Safe Medication Administration Research Articles

Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses' perceptions of their roles and responsibilities.

Safe medication management is a cornerstone of nursing practice. Nurses prepare patients for discharge which includes the ongoing safe administration of medications. Medication reconciliation at hospital discharge is an interprofessional activity that helps to identify and rectify medication discrepancies or errors to ensure the accuracy and completeness of discharge medications and information. Nurses have a role in medication safety; however, their involvement in medication reconciliation at hospital discharge is poorly described. The study's aim was to describe acute care nurses' perceptions of their roles and responsibilities in medication reconciliation at hospital discharge, including barriers and enablers. Using focus groups, this exploratory descriptive study gathered qualitative data from nurses working in five acute care clinical units (medical, surgical and transit/discharge lounge) at a tertiary Australian hospital. The data were analysed using inductive content analysis and reported following the COREQ checklist. Thirty-two nurses were recruited. Three themes emerged from the data: nurses' medication reconciliation role involves chasing, checking and educating; burden of undertaking medication reconciliation at hospital discharge; team collaboration and communication in medication reconciliation. Nurses had a minor role in medication reconciliation at hospital discharge due to a lack of organisation clinical practice guidance and specialised training. Standardising interprofessional medication reconciliation processes and increasing nurses' involvement will help to streamline this task, reduce discharge delays, workload pressure and improve patient safety. Medication reconciliation at hospital discharge is an interprofessional patient safety activity, however little is known about nurse's role and responsibilities. This study reports nurses' important contribution to patient safety in terms of healthcare team coordination, medication checking and patient education. Supportive organisations and collaborative teams increased nurses' willingness to complete this activity.

Prospective preference assessment for the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial

BackgroundClinical trials face major barriers such as under-enrollment and selective enrollment, which threaten study completion and undermine validity and generalizability. Thus, we conducted a prospective preference assessment (PPA) prior to commencing the Comparison of Analgesic Regimen Effectiveness and Safety in Surgery (CARES) trial—a randomized controlled study comparing the outcomes of managing acute postoperative pain between opioid-sparing and opioid-based therapies. This PPA aimed to (1) determine the patients’ willingness to participate in the CARES trial, (2) identify the areas for improvement, and (3) assess the differences between willing and unwilling patients.MethodsPatients undergoing elective laparoscopic cholecystectomy were recruited between August 2019 and February 2020 from two academic hospitals. A survey was administered to each patient consisting of (1) a vignette describing the trial, (2) an assessment of the patients’ understanding of the trial, (3) open-ended questions assessing the attitudes towards the trial, and (4) patient-completed questionnaires. Data were analyzed qualitatively with thematic analysis and quantitatively with the Wilcoxon signed-rank and chi-square tests.ResultsForty-two patients were enrolled and grouped based on the 6-point Likert scale into willing (4–6, 71%) and not willing (1–3, 29%) to participate in the CARES trial. There were no significant differences with respect to all variables: age, education, sex, visible minority status, previous research, previous surgery, regular use of pain medications, surgical concerns, previous discussions on pain management, significant pain within the past 3 months, and significant use of pain medication within the past month. Factors that motivated participation were contributing to scientific research (45%), altruism (29%), and improving personal pain (24%). Common discouraging factors were negative perceptions of opioids (29%), side effects (21%), being blinded to the study medication (21%), and poor pain management (19%).ConclusionsThis PPA revealed that two key discouraging factors for patients were being blinded to the type of pain medication being taken and the potential for poor pain management as a consequence of participation. Modifications to improve patient acceptance of the CARES trial include ensuring sufficient rescue medicine and follow-up visits consistent with current standards of care for all patients, as well as patient education surrounding safe administration and side effects of the study medications.

Proper Titration Orders Are Essential for Patient Safety.

Proper Titration Orders Are Essential for Patient Safety.

Barcode Medication Administration Software Technology Use in the Emergency Department and Medication Error Rates.

High-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.

Medication Administration Safety Practices and Perceived Barriers Among Nurses: A Cross-Sectional Study in Northern Nigeria.

Safe medication administration is a vital process that ensures patients' safety and quality of life. However, reports of medication errors and their solutions are lacking. The aim of this study was to examine the correlation between medication administration safety practices and perceived barriers among nurses in northern Nigeria. A descriptive approach to research and cross-sectional design was applied to this study. The study population included nurse employees of the Zamfara State Government in northern Nigeria. Simple random sampling and systematic sampling were used in selecting the respondents of the study. Descriptive analysis and the Spearman rank-order correlation were used in data analysis. Fewer than 50% of the respondents were found to agree or strongly agree that they identify allergic patients before administering medication. Most of the respondents had agreed or strongly agreed with the following as barriers to medication administration safety practices: lack of appropriate coordination between physicians and nurses, and lack of favorable policies and facilities. There was a very weak positive correlation between medication safety practices and barriers to medication safety practices, and the correlation was statistically significant (rs = 0.180, P = 0.009). There was a high level of desirable medication administration safety practices that the respondents followed. Nonidentification of a patient's allergic status and inadequate information on the effects of medications were among the identified medication administration practice gaps. There should be policies guiding medication administration in all hospitals in Zamfara, Nigeria.

Nurses’ perceptions of medication administration safety in public hospitals in the Gauteng Province: A mixed method study

BackgroundLimited data on factors perceived to impact on medication administration errors and possible solutions to such errors in low- and middle-income settings like South Africa is available. MethodsA mixed-methods research design was used. Data were gathered from 280 medication administrators using self-report surveys, and 15 nursing unit managers using semi-structured individual interviews. ResultsCauses of medication error related to communication, human, environmental and medication factors were considered to have a moderate risk. Workload (M = 3.39; SD 0.91), stock problems (M = 3.18; SD 0.96) and illegible prescriptions (M = 3.05; SD 1.09) pose the greatest threats to medication administration safety. Most participants (n = 184; 71.1 %) agreed that medication errors never or rarely occurred in their units. The majority of respondents graded overall patient safety as excellent or very good (n = 161; 61.5 %). On safety culture, nurses felt that they are actively attempting to improve medication safety (n = 239; 90.5 %), that people support one another in the unit (n = 216; 80 %), and that their procedures and systems are good at preventing errors (n = 210; 80.2 %). Participants felt that medication administration errors were rarely reported, mostly due to fear and administrative response. Qualitative findings supported the quantitative data, adding knowledge, skill and attitude of staff as further threats to medication administration safety. Adherence to protocols, auditing, education and training, collaboration and support, communication, awareness of changes, resource management and time management were identified as possible mitigating factors. ConclusionsSolutions aimed at preventing medication errors should be based on causes identified within a specific context. In the Gauteng Province, multidisciplinary collaboration and communication; support of nurses by the hospital administration; hospital systems, procedures and initiatives; better resource management and improved pharmacological training could be seen as the foundation for improved medication administration safety.

Safe administration of medications by nursing professionals in the hospital environment: scoping review protocol

Objective: mapping strategies for safe drug administration by nursing professionals in the hospital environment. Method: scoping review conducted according to the Joanna Briggs Institute (JBI) methodology guided by the research question: What strategies for safe medication administration have been used by nursing professionals in the hospital context? The search will be carried out in six databases and in the gray literature, using the Rayyan software to manage the collection and selection of studies. The title and abstract of all identified studies will be evaluated, based on the established inclusion and exclusion criteria, by two reviewers independently and a third reviewer to resolve possible discrepancies. The data will be summarized in a descriptive way. A narrative summary will accompany the tabulated and mapped results and describe how the results relate to the objective and issue of the review.

Intervenções do enfermeiro no atendimento seguro ao paciente crítico na emergência: uma revisão integrativa

The aim was to identify in the literature the interventions of nurses related to safe care for critical patients in the Emergency Unit. Integrative review study based on scientific data from February to April 2021, with descriptive data analysis. In 25 articles included in the final sample, interventions related to three categories were identified: 1) patient identification and safe practice in the safe administration of medications; 2) Effective communication with the pre-hospital care team (APH) and intra-hospital care; 3) nurse management and organizational performance of the team in the quality of care. However, no studies on safe surgery were found and the majority considered were of the descriptive type and did not analyze the effectiveness of interventions. Studies are needed that point to the effectiveness of interventions related to the care of critically ill patients in emergencies, as well as organizational proposals for structuring the nursing team in these services.

Safe administration of medications by nursing professionals in the hospital environment: scoping review protocol

Objective: mapping strategies for safe drug administration by nursing professionals in the hospital environment. Method: scoping review conducted according to the Joanna Briggs Institute (JBI) methodology guided by the research question: What strategies for safe medication administration have been used by nursing professionals in the hospital context? The search will be carried out in six databases and in the gray literature, using the Rayyan software to manage the collection and selection of studies. The title and abstract of all identified studies will be evaluated, based on the established inclusion and exclusion criteria, by two reviewers independently and a third reviewer to resolve possible discrepancies. The data will be summarized in a descriptive way. A narrative summary will accompany the tabulated and mapped results and describe how the results relate to the objective and issue of the review.

Safe administration of medications by nursing professionals in the hospital environment: scoping review protocol

Objective: mapping strategies for safe drug administration by nursing professionals in the hospital environment. Method: scoping review conducted according to the Joanna Briggs Institute (JBI) methodology guided by the research question: What strategies for safe medication administration have been used by nursing professionals in the hospital context? The search will be carried out in six databases and in the gray literature, using the Rayyan software to manage the collection and selection of studies. The title and abstract of all identified studies will be evaluated, based on the established inclusion and exclusion criteria, by two reviewers independently and a third reviewer to resolve possible discrepancies. The data will be summarized in a descriptive way. A narrative summary will accompany the tabulated and mapped results and describe how the results relate to the objective and issue of the review.

Design and Implementation of Hospital Automatic Nursing Management Information System Based on Computer Information Technology.

Clinical nursing work fails to integrate various nursing tasks such as basic care, observation of patients' conditions, medication, treatment, communication, and health guidance to provide continuous and full nursing care for patients. Based on this, this paper uses the Internet of Things (IoT) technology to optimize the infusion process and achieve closed-loop management of medications and improve the efficiency and safety of infusion and medication administration by using a rational and effective outpatient and emergency infusion and medication management system. The system was built by applying wireless network, barcode technology, RFID, infrared tube sensing, and other technologies and was combined with actual nursing work to summarize application techniques and precautions. The application of this system will become a new highlight of medical informatization, improve patient experience, monitor infusion safety, enhance nursing care, reduce emergency medical disputes, improve patient satisfaction, and will create good social and economic benefits for the hospital.

Combining research and design: A mixed methods approach aimed at understanding and optimising inpatient medication storage systems.

BackgroundAlmost every patient admitted to hospital will receive medication during their stay. Medication errors are an important cause of patient morbidity and mortality, as well as an economic burden for healthcare institutions. Research suggests that current methods of storing medication on hospital wards are not fit for purpose, contributing to inefficiency and error.AimTo improve medication storage in inpatient areas, by exploring variation and challenges related to medication storage and designing a prototype solution.MethodsSet in four hospitals in an English teaching hospital trust, the study used a mixed methods approach comprising a quantitative descriptive survey of storage facilities and practices followed by mixed methods observations of medication rounds and interviews with patients, nurses and pharmacy staff. Quantitative data were presented descriptively and qualitative data analysed thematically and using a human-centered design approach.ResultsWe identified wide variation in medication storage facilities and practices across 77 wards. Observations and staff interviews in six wards revealed five problem areas: poor management of multiple storage facilities; lack of visibility and organisation of medication within trolleys; inadequate size of storage; lack of ownership and knowledge of standard practice; and use of key locks. Patients were largely satisfied with receiving their medication. Systematic and consistent physical organisation of medication in medication trolleys, and integrating and implementing principles of best practice, were identified as areas for intervention.Discussion and conclusionVariation in medication storage facilities and practices existed both across the organization and on individual wards. Multiple challenges were identified in how medication was stored, which if addressed may improve the efficiency and safety of medication administration and in turn, staff and patient experience. The use of design principles alongside a research approach resulted in a rapid, iterative process for developing and refining potential solutions to improve inpatient medication storage.

Safe administration of medications by enteral tube

Rationale: The aim was to increase safety in the use of drugs in patients with enteral tube (ET) by providing information both to health professionals and to the patient himself.

Comparing the Effects of Traditional Education and Root-Cause Analysis on Nursing Students' Attitudes About Safety Culture and Knowledge of Safe Medication Administration Practices: An Experimental Study.

Root-cause analysis (RCA) has been used for decades to support a culture of safety in health care institutions. Although RCA has been recommended for inclusion in a nursing curriculum, little research has been conducted on educational strategies or outcomes. The study aims were to compare differences in attitudes about safety culture and knowledge of safe medication administration after education about RCA (intervention) versus traditional safe medication administration education (control) and to provide psychometric data for the Safety Attitudes Questionnaire (SAQ) with nursing students. An experimental pretesfy/posttest study was conducted in 3 schools of nursing (N = 117). Although there was no significant difference in outcomes between the control and intervention groups, increases in SAQ scores were observed for the intervention group. The Cronbach's α for the SAQ was .93. The SAQ is a reliable instrument for measuring safety culture in schools of nursing.

Medication administration behaviors in prelicensure nursing students: A longitudinal, cohort study

AimThis longitudinal study identified changes in safe medication administration behaviors in a single cohort of students followed over four semesters of nursing school. BackgroundOver 40% of a nurse’s shift is dedicated to the processes of medication administration, placing them in a position to interrupt costly medication errors. Yet, despite efforts to decrease medication errors, including electronic medical records, smart pumps, and standardized processes, 5% of hospitalized patients experience adverse drug events and the sequela costs billions of dollars annually. One cognitive aid first introduced in nursing school to help nurses administer medications safely is the rights method, including the foundational five (patient, medication, dose, route, and time). However, facility restrictions, complicated electronic health records, and high faculty-to-student ratios are limiting opportunities to apply these rights and develop safe medication administration competency. Although nursing faculty and clinical partners expect competency when initially licensed as professionals, graduating nursing students are not competent and new graduates feel ill prepared to deliver medications safely. Previous studies report findings on safe medication administration in different cohorts of nursing students, but none has followed the same cohort of students throughout nursing school. DesignUsing a non-experimental design, the same cohort of nursing students was followed over four semesters and observed independently administering medications in simulation scenarios. MethodsEach semester, this cohort of students self-selected into 10–12 simulation groups. One student from each group was randomized to the role of primary nurse. Guided by the NLN/Jeffries simulation theory and the International Nursing Association for Clinical Simulation and Learning’s Standards of Best Practice: SimulationSM, students participated in four simulations that required the primary nurse to deliver medications as part of clinical care. A single investigator completed an observational checklist during the simulations on verification of the foundational five rights in these students. ResultsVerification of most rights varied each semester, but students consistently did poorly verifying right dose. One hundred percent of students observed in the first semester did not verify all five rights. At the time of graduation, 80% of students observed did not verify all five rights prior to medication administration. ConclusionsThese concerning findings align with previous research showing that students are not safely administering medications in patient care settings. Educators, administrators, and healthcare systems need to ensure that students receive consistent, high-quality experiences vital to training future nurses for competency in safe medication administration.

Developing an immersive virtual reality medication administration scenario using the nominal group technique

AimThis paper aims to describe how the Nominal Group Technique was applied to obtain focused content to develop medication administration error scenarios for future use to educate practicing RNs with immersive virtual reality simulation. BackgroundIn the United States, medication errors account for up to $46 million in daily loss to hospital operational budgets. Each phase of prescribing, dispensing, administration, monitoring, and reconciliation is crucial in reducing potentially life-threatening outcomes associated with medication errors. Registered Nurses are responsible for safely administering diverse classifications of medications to patients in various healthcare settings. However, human and system factors can contribute to the exposure of hospitalized patients to a medication error. Virtual reality simulation-based education can be a methodology to educate practicing Registered Nurses on safe medication practices. DesignA Nominal Group Technique process was used to generate consensus from participating Registered Nurses on human and system factors that can contribute to medication administration errors. MethodsThe process consisted of (a) preparation, (b) running the group with an introduction of the subject, (c) generation of ideas, (d) listing of ideas, (e) discussion of ideas, (f) ranking of top ideas, (g) voting on top ideas, (h) discussion of the vote outcome, and (i) re-ranking and rating the top items. Human and system factor idea items encompassed medication errors during ordering, prescribing, or administering medications. Both novice and experienced Registered Nurses rank-ordered these factors as those most likely to encounter or which would most likely occur during one working shift. ResultsDescriptive statistics of frequencies and percentages were used to analyze the findings when grouped by human and system factor categories. Non-parametric testing with a Kruskal-Wallis test was conducted to compare the human and system factors by categories and years of Registered Nurse experience. Findings revealed that the factors of Time Management: getting behind, hurried, urgent (KW-H 11.2, df 4, p = .025) and Right Medication: medications have similar look and sound-alike names (KW-H 11.1, df 4, p = .025) impacted safe medication administration for both the novice and experienced nurse. ConclusionThe NGT process identified human and system factors contributing to errors and impacting safe medication administration practices. Findings will support the creation of medication administration scenarios for use with immersive virtual reality simulation.

Training Strategies: Effect on the Nurse Interns' Medication Administration Safety

Background: Medication administration is an important part of delivering quality nursing care. The nurse intern should follow the specific guidelines to enhance their medication administration safety. Aim: The study aims to assess the effect of training strategies on the nurse intern's medication administration safety. The research hypothesis was that the implementation of the training strategies affect on the nurse intern's medication administration safety. Subjects and methods: The study was conducted at Ain Shams University Hospitals using a pre-experimental one group pretest, posttest design on 90 nurse intern. Three tools were used in data collection, namely medication administration knowledge questionnaire, an observational checklist for safety performance, and an attitude rating scale. Results: The results revealed that none of the interns had satisfactory knowledge in pretest; this significantly improved after implementation of guidelines (52.2%) also in follow up phase (58.9%). The pre-intervention adequate practice was 28.9%; it significantly improved to 100.0% at the post phase, and slightly declined to 97.0% at the follow-up phase. For attitude, it was positive among 75.6% of interns at the pre phase, and significantly increased to 96.0% at post phase, and to 100.0% at follow up phase. In multivariate analysis, the guidelines were the main independent positive predictor of nurse interns’ knowledge, attitude, and practice scores. Conclusion: The implementation of the training strategies led to significant improvements in nurse interns’ knowledge, practice and attitude, which leads to accepting the predetermined study hypothesis. Recommendations: The developed guidelines should be implemented in nursing internship orientation programs. These programs should give more emphasis to medication administration knowledge and practice with more focus on identified gaps and deficiencies. Further research is proposed to investigate the effects of different training styles, and the distractions and barriers that may increase nurse intern’s risk of committing medication administration errors.

Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study

BackgroundDespite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. ObjectivesTo assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. DesignA cross-sectional observational study. SettingsOne university four-year nursing program each in Indonesia, Taiwan, and Thailand. ParticipantsA total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. MethodsThe medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. ResultsOverall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. ConclusionsMedication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.

Clinical Reasoning, Judgment, and Safe Medication Administration Practices in Senior Nursing Students.

Medication errors occur at alarming rates. Safe medication administration practices require more than observing patient safety rights and psychomotor skills. The purpose of this study was to explore the relationships between clinical judgment skills and reasoning processes and safe medication practices in senior nursing students. Using a cross-sectional design, 29 students from 3 schools of nursing watched a video simulation of a nurse administering medications in a clinical setting. At predetermined times, reflections on the medication administration practices were journaled. Journals were scored for clinical reasoning processes and clinical judgment using the Clinical Judgment Rubric-Reflective Journal (CJR-RJ) and for medication administration best practices. Students scored low on the CJR-RJ (mean [SD], 5.2 [1.7]). We found a positive relationship between clinical judgment skills and safe medication practices (r = 0.39, t27 = 2.94, P = .018). The clinical reasoning process of Interpreting was a significant indicator of best practices (b = 1.4, t28 = 2.81, P = .010). Our findings suggest that students struggle to connect theory to practice, emphasizing the need to plan experiential learning opportunities for students to develop clinical reasoning, particularly in Interpreting, and judgment skills to prevent medication errors upon entry to practice.

UK framework for basic epilepsy training and oromucosal midazolam administration

BackgroundUK wide Oromucosal Midazolam is used as an emergency treatment in community for seizures administered by family/carers with the right training. The Joint Epilepsy Council (JEC) UK which produced the training guidelines disbanded in 2016. PurposeProvide standards for basic epilepsy education and rescue medication (Midazolam) administration. MethodsThe Epilepsy Nurses Association (ESNA), The International League against Epilepsy, British Chapter (ILAE) and the Royal college of Psychiatrists (RCPsych), used the Delphi process to update guidelines for the administration of oromucosal midazolam including developing a voluntary on-line test for carers. During 2017–2019 a facilitator worked with two ESNA committees to update the existing guidance and another to develop a question-bank. Both committee outputs were circulated to the ESNA membership, then ILAE and RCPsych for review. Patient-facing organizations and charities’ opinions were solicited. All feedback was assimilated. A private provider was contracted to deliver the test. ResultsA consensus process involving two task and finish groups of 19 people each compared, reflected, debated, and engaged with stakeholders across three stages. The updated ratified guidelines were circulated nationally. The Delphi process highlighted many regions and individuals had local assessment tools and procedures in place, while others (around 50%) had no assessment provision. 278 carers with a 95% pass-rate and 100% positive feedback have undertaken the online test (10/2020). ConclusionThe UK-wide care provision gap in basic epilepsy-training and safe rescue medication administration is now addressed. A two-yearly update to the guidelines and test is planned.