technology, telemedicine, and mobile health applications. Drawing upon a rich tapestry of scholarly literature, real-world case studies, and practical implementations, this paper meticulously examines the multifaceted landscape of HIT's influence on medication management. Through a comprehensive synthesis of evidence, we uncover the diverse benefits, confront the inherent challenges, and illuminate the promising vistas that emerge from the integration of HIT into medication-related processes. At the core of this exploration lies an urgent call to comprehend the evolving role of HIT in error reduction, recognizing its pivotal significance for healthcare stakeholders. By assimilating insights from disparate sources, we endeavor to empower stakeholders with the knowledge necessary to optimize patient outcomes, fortify the fabric of care delivery, and foster a culture of safety and excellence in medication administration. In essence, this review serves as a guiding compass amidst the labyrinth of healthcare challenges, illuminating pathways towards safer, more efficient, and more effective medication management practices. As we navigate this terrain, let us remain steadfast in our commitment to harness the transformative power of HIT, thereby ushering in a new era of enhanced patient safety, elevated care quality, and sustainable healthcare systems. In the contemporary healthcare landscape, medication errors represent a significant concern, posing risks to patient safety, quality of care, and overall healthcare costs. However, advancements in healthcare information technology (HIT) offer promising solutions to mitigate these errors.

The Impact of High-Fidelity Simulation on Undergraduate Nursing students Performing Safe Medication Administration: A Systematised Review

The Impact of High-Fidelity Simulation on Undergraduate Nursing students Performing Safe Medication Administration: A Systematised Review

Devices for securing and administering pediatric compounded oral liquids: survey results from French university hospitals.

Oral liquid forms, either commercial or compounded, are preferred in pediatrics due to their suitability for weight-based dosing and acceptability for children. The choice of dosing delivery devices associated with oral liquid forms is important to ensure accurate dosing, ease of administration, and patient safety. Given the prevalence of compounding in pediatric settings, this study aimed to investigate the practices among French university hospitals concerning the selection of dosing delivery devices associated with compounding oral liquid forms for children. An online survey was distributed to pharmacists involved in compounding in French university hospitals. The survey covered aspects such as the presence of child-resistant caps, types of dosing devices, the presence of bottle adapters, and the type of bottle adapters used. Among the 36 hospital pharmacies contacted, 24 responded to the survey. One pharmacy employed child-resistant caps for compounded liquid forms. Enteral syringes emerged as the primary dosing device (71%), with a minority using luer/luer-lock syringes (21%). Spoon and measuring cup usage was reported by none. Approximately two-thirds of the pharmacies (67%) used a bottle adapter in conjunction with the sampling device. Conclusion: The study highlighted diversity in the practices of French university hospitals regarding dosing delivery devices associated with compounding oral liquid forms for pediatric patients. The findings underscored the need for standardized guidelines to streamline practices and enhance safety and precision in compounded medication administration for children. What is Known: • Administration devices are important to ensure the correct administration of the required dose of oral liquids in pediatrics. • For compounded oral liquid forms, the selection and supply of administration devices are managed by compounding pharmacies from those available on the market. What is New: • The study highlighted the variability of administration devices associated with compounded liquids for oral use in French hospital pharmacies.

Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units

Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews. We found that a combination of the physical environment, traditional work systems and team norms were among the systemic barriers to medicines safety. The layout of wards discouraged teamworking and reinforced professional boundaries. Workspaces were inadequate, and interruptions were uncontrollable. A less experienced workforce undertook prescribing and verification while more experienced nurses undertook administration. Guidelines were inadequate, with actors muddling through together. Formal controls against ADEs included checking (of prescriptions and administration) and barcode administration systems, but these did not integrate into workflows. Families played an important part in the safe administration of medication and provision of information about their children but were isolated from other parts of the system.

The Relationship Between The Implementation of Patient Safety and The Quality of Nursing Services at Purwokerto Islamic Hospital

Background : Patient safety in drug administration is still a top global health priority because patient safety has become the most important indicator in the health care system for good and bad patient health. The lower the implementation of patient safety in administering medication, the better the quality of nursing services will be. Research Objective: To determine the relationship between the implementation of patient safety in administering inpatient medication and the quality of nursing services at RSI Purwokerto. Method: Quantitative methods were used with a correlational descriptive design with a cross-sectional approach. The sampling technique was total sampling, totaling 90 respondents. Results: From this research, the results showed that there were 41 inpatient nurses (91.1%) who implemented patient safety in administering medication well, and 42 inpatient nurses (93.3%) who assessed the quality of nursing services at RSI Purwokerto as good . The results of the bivariate analysis showed that there was a significant relationship between the implementation of patient safety in administering medication and the quality of nursing services at RSI Purwokerto (p0.05). Conclusion: There is a relationship between the implementation of patient safety in inpatient medication administration and the quality of nursing services in hospitals.

Nursing Students' Perceptions Regarding Teaching and Learning Practices That Promote Safe Medication Administration.

This article reports on a study conducted to explore what helps and what complicates learning safe medication administration. In this study, nurse educators explored students' perspectives on effective teaching practices, what influences medication errors and near misses, and strategies for improving students' learning about medication administration. Students ranked nursing instructors, peers, and staff nurses as having the greatest positive impact on both their learning and patient safety. Good relationships, an appropriate pace of learning, and practice were also beneficial. Noise, time constraints, and interruptions were negatively associated with learning and patient safety.

Medication Safety Counseling Practices of Pediatric Primary Care Clinicians.

Medication exposures and poisonings are a major cause of pediatric morbidity and mortality. Unsafe patient practices are well documented despite the American Academy of Pediatrics recommending that pediatric primary care clinicians discuss medication safety with patients. Current clinician counseling practices for pediatric patients are unknown. Studies of adult patients suggest that physician counseling practices often focus on administration but not storage or disposal. To address this gap, we administered a web-based survey to clinically active pediatric primary care clinicians in two mid-Atlantic health care systems. Survey content focused on characteristics of medication safety counseling practices by age group, including safe medication storage, administration, and disposal. Of 151 clinicians emailed, 40 (26.5%) responded. The majority were physicians (93.5%), female (87.1%), and completed residency/clinical training in pediatrics >15 years ago (58.1%). Most (82.5%) reported having >1 pediatric patient (aged < 19 years) in their practice who experienced an unintentional or intentional medication exposure or poisoning event. Reported practices for medication safety counseling often varied by patient age but safe disposal was rarely addressed for any age group. Respondents generally felt less knowledgeable and less comfortable with providing counseling on safe disposal in comparison to safe storage and safe administration. Nearly all respondents (97%) would like to provide more counseling about medication safety, and the majority (81.3%) wanted additional educational resources. In this survey, we identified several modifiable deficits in pediatric medical counseling practices and a need for additional clinician training and resources, most notably in the content area of safe disposal.

Maintaining patient safety in medication administration

Maintaining patient safety in medication administration

Factors associated with continuing education needs in medication administration among school nurses.

To investigate the continuing education requirements and factors influencing school nurses' needs in relation to medication administration on school campuses. A total of 391 school nurses working in K-12 schools in Taiwan were invited to participate in an online questionnaire survey. This cross-sectional study employed a probability proportionate to size technique along with a random sampling method. Data were collected from February to April 2023. School nurses reported a significant demand for continuing education and perceived moderate levels of stress and government support related to medication administration. Among the various dimensions, the highest demand was observed for 'definition of campus medication errors' and 'regulations for campus medical orders.' Moreover, the 'identifying drug interactions' and 'adverse drug effects and referrals' dimensions were identified as the most stressful aspects. Notably, perceived stress emerged as the sole predictive factor for continuing education demand, accounting for 16.1% of the variance. The study found that there was a significant demand for and moderate stress related to continuing education among school nurses. Therefore, it is crucial for the government and school nursing organizations to develop targeted programs focusing on medication administration. These initiatives should be designed to enhance nurses' capabilities and reduce their stress, thereby ensuring safe medication administration on campuses. Continuing education enables school nurses to acquire up-to-date knowledge and improve the workflow in their practice. This study highlights a strong need for education in medication administration with a focus on 'campus medication error definitions' and 'campus medical order regulations.' The government and relevant school nursing organizations should prioritize the development and implementation of continuing education programs to decrease the school nurses' stress related to medication administration. No patient or public contribution. This study adhered to the relevant cross-sectional EQUATOR STROBE guidelines.

Effect of Augmented Reality Smart Glasses-based Nursing Skills Training for Nursing Students’ Medication Administration Safety Competency: A Quasi-experimental Study

Purpose: This study investigated the effects of augmented reality (AR) smart glasses-based nursing skills training for nursing students’ medication administration safety competency. Methods: A nonequivalent control group non-synchronized design was used. The participants were 63 sophomore nursing students taking fundamental nursing practice, with 33 in the experimental group and 30 in the control group. The nursing intervention in this study was AR smart glasses-based training on peripheral intravenous infusion nursing skills. In the pretest, information about participants’ general characteristics and confidence in medication safety were collected, and the post-test measured flow degree, learning satisfaction, skill competency, and confidence in medication safety. The collected data were analyzed using the &lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test, the Fisher exact test, and the independent t-test. Results: There were significant differences in the flow degree score, learning satisfaction score, and skill competency score between the two groups. Conclusion: This study confirmed that providing AR smart glasses-based nursing skills training for medication administration contributed to increasing flow degree, learning satisfaction, and skill competency among nursing students.

Development of an Administration Guideline of Oral Medicines to Patients with Dysphagia.

Background and Objectives: There is increasing evidence that patients with dysphagia often have limited access to suitable oral dosage forms, especially when administered via an enteral feeding tube (FT). In addition, there is a lack of clear and readily available information from drug manufacturers on how to administer medications to patients with dysphagia. This study aimed to develop a practical guide for healthcare professionals to increase the safe and effective administration of oral medications to patients with dysphagia. Materials and Methods: The data were collected from existing English databases and handbooks available to develop an easy-to-use tabular guideline presenting all relevant information using keywords and short expressions. The working group differentiated 514 formulation types, and the information was collected and added to the guideline separately. In addition, the instructions for the patients taking the medicines orally or via FT were described separately. Results: The guideline consisted of 24 keywords or short expressions developed by the working group and described the instructions to use them. The guideline contained 343 active pharmaceutical ingredients and 19 fixed-dose combinations. Conclusions: Knowledge about proper medication preparation and administration for patients with swallowing difficulties is limited but essential. It is crucial to encourage drug manufacturers to provide this information as a standard to ensure the safe and effective use of medications for all patient groups.

Assessment of Nurses Education and Attitudes Toward Patient Safe Medication Administration in Georgia

Assessment of Nurses Education and Attitudes Toward Patient Safe Medication Administration in Georgia

Frequency of nursing student medication errors: A systematic review

Background: Health promotion and patient safety are the main targets of the healthcare provision by the National Health Systems. As for the nursing profession, nursing students make medication errors during clinical interventions, which could be a potential danger to patient safety. The investigation of the frequency of nursing student medication errors, as well as the frequency of each type of nursing student medication errors. Method and Material: A systematic review of the literature was conducted on the electronic database "PubMed" with the keywords: "medication error", "prescribing error", "drug error", "drug use error", "drug mistake", "wrong drug", "wrong dose", "administration error", "dispensing error", "incorrect drug", "incorrect dose", "inappropriate prescribing", "inappropriate medication", "transcription error", "nursing student", "nursing trainee" and on the Greek electronic database IATROTEK-online with the keywords: "medication errors" and "nursing students", without time limit for the publication of scientific papers. On PubMed, the keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English and Greek language, were conducted on animals, and were case studies, editorials, and letters to the editor. Results: Of the 47 scientific papers retrieved, 6 were included in the systematic review. A total of 1,904 nursing student medication errors were recorded by nursing students. The majority of errors were: 1) wrong dose form (330,17%), 2) omission error (313, 16.4%), and 3) wrong time (259, 13.6%). Conclusions: The frequency of nursing student medication errors is high. The safe administration of medications is an important skill that nursing students should learn. medication administration.

Comparing Virtual Simulations to Paper Case Studies in Combination With Manikin-Based Medication Administration Simulations: A Quasi-Experimental Study.

Medication errors are among the most common preventable adverse events in health care. A quasi-experimental approach with a pre/posttest design was used to explore the effectiveness of an enhanced medication administration simulation bundle that included the use of manikin-based simulation-based experiences (SBEs) in combination with either virtual SBEs (V-SBEs) for deliberate practice (DP) or traditional paper case studies for DP on safe medication administration in undergraduate nursing students. Nursing students (n = 101) participated in multiple medication administration-focused SBEs including DP via V-SBEs or DP via traditional paper case studies. Student performance in the medication administration SBEs improved after the third experience. There was no statistically significant difference between the V-SBE groups compared with the traditional paper case study groups across the 3 medication administration-focused SBEs. Findings from this study highlight the importance of DP with medication administration for undergraduate nursing students.

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.

Barcode andradio frequency identification utilization varied across Korean hospitals.

Barcodes and radio frequency identification (RFID) are increasingly used in health care to improve patient safety. However, studies on their utilization in clinical settings are limited. This study aimed to comprehensively examine the utilization status of barcodes and RFID in Korean hospitals, recognize the effects and obstacles associated with utilization, and explore the measures to expand the applications of barcodes and RFID. A self-reported online survey was conducted in tertiary hospitals, general hospitals, hospitals, and nursing hospitals in the Republic of Korea. The survey questionnaire comprised questions on barcodes and RFID utilization status, the effect of barcodes and RFID utilization, measures to expand the utilization of barcodes and RFID, and information on respondents' demographics and hospitals. A representative from each of 23 tertiary hospitals, 101 general hospitals, 232 hospitals, and 214 nursing hospitals completed the survey (total response rate 17%). The data were analysed using the chi-square test or Fisher's exact test to determine the differences in responses based on the type and characteristics of hospitals. The tertiary hospitals had the highest utilizations of both RFID and barcodes (n = 10, 43.5%), whereas the nursing hospitals had the lowest (n = 96, 55.1%). Barcodes and RFID were most commonly used in the visits and security management domains. However, the use of barcodes and RFID in medication dispensing and administration safety was low, despite its value in improving patient safety. The hospitals recognized the positive effect of utilization of barcodes and RFID, reporting the highest frequency for the prevention of patient safety incidents (n = 79, 85.9%). Nevertheless, the cost of barcodes and RFID facility investments (n = 128, 90.3%) appeared to be the greatest obstacle to the introduction of barcodes and RFID. Hence, barcodes and RFID facility investment support (n = 133, 95.5%) were given the highest priority among the measures to expand barcode and RFID utilization in health care. The utilization of barcodes and RFID varied across the type and domain of hospitals in the Republic of Korea. Hospitals recognized the positive effects of barcode and RFID utilization. Nonetheless, all hospitals were concerned about the cost of investment and maintenance of barcode and RFID facilities as the main obstacles to utilization. Therefore, a support plan must be developed for the cost of barcodes and RFID facility investments to expand barcode and RFID utilization in health care.

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

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