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Mafumo JL, Luhallma TR, Maputle MS. Professional nurses supporting learners during professional socialisation in Limpopo province. Health SA 2024; 29:2450. [PMID: 38322364 PMCID: PMC10839184 DOI: 10.4102/hsag.v29i0.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/16/2023] [Indexed: 02/08/2024] Open
Abstract
Background Professional nurses play a significant role in the professional socialisation of learner nurses during clinical placement. Clinical placements are areas of experiential learning as learner nurses come in contact with real-life experiences. Professional nurses are custodians of learners and need to offer them support. Aim The study sought to explore the role of professional nurses in supporting learner nurses during professional socialisation. Setting Four clinical health facilities in Limpopo province at different levels of care were purposely sampled to obtain information from different levels of care. Methods An ethnonursing approach and qualitative, explorative design was used. Non-probability purposive sampling was used to select 25 professional nurses. The criteria were professional nurses with 3 years of experience in professional socialisation and working in institutions accredited for clinical placement of learner nurses registered in the undergraduate programme. Data were collected through a face-to-face interview until data saturation was reached. Tesch's open coding system was used to analyse data. Results Professional nurses acknowledged that their responsibilities in supporting learners during professional socialisation are mentoring, teaching and being competent practitioners. Professional nurses were aware of their role in transferring ethical skills and knowledge to learners through professional socialisation. Conclusion The effectiveness of professional socialisation of learner nurses depends on the support offered during clinical placements. Contribution The study adds to the body of knowledge in nursing education and practice because when learners are offered support in the clinical areas, their learning journey will be of positive experience leading to competent practitioners.
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Affiliation(s)
- Julia L Mafumo
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Takalani R Luhallma
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Maria S Maputle
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
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2
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Ellaway RH. Inattention in health professions education scholarship. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:319-322. [PMID: 37140663 DOI: 10.1007/s10459-023-10235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
In this editorial, the Editor-in-Chief considers inattention to details and the implications thereof in education scholarship and academic writing.
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Affiliation(s)
- Rachel H Ellaway
- Department of Community Health Sciences and Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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3
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Hoffmann M, Schwarz CM, Schwappach D, Banfi C, Palli C, Sendlhofer G. Speaking up about patient safety concerns: view of nursing students. BMC Health Serv Res 2022; 22:1547. [PMID: 36536431 PMCID: PMC9761031 DOI: 10.1186/s12913-022-08935-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND "Speaking up" is considered an important patient safety behaviour. The main idea is to voice patient safety concerns; however, several studies revealed that the organisational culture can be obstructive. In previous studies, we already identified barriers for doctors, nurses and medical students. In the current study, we explore how nursing students use "speaking up" during their internship in an academic teaching hospital. METHODS Between 2019 and 2020, 212 nursing students were invited to take part in the survey. The validated Speaking Up about Patient Safety Questionnaire (SUPS-Q) was used to assess speaking up behaviours in nursing students. The SUPS-Q consisted of three behaviour related scales (11 items), three culture related scales (11 items), a question regarding barriers to speak up as well as a clinical vignette assessing a hypothetical speaking up situation. RESULTS In total, 118 nursing students took part in the survey (response rate: 56%). Most of them noticed specific safety concerns, observed errors or rule violations. The vignette was seen as very realistic and harmful to the patient. However, the majority responded that they did not speak up and remained silent. They reported a rather discouraging environment and high levels of resignation towards speaking up. However, more advanced students were less likely to speak up than less advanced students (p = 0.027). Most relevant barriers were fear of negative reaction (64%), reaction not predictable (62%) and ineffectiveness (42%). CONCLUSIONS Survey results of nursing students imply that speaking-up behaviours and remaining silent are common behaviours and coexist in the same individual. The clinical vignette and barriers to speaking up revealed that a hierarchical system does not support speaking-up behaviours. Organizational development is needed to foster professional teamwork, support attentive listening, encourage critical thinking, and problem-solving skills.
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Affiliation(s)
- Magdalena Hoffmann
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Christine Maria Schwarz
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - David Schwappach
- grid.5734.50000 0001 0726 5157Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Chiara Banfi
- grid.11598.340000 0000 8988 2476Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Christoph Palli
- grid.452085.e0000 0004 0522 0045Institute of Health Care and Nursing, University of Applied Sciences FH Joanneum, Alte Poststrasse 149, 8020 Graz, Austria
| | - Gerald Sendlhofer
- grid.411580.90000 0000 9937 5566Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036 Graz, Austria ,grid.11598.340000 0000 8988 2476Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
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4
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Naseralallah L, Stewart D, Azfar Ali R, Paudyal V. An umbrella review of systematic reviews on contributory factors to medication errors in healthcare settings. Expert Opin Drug Saf 2022; 21:1379-1399. [DOI: 10.1080/14740338.2022.2147921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Lina Naseralallah
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Derek Stewart
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ruba Azfar Ali
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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5
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Webster CS. Existing Knowledge of Medication Error Must Be Better Translated Into Improved Patient Safety. Front Med (Lausanne) 2022; 9:870587. [PMID: 35655855 PMCID: PMC9152084 DOI: 10.3389/fmed.2022.870587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Craig S. Webster
- Department of Anaesthesiology and Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
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6
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Derese M, Agegnehu W. Challenges of Medical Error Reporting in Mizan-Tepi University Teaching Hospital: A Qualitative Exploratory Study. Drug Healthc Patient Saf 2022; 14:51-59. [PMID: 35502287 PMCID: PMC9056101 DOI: 10.2147/dhps.s347738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Medical error is defined as “an act of omission or commission in planning or execution that contributes or could contribute to an unintended result”. It is a serious public health problem that can pose a threat to patient safety and if managed it can be an opportunity to an organizational learning. This study aimed to assess the challenges of error reporting. Methods Explorative qualitative cross-sectional study was conducted. The study was conducted among healthcare providers in Mizan-Tepi University Teaching Hospital. The study participants were selected purposely based on the patient contact hour and had served in this hospital for long period of time. Twenty-one in-depth interviews were undertaken. From each wards, three in-depth interviews were held. Case team leaders and other healthcare providers were identified and interviewed. The data were analyzed thematically. Results Twenty-one healthcare providers were recruited for this study. Majority of the participants, 12 (57.1%) were nurses and midwives and as to marital status, 18 (85.7%) were married. Challenges for reporting medical errors were identified as perceived lack of confidentiality of the medical errors, perceived punitive measures, lack of good reporting system, perceived fear of losing acceptance, lack of learning culture from errors, information asymmetry, mass-media publication of medical errors, avoidance of conflict and attitude of health professionals. Conclusion There were system and individual related challenges for reporting of medical errors. Healthcare managers should enhance medical error reporting for organizational learning by addressing these system and individual factors.
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Affiliation(s)
- Msganaw Derese
- Department of Nursing, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Wubetu Agegnehu
- Department of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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7
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Gip H, The Khoa D, Guchait P, Fernando Garcia R, Pasamehmetoglu A. Employee mindfulness and creativity: when emotions and national culture matter. SERVICE INDUSTRIES JOURNAL 2022. [DOI: 10.1080/02642069.2022.2037570] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Huy Gip
- Conrad N. Hilton College of Hotel and Restaurant Management, University of Houston, Houston, TX, USA
| | - Do The Khoa
- Conrad N. Hilton College of Hotel and Restaurant Management, University of Houston, Houston, TX, USA
- Institute of Service Science, College of Technology Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Priyanko Guchait
- Conrad N. Hilton College of Hotel and Restaurant Management, University of Houston, Houston, TX, USA
| | | | - Aysin Pasamehmetoglu
- School of Applied Sciences, Hotel Management Program, Ozyegin University, Istanbul, Turkey
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8
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Alrabadi N, Shawagfeh S, Haddad R, Mukattash T, Abuhammad S, Al-rabadi D, Abu Farha R, AlRabadi S, Al-Faouri I. Medication errors: a focus on nursing practice. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Objectives
Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.
Methods
A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.
Key findings
This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.
Conclusions
Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaima Shawagfeh
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Daher Al-rabadi
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Abu Farha
- Department of Pharmacology and Pharmacotherapy, Applied Science Private University, Amman, Jordan
| | - Suzan AlRabadi
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Ibrahim Al-Faouri
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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9
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To TP, Brien JA, Story DA. Barriers to managing medications appropriately when patients have restrictions on oral intake. J Eval Clin Pract 2020; 26:172-180. [PMID: 30968525 DOI: 10.1111/jep.13139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Investigation of several serious adverse events in our organization highlighted that medications were managed inappropriately when patients have oral intake restrictions. The aim of this work was to identify the barriers to optimal medication management when patients have restrictions on their oral intake. METHOD Data were feedback and comments obtained between 2011 and 2014 from a hospital-wide quality assurance project. Data had not been purposefully collected and were in response to a general request for feedback regarding managing oral medications when patients have oral intake restrictions. Data came from a range of clinical staff and from various forums associated with the quality assurance project, including 37 presentations, 34 group meetings, and over 50 one-on-one meetings, as well as emails and other sources. Data were analysed using the thematic analysis approach. Data were coded inductively, and the domains of the Theoretical Domains Framework were used to categorize the data. Subthemes and themes were then developed. RESULTS Barriers could be broadly grouped into systems-level issues (organizational guidance and work environment) and the individual person-level issues (staff knowledge and beliefs). These barriers highlight the complexity of the medication management task. The lack of standardized guidance and consistent terminology regarding medication administration when patients have restrictions on oral intake, particularly when fasting or nil by mouth, were important systems factors, as were workflow issues and the "culture" of the environment in which staff practiced. Lack of knowledge about medication administration, social influences, and role interpretation were important individual person factors. CONCLUSION Systems- and individual person-level issues were significant contributors to inappropriate medication management when patients have oral intake restrictions. Many of the barriers may be addressed with systems approaches such as hospital-wide guidance that simplifies and standardize oral medication administration instructions, particularly regarding fasting and nil by mouth terminology.
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Affiliation(s)
- The-Phung To
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jo-Anne Brien
- St Vincent's Hospital, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David A Story
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Reynolds TL, DeLucia PR, Esquibel KA, Gage T, Wheeler NJ, Randell JA, Stevenson JG, Zheng K. Evaluating a handheld decision support device in pediatric intensive care settings. JAMIA Open 2019; 2:49-61. [PMID: 31984345 PMCID: PMC6951880 DOI: 10.1093/jamiaopen/ooy055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate end-user acceptance and the effect of a commercial handheld decision support device in pediatric intensive care settings. The technology, pac2, was designed to assist nurses in calculating medication dose volumes and infusion rates at the bedside. MATERIALS AND METHODS The devices, manufactured by InformMed Inc., were deployed in the pediatric and neonatal intensive care units in 2 health systems. This mixed methods study assessed end-user acceptance, as well as pac2's effect on the cognitive load associated with bedside dose calculations and the rate of administration errors. Towards this end, data were collected in both pre- and postimplementation phases, including through ethnographic observations, semistructured interviews, and surveys. RESULTS Although participants desired a handheld decision support tool such as pac2, their use of pac2 was limited. The nature of the critical care environment, nurses' risk perceptions, and the usability of the technology emerged as major barriers to use. Data did not reveal significant differences in cognitive load or administration errors after pac2 was deployed. DISCUSSION AND CONCLUSION Despite its potential for reducing adverse medication events, the commercial standalone device evaluated in the study was not used by the nursing participants and thus had very limited effect. Our results have implications for the development and deployment of similar mobile decision support technologies. For example, they suggest that integrating the technology into hospitals' existing IT infrastructure and employing targeted implementation strategies may facilitate nurse acceptance. Ultimately, the usability of the design will be essential to reaping any potential benefits.
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Affiliation(s)
- Tera L Reynolds
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA
| | - Patricia R DeLucia
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Karen A Esquibel
- Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Todd Gage
- InformMed, Inc., Peoria, Illinois, USA
| | | | - J Adam Randell
- Department of Psychology, University of Central Oklahoma, Edmond, Oklahoma, USA
| | - James G Stevenson
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA
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Izadpanah F, Nikfar S, Bakhshi Imcheh F, Amini M, Zargaran M. Assessment of Frequency and Causes of Medication Errors in Pediatrics and Emergency Wards of Teaching Hospitals Affiliated to Tehran University of Medical Sciences (24 Hospitals). J Med Life 2018; 11:299-305. [PMID: 30894886 PMCID: PMC6418340 DOI: 10.25122/jml-2018-0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction and Objective: Medical errors and adverse events are among the major causes of avoidable deaths and costs incurred on health systems all over the world. Medical errors are among the main challenges threatening the safety of patients in all countries and one of the most common types of medical errors is medication errors. This study aimed to determine the frequency, type, and causes of medication errors in the emergency and pediatric wards of hospitals affiliated to Tehran University of Medical Sciences in 2017. Materials and Methods: This study was a cross-sectional descriptive study which was conducted on 423 nurses working in teaching hospitals affiliated to Tehran University of Medical Sciences in 2017. The subjects were selected using the stratified sampling method. A total of 49 teaching hospitals in Tehran are affiliated to Tehran University of Medical Sciences and they are divided into two groups of general and specialized hospitals. Of all, 10 general hospitals and 14 specialized hospitals were randomly selected. The required data was collected using a three-part questionnaire. Using the SPSS software (version 18), the collected data was analyzed by means of ANOVA, Pearson Correlation Coefficient, and t-test and the results were reported as frequency, percentage, mean, and standard deviation. Results: According to the results of this study, the mean total number of medication errors that occurred within one month in the pediatric and emergency wards was roughly 41.9 cases, as stated by the nurses. The mean number of medication errors was higher in men than in women. Also, the two variables of gender and the type of shift work were related to medication errors; specifically, it was higher first in the evening and night shifts and then in the morning and evening shifts, respectively. Also, the number was higher in night shifts than in the morning shifts. The most common types of medication errors were: administration of the drugs at the wrong time, using a wrong technique of administration, wrong dosage, forgetting the dosage of the drug, administrating additional doses, administrating the drug to a wrong patient, and following the oral orders of physicians. On the other hand, the most common causes of medication errors in clinical wards were the following: illegible physician orders, shortage of manpower and high workload, incomplete physician orders, the use of lookalike and sound-alike drugs, absence of pharmacist/pharmaceutical expert in the ward, lack of dosage forms appropriate for children, and lack of adequate training regarding drug therapy. Discussion and Conclusion: Considering the results of this study, it is necessary to reduce the workload and working hours of nurses, increase medical staff's awareness of the significance of medication errors, revise the existing techniques of drug prescription, and update the indices of human resource in hospitals. It is also necessary to correct the process of naming and selecting the dosage forms of drugs by the industry.
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Affiliation(s)
| | | | | | - Mina Amini
- Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Zargaran
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences. Tehran, Iran
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12
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McCleery A, Devenny K, Ogilby C, Dunn C, Steen A, Whyte E, Darling R, VanderHoek R, MacIntyre A, Carpenter S, Wallace G, Calder L. Using medicolegal data to support safe medical care: A contributing factor coding framework. J Healthc Risk Manag 2018; 38:11-18. [PMID: 30074677 DOI: 10.1002/jhrm.21348] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Traditional medicolegal data analysis focuses on physician care, without a full acknowledgment of the effects of team, organizational, and system factors. We developed a patient safety-informed contributing factor framework to strengthen the coding and analysis of medicolegal data. MATERIALS AND METHODS We incorporated patient safety theory and human factors science into our medicolegal case coding practices to improve our understanding of the many factors that contribute to medicolegal events. RESULTS AND DISCUSSION A new framework was developed that has at its core, patients and their experience, and looks beyond the provider factors that are often the focus of medicolegal analysis to give greater consideration to the influence of team, organizational, and system factors. We anticipate that this substantial shift will strengthen our knowledge translation efforts to help improve the safety of medical care. CONCLUSION We believe that reframing medicolegal case coding systems to better identify the influence of team, organizational, and system factors will increase the utility of this analysis in patient safety research, and health care quality improvement.
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Affiliation(s)
| | | | | | - Cynthia Dunn
- Canadian Medical Protective Association, Ottowa, Canada
| | - Anne Steen
- Canadian Medical Protective Association, Ottowa, Canada
| | - Eileen Whyte
- Canadian Medical Protective Association, Ottowa, Canada
| | - Renee Darling
- Canadian Medical Protective Association, Ottowa, Canada
| | | | | | | | | | - Lisa Calder
- Canadian Medical Protective Association, Ottowa, Canada
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13
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Janmano P, Chaichanawirote U, Kongkaew C. Analysis of medication consultation networks and reporting medication errors: a mixed methods study. BMC Health Serv Res 2018; 18:221. [PMID: 29587762 PMCID: PMC5872530 DOI: 10.1186/s12913-018-3049-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine characteristics of verbal consultation about medication within social networks of hospital inpatient medication system, and their associations with medication error reporting. METHOD The setting was a 90-bed provincial district hospital with 4 wards, 7 physicians, 5 pharmacists, 44 nurses, 5 pharmacist assistants, and 4 unskilled ancillary workers. A mixed method comprising (i) a prospective observational study for investigating incidences and the nature of reporting medication errors, and (ii) a social network analysis for patterns of interaction. RESULTS Out of 5296 prescriptions, 132 medication errors were reported during the one month study period: an incidence rate of 2.5%. Every incident of medication errors was formally documented through pharmacists. The most frequent medication errors were in pre-transcribing (n = 54; 40.9%). The pharmacists were central in the whole network of consultation on medication with the mean in-degree centrality of 35 (SD 14.9) and mean out-degree centrality of 15.4 (SD 11.1). Two bridging participants were identified who were influential communicators connecting the network (betweenness centrality). Medication error reporting were influenced by (i) participants whose advice is sought and viewed as trustworthy (in-degree centrality; p < 0.001), (ii) sex (p = 0.01), and (iii) level of education (p = 0.04). CONCLUSION In-degree centrality was the most important network characteristic. A culture of medication safety can be fostered by encouraging consultation about the medication of in-patients within the hospital network where reporting of medication errors is essential.
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Affiliation(s)
- Pattarida Janmano
- Department of Pharmacy, Phrasamutchedisawatyanon Hospital, Samutprakan, 10290, Thailand.,Research Centre for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000, Thailand
| | - Uraiwan Chaichanawirote
- Faculty of Nursing, Naresuan University, Phitsanulok, 65000, Thailand.,Research Centre for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000, Thailand
| | - Chuenjid Kongkaew
- Research Centre for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000, Thailand. .,Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
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14
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Cross R, Bennett PN, Ockerby C, Wang WC, Currey J. Nurses' Attitudes Toward the Single Checking of Medications. Worldviews Evid Based Nurs 2017; 14:274-281. [PMID: 28437836 DOI: 10.1111/wvn.12201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The policy of single over double checking of medications has been adopted by many health services; however, nurses' attitudes toward single-checking medications remains unclear. The aim of this study was to explore the attitudes of nurses who single check and administer medications in a setting where single checking has been in place for over a decade. METHODS A cross-sectional survey design using the validated Single Checking Administration Medication Scale-II to registered nurses (n = 299) working in one metropolitan teaching hospital in Victoria, Australia. Descriptive analyses for participants' demographics were examined and confirmatory factor analysis (CFA) was performed on the survey items to represent the main themes of nurses' attitudes toward single checking. RESULTS Nurses reported single checking allowed a greater accountability as a professional nurse and more control over drug administration. The efficiency of single checking was welcomed by nurses through reductions in administration time and workplace interruptions. Nurses were more likely to adhere to drug administration procedures when single checking and this process facilitated drug knowledge updates. There was significant variance in attitudes amongst nurses based upon current appointment and years of clinical experience. Free text responses indicated nurses' attitudes were situated in the context of the traditional double-checking system. LINKING EVIDENCE TO ACTION Understanding nurses' attitudes toward single checking may assist health care services to positively address medication safety. Accountability, efficiency and knowledge are important for nurses when administering medications. Nurses' attitudes are varied when correlated with demographic characteristics.
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Affiliation(s)
- Rachel Cross
- Lecturer, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Paul N Bennett
- Honorary Professor, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Research Director, Pediatric Hospital Medicine, Stanford University, Stanford, CA, USA.,Director, Medical and Clinical Affairs, Satellite Healthcare, San Jose, CA, USA
| | - Cherene Ockerby
- Monash Medical Centre, Deakin University & Monash Health Partnership Centre for Nursing Research, Victoria, Australia
| | - Wei Chun Wang
- Research Fellow, Western Health Centre for Nursing Research, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Judy Currey
- Director of Postgraduate Studies, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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15
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Swartwout E, Rodan M. The Development and Testing of the Psychometric Properties of the Emotional Response and Disclosure of Errors in Clinical Practice Instrument. J Nurs Meas 2017; 25:184-200. [PMID: 28395708 DOI: 10.1891/1061-3749.25.1.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE A tool to measure the nurses' emotional response after an error in clinical practice and the potential impact emotion can have on disclosure is lacking. This study tested the psychometric properties of the Emotional Response and Disclosure of Errors in Clinical Practice instrument. METHODS The instrument was tested among 497 nurses with psychometric evaluation for validity, reliability, and exploratory factor analysis. RESULTS Exploratory factor analysis revealed a 3-factor solution which accounted for 55.4% of the total variance. Internal consistency results were Cronbach's alpha = .935 for the overall scale and each domain: concern = .907, anxiety = .888, and disbelief = .775. CONCLUSIONS Use of this valid and reliable instrument in practice and education can assist with patient safety efforts. Further testing of the instrument is recommended among other health care professionals.
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16
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Kavanagh C. Medication governance: preventing errors and promoting patient safety. BRITISH JOURNAL OF NURSING 2017; 26:159-165. [PMID: 28185490 DOI: 10.12968/bjon.2017.26.3.159] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline Kavanagh
- Lecturer, Department of Nursing, Health Sciences and Social Care, Galway-Mayo Institute of Technology, Mayo Campus, Castlebar, County Mayo, Ireland
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17
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Higuchi A, Higami Y, Takahama M, Yamakawa M, Makimoto K. Potential underreporting of medication errors in a psychiatric general hospital in Japan. Int J Nurs Pract 2016; 21 Suppl 2:2-8. [PMID: 26125569 DOI: 10.1111/ijn.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to explore a pattern of underreporting within a psychiatric general hospital in Japan. All the medication errors reported online in 2010 were analysed. This research was approved by the university and the study hospital. There were 651 incidents related to medication errors. Medication error rate per 1000 patient days was 2.14 (range: 0.45-6.05). Medication error rates between two acute care wards with comparable case and staff mix differed. A low proportion of intercepted near-misses and low medication error rates around mealtime in acute care 1 were suggestive of under-reporting. Two dementia care wards with low medication error rates had no report of intercepted errors, which was also suggestive of underreporting. Ward-specific medication error rates and patterns are useful to identify wards with potential underreporting of medication error within the hospital.
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Affiliation(s)
- Akari Higuchi
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Yoko Higami
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Masakazu Takahama
- Patient Safety and Infection Control Department, Asakayama General Psychiatric Hospital, Osaka, Japan
| | - Miyae Yamakawa
- Department of Nursing, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Kiyoko Makimoto
- Graduate School of Medicine, Department of Nursing, Osaka University, Suita City, Osaka, Japan
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18
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Valizadeh S, Feizalahzadeh H, Avari M, Virani F. Effect of Education of Principles of Drug Prescription and Calculation through Lecture and Designed Multimedia Software on Nursing Students' Learning Outcomes. Electron Physician 2016; 8:2691-9. [PMID: 27648199 PMCID: PMC5014511 DOI: 10.19082/2691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/03/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Medication errors are risk factors for patients' health and may have irrecoverable effects. These errors include medication miscalculations by nurses and nursing students. This study aimed to design a multimedia application in the field of education for drug calculations in order to compare its effectiveness with the lecture method. METHODS This study selected 82 nursing students of Tabriz University of Medical Sciences in their second and third semesters in 2015. They were pre-tested by a researcher-made multiple-choice questionnaire on their knowledge of drug administration principles and ability to carry out medicinal calculations before training and were then divided through a random block design into two groups of intervention (education with designed software) and control (lecturing) based on the mean grade of previous semesters and the pre-test score. The knowledge and ability post-test was performed using the same questions after 4 weeks of training, and the data were analyzed with IBM SPSS 20 using independent samples t-test, paired-samples t-test, and ANCOVA. RESULTS Drug calculation ability significantly increased after training in both the control and experimental groups (p<0.05). However, no significant difference emerged between the two groups in terms of medicinal calculation ability after training (p>0.05). The results showed that both training methods had no significant effect on study participants' knowledge of medicinal principles (p>0.05), whereas the score of knowledge of medicinal principles in the control group increased non-significantly. The results of the Kolmogorov-Smirnov test show that, since p>0.05, the data in the variable of knowledge of drug prescription principles and ability of medicinal calculations had a normal distribution. CONCLUSION The use of educational software has no significant effect on nursing students' drug knowledge or medicinal calculation ability. However, an e-learning program can reduce the lecture time and cost of repeated topics, such as medication, suggesting that it can be an effective component in nurse education programs.
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Affiliation(s)
- Sousan Valizadeh
- Associate Professor, Department of Pediatrics Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Feizalahzadeh
- Assistant Professor, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Avari
- M.Sc. Student of Nursing, Tabriz University Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faza Virani
- M.Sc. of Nursing, Educational Member, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Abbasi M, Zakerian A, Kolahdouzi M, Mehri A, Akbarzadeh A, Ebrahimi MH. Relationship between Work Ability Index and Cognitive Failure among Nurses. Electron Physician 2016; 8:2136-43. [PMID: 27123223 PMCID: PMC4844480 DOI: 10.19082/2136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/25/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Frequent nursing errors are considered as factors that affect the quality of healthcare of patients. Capable nurses who are compatible with work conditions are more focused on their tasks, and this reduces their errors and cognitive failures. Therefore, this study was conducted with the aim of investigating the relationship between work ability index (WAI) and cognitive failures (CFs) as well as some factors that affect them in nurses working in the ICU, CCU, and emergency wards. METHODS This descriptive-analytical and cross-sectional study was conducted with 750 nurses at educational hospitals affiliated with the Tehran University of Medical Sciences in 2015. A questionnaire of work ability index and cognitive failures was used to collect data. The data were analyzed using SPSS 20 and the Pearson and Spearman correlation coefficients, chi-squared, ANOVA, and the Kruskal-Wallis tests. RESULTS Using the Pearson correlation test, the results of this study showed that there is a significant, inverse relationship between WAI, personal prognosis of work ability, and mental resources with CFs along with all its subscales in nurses (p < 0.05). In addition, there was an inverse and significant relationship between the total score of CFs and the estimated work impairment due to diseases (p < 0.05). There was a significant positive correlation of CFs with age and experience, while WAI was inversely related to age, work experience, and body mass index (BMI) (p < 0.05). WAI and CFs were related significantly to working units (p < 0.05). CONCLUSION Considering the results obtained in this study, WAI and the cognitive status of nurses were lower than the specified limit. It is suggested that the work ability of nurses be improved and that their CFs be reduced through various measures, including pre-employment examinations, proper management of work-shift conditions, and using engineering and administrative strategies to ensure the safety of hospitalized patients.
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Affiliation(s)
- Milad Abbasi
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
- M.Sc. of Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Zakerian
- Ph.D. of Occupational Health Engineering, Associate Professor, Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Kolahdouzi
- M.Sc. of Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Sahahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Mehri
- M.Sc. of Occupational Health Engineering, Department of Occupational Health Engineering, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Arash Akbarzadeh
- M.Sc. of Biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ebrahimi
- M.D, Assistant Professor of Occupational Medicine, Department of Occupational Health Engineering, Occupational and Environmental Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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20
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Durosaiye IO, Hadjri K, Liyanage CL. Identifying Challenging Job and Environmental Demands of Older Nurses Within the National Health Service. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:82-105. [DOI: 10.1177/1937586715613586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To explore the existing theoretical contexts of the job and environmental demands of the nursing profession in the National Health Service (NHS) and to investigate how these job and environmental demands impact on the personal constructs of older nurses within the NHS. Background: Nursing is the single most widely practiced profession in the healthcare sector in the United Kingdom. However, nurses contend with challenging job and environmental demands on a daily basis, which deplete them of personal constructs (or resources) required to stay in the profession. Methods: A multilevel exploratory qualitative research design was employed. Ten managers were interviewed for the preliminary study, based on which the three characteristics of an age-friendly NHS workplace were established: health, retirement, and flexibility. Then an in-depth literature review revealed that the most adversely affected job within the NHS was the nursing profession. Finally, a focus group study was undertaken with six older nurses working in the NHS. Results: The most compelling finding of this study is that older nurses would generally not want to stay on the job if they had to work in the ward area. The physical, cognitive, and sensory constructs of older nurses are negatively affected by the job and environmental demands of the ward areas. Conclusions: Understanding how these job and environmental demands of the workplace affect an older nurse’s personal constructs may help support a better design of nurse work and the wards and help extend the working lives of older nurses in the NHS.
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21
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Feleke SA, Mulatu MA, Yesmaw YS. Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC Nurs 2015; 14:53. [PMID: 26500449 PMCID: PMC4618536 DOI: 10.1186/s12912-015-0099-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 09/30/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay. It also increases costs for clinicians and healthcare systems. Due to this, assessing the magnitude and associated factors of medication administration error has a significant contribution for improving the quality of patient care. The aim of this study was to assess the magnitude and associated factors of medication administration errors among nurses at the Felege Hiwot Referral Hospital inpatient department. METHODS A prospective, observation-based, cross-sectional study was conducted from March 24-April 7, 2014 at the Felege Hiwot Referral Hospital inpatient department. A total of 82 nurses were interviewed using a pre-tested structured questionnaire, and observed while administering 360 medications by using a checklist supplemented with a review of medication charts. Data were analyzed by using SPSS version 20 software package and logistic regression was done to identify possible factors associated with medication administration error. RESULT The incidence of medication administration error was 199 (56.4 %). The majority (87.5 %) of the medications have documentation error, followed by technique error 263 (73.1 %) and time error 193 (53.6 %). Variables which were significantly associated with medication administration error include nurses between the ages of 18-25 years [Adjusted Odds Ratio (AOR) = 2.9, 95 % CI (1.65,6.38)], 26-30 years [AOR = 2.3, 95 % CI (1.55, 7.26)] and 31-40 years [AOR = 2.1, 95 % CI (1.07, 4.12)], work experience of less than or equal to 10 years [AOR = 1.7, 95 % CI (1.33, 4.99)], nurse to patient ratio of 7-10 [AOR = 1.6, 95 % CI (1.44, 3.19)] and greater than 10 [AOR = 1.5, 95 % CI (1.38, 3.89)], interruption of the respondent at the time of medication administration [AOR = 1.5, 95 % CI (1.14, 3.21)], night shift of medication administration [AOR = 3.1, 95 % CI (1.38, 9.66)] and age of the patients with less than 18 years [AOR = 2.3, 95 % CI (1.17, 4.62)]. CONCLUSION In general, medication errors at the administration phase were highly prevalent in Felege Hiwot Referral Hospital. Documentation error is the most dominant type of error observed during the study. Increasing nurses' staffing levels, minimizing distraction and interruptions during medication administration by using no interruptions zones and "No-Talk" signage are recommended to overcome medication administration errors. Retaining experienced nurses from leaving to train and supervise inexperienced nurses with the focus on medication safety, in addition providing convenient sleep hours for nurses would be helpful in ensuring that medication errors don't occur as frequently as observed in this study.
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Affiliation(s)
- Senafikish Amsalu Feleke
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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22
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Ayoubian A, Habibi M, Yazdian P, Bagherian-Mahmoodabadi H, Arasteh P, Eghbali T, Emami Meybodi T. Survey of Nursery Errors in Healthcare Centers, Isfahan, Iran. Glob J Health Sci 2015; 8:43-8. [PMID: 26493426 PMCID: PMC4803973 DOI: 10.5539/gjhs.v8n3p43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background & Aim: Nurse's mistakes usually have a strong effect on the patients trust and satisfaction in the health services systems, and it can also lead to stress and moral contradicts among nurses. This study has aimed to survey the rate of nurses’ mistakes, according to documents in the Isfahan Province during 2007-2012. Methods: The study was a descriptive cross-sectional study. The sample population consisted of all complaints concerning nursing services provided in hospitals, private clinics and other health service centers between 2007 and 2012, submitted to the Forensic Medicine Commission Office, in Isfahan. The data were collected by a cheklist and analyzed using SPSS version 16.0 software. Results: Out of 708 complaints, 70 (9.8%) cases were related to nurses. Twenty-four cases led to awards. The age range of nurses was 35-40 (25.7%). Out of 70 nurses with a record, 75% (53 people) were female and the rest were male. Sixty four nurses (91.4%) were working in hospitals. Negligence was the first basis of the court rulings (16 cases out of 24). Nurses’ recklessness in providing services was due to their convictions among 66.7% of the cases Conclusion: Although efforts to reduce and control nurses’ faults and mistakes depends on using a system for studying and removing the factors which lead to faults, human error is inevitable in every occupation and a 100% accurate operation is unreachable.
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23
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Gransjön Craftman Å, Westerbotn M, von Strauss E, Hillerås P, Marmstål Hammar L. Older people's experience of utilisation and administration of medicines in a health- and social care context. Scand J Caring Sci 2015; 29:760-8. [DOI: 10.1111/scs.12207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Åsa Gransjön Craftman
- Sophiahemmet University and Aging Research Center (ARC); Karolinska Institutet and Stockholm University; Stockholm Sweden
| | - Margareta Westerbotn
- Sophiahemmet University and Division of Nursing; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
| | - Eva von Strauss
- Aging Research Center (ARC); The Swedish Red Cross University College; Karolinska Institutet and Stockholm University; Stockholm Sweden
| | - Pernilla Hillerås
- Sophiahemmet University and Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Lena Marmstål Hammar
- School of Health, Care, and Social Welfare; Mälardalen University; Västerås Sweden
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24
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Gransjön Craftman A, Hammar LM, von Strauss E, Hillerås P, Westerbotn M. Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services. Int J Older People Nurs 2014; 10:201-10. [PMID: 25515934 DOI: 10.1111/opn.12073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge. AIM The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. METHODS Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis. RESULTS According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. CONCLUSIONS Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients. IMPLICATIONS FOR PRACTICE This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.
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Affiliation(s)
- Asa Gransjön Craftman
- Sophiahemmet University, Stockholm, Sweden.,Aging Research Center (ARC) Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lena M Hammar
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm.,School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Eva von Strauss
- Aging Research Center (ARC) Karolinska Institutet and Stockholm University, Stockholm, Sweden.,The Swedish Red Cross University College, Stockholm, Sweden
| | - Pernilla Hillerås
- Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Margareta Westerbotn
- Sophiahemmet University, Stockholm, Sweden.,Division of Caring Science, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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Parry AM, Barriball KL, While AE. Factors contributing to registered nurse medication administration error: a narrative review. Int J Nurs Stud 2014; 52:403-20. [PMID: 25443300 DOI: 10.1016/j.ijnurstu.2014.07.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the factors contributing to Registered Nurse medication administration error behaviour. DESIGN A narrative review. DATA SOURCES Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. REVIEW METHODS A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. RESULTS The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. CONCLUSION The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error.
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Affiliation(s)
- Angela M Parry
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK.
| | - K Louise Barriball
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK
| | - Alison E While
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK
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26
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Chan C, Scott-Ladd B. The Judas Within: A Look at the Sexual Abuse Crisis in the Catholic Church. ETHICS & BEHAVIOR 2014. [DOI: 10.1080/10508422.2013.865525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Renata Grou Volpe C, Moura Pinho DL, Morato Stival M, Gomes de Oliveira Karnikowski M. Medication errors in a public hospital in Brazil. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:552-559. [PMID: 24933543 DOI: 10.12968/bjon.2014.23.11.552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes the analysis of the frequency, type and risk factors relating to errors in the preparation and administration of medications in patients admitted to a public hospital in Brasilia Federal District, Brazil, which serves a population of approximately 500,000 inhabitants. Patients are commonly affected and harmed by medication errors, almost half of which are preventable. This is a cross-sectional, descriptive and exploratory study conducted in a clinical medicine unit. Direct observations were made by eight nurse technicians. The type of error, the type of drug involved and associated risk factors were analysed. Relationships between the occurrence of errors and risk factors were studied with logistic regression models. Of the 484 observed doses, 69.5% errors occurred during drug administration, 69.6% during the preparation stage, 48.6% were timing errors, 1.7% were dose-related errors and 9.5% were errors of omission. More than one error was detected in 34.5% of occasions. Unlabelled drugs increased the risk of timing errors by a factor of 13.72. Interruptions in preparation increased the risk of errors by a factor of 3.75. Caring for a larger number of patients (8-9) increased the risk of timing errors by a factor of 8.27. The research shows the need to manage the risk of medication errors in their real-life contexts by interposing safety barriers between the hazards and potential errors.
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Hemingway S, McCann T, Baxter H, Smith G, Burgess-Dawson R, Dewhirst K. The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings. Int J Nurs Pract 2014; 21:733-40. [PMID: 24666641 DOI: 10.1111/ijn.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Steve Hemingway
- Mental Health, School of Health and Human Sciences; University of Huddersfield; Huddersfield UK
| | - Terence McCann
- Nursing Research; Victoria University; Melbourne Victoria Australia
| | - Hazel Baxter
- Older Peoples and Learning Disabilities Service Clinical Governance Support Team, Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
| | - George Smith
- Nurse Education Leadership and Development, Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
| | - Rebecca Burgess-Dawson
- Practice Learning Facilitation Office, Castleford & Normanton District Hospital; South West Yorkshire Partnership NHS Foundation Trust; Castleford UK
| | - Kate Dewhirst
- Fieldhead Hospital; South West Yorkshire Partnership Foundation Health Trust; Wakefield UK
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29
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Saleh AM, Awadalla NJ, El-masri YM, Sleem WF. Impacts of nurses’ circadian rhythm sleep disorders, fatigue, and depression on medication administration errors. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Turner S, Ramsay A, Fulop N. The role of professional communities in governing patient safety. J Health Organ Manag 2013; 27:527-43. [DOI: 10.1108/jhom-07-2012-0138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PROBLEM Nursing administrators reported that medication administration errors had continued despite the use of bar code medication administration, especially in terms of omitted medications. Nurse administrators within the study hospital identified a need to add back up safety systems in order to reduce the number of omitted medications. Interruptions and distractions were identified as leading constraints to accurate medication administration. METHODS This pre-post quality improvement study used a convenience sample of nurses on one medical surgical unit to observe the effect of specific protocols to decrease interruptions and distractions during medication administration. Nurses' were observed during medication administration cycles, and the medication time was measured in hours and minutes using a stop watch. The number of distractions and interruptions was counted by category. A participant survey was used to determine nurses perceptions of distractions and interruptions experienced. FINDINGS The five-part intervention decreased nurses interruptions and distractions by 84% compared with the control group. The results indicated the type of distractions and interruptions nurses typically experience during medication administration was highest from conversation in the environment (M = 5.0 ± 3.4) and by other personnel (M = 6.38 ± 2.6). CONCLUSION This process improvement project determined that a five-part protocol would reduce distractions and interruptions for nurses, save time in the process, and reduce omitted medications. Other visible symbols such as a vest with wording may show different results when combined with the other elements of the protocol. Anecdotal comments from nurses during and after observations divulged workplace issues surrounding medication delivery that may need investigation.
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Affiliation(s)
- Tess M Pape
- Lamar University, Beaumont, TX; Capella University, Minneapolis, MN
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Al-Arifi MN. Community pharmacists' attitudes toward dispensing errors at community pharmacy setting in Central Saudi Arabia. Saudi Pharm J 2013; 22:195-202. [PMID: 25061403 DOI: 10.1016/j.jsps.2013.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The main objective of this study was to survey pharmacists' attitudes toward dispensing errors in community pharmacy settings in Saudi Arabia. METHODS A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from March through September 2012. A stratified random sample of eight hundred registered pharmacy practitioners was collected all over Riyadh region. Statistical analysis was done using SPSS version19.0 for windows (SPSS Inc., Chicago, Illinois). RESULTS The response rate was almost 82%. The majority of the respondents are young adults (90.2%). The median for years of registration of respondent pharmacists was 9 years (range 1-37 years). About 62% (407) of the respondents have a positive response while only 37.8% (n = 248) have a negative response in this respect. The major factors identified were pharmacist assistant (82.2%) and high workload (72.5%). The most appreciated factors that help reducing dispensing errors are improving doctors' hand writing and reducing work load of the pharmacist (82.9% and 82.8% respectively), having drug names that are distinctive (76.1%) and having more than one pharmacist in duty (75.5%). CONCLUSION In conclusion, majority of community pharmacists indicated that the risk of dispensing errors was increasing and most of them were aware of dispensing errors. It is obvious from the study results that dispensing errors is a big concern for community pharmacy practice in Saudi Arabia. Therefore, there is an urgent need for the professional organizations and Pharmacy Boards in Saudi Arabia to determine standards for the profession.
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Affiliation(s)
- Mohamed N Al-Arifi
- Clinical Pharmacy Department, Director of Drug and Poison Information Center, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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The factors affecting the refusal of reporting on medication errors from the nurses' viewpoints: a case study in a hospital in iran. ISRN NURSING 2013; 2013:876563. [PMID: 23691354 PMCID: PMC3649500 DOI: 10.1155/2013/876563] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 03/12/2013] [Indexed: 11/22/2022]
Abstract
Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses' viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses (n = 100) working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent t-test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (3.56 ± 0.996), factors related to the process of reporting (3.32 ± 0.797), and fear of the consequences of reporting (3.01 ± 1.039), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (P < 0.008).
Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety.
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Rozenbaum H, Gordon L, Brezis M, Porat N. The use of a standard design medication room to promote medication safety: organizational implications. Int J Qual Health Care 2013; 25:188-96. [DOI: 10.1093/intqhc/mzt005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Van Dyck C, Dimitrova NG, de Korne DF, Hiddema F. Walk the talk: leaders' enacted priority of safety, incident reporting, and error management. Adv Health Care Manag 2013; 14:95-117. [PMID: 24772884 DOI: 10.1108/s1474-8231(2013)0000014009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). DESIGN/METHODOLOGY/APPROACH Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. FINDINGS As hypothesized, leaders' enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders' enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders' role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. RESEARCH IMPLICATIONS We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. PRACTICAL IMPLICATIONS Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. VALUE/ORIGINALITY Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.
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Hemingway S, Snowden A. Debating mental health nurses’ role in medicines management. ACTA ACUST UNITED AC 2012; 21:1219-23. [DOI: 10.12968/bjon.2012.21.20.1219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Craftman AG, von Strauss E, Rudberg SL, Westerbotn M. District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice. J Clin Nurs 2012; 22:569-78. [DOI: 10.1111/j.1365-2702.2012.04262.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Unver V, Tastan S, Akbayrak N. Medication errors: Perspectives of newly graduated and experienced nurses. Int J Nurs Pract 2012; 18:317-24. [DOI: 10.1111/j.1440-172x.2012.02052.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vesile Unver
- Gulhane Military Medical Academy; School of Nursing; Ankara; Turkey
| | - Sevinc Tastan
- Gulhane Military Medical Academy; School of Nursing; Ankara; Turkey
| | - Nalan Akbayrak
- School of Nursing; Gulhane Military Medical Academy; Ankara; Turkey
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Boyle TA, Scobie AC, MacKinnon NJ, Mahaffey T. Quality-related event learning in community pharmacies: manual versus computerized reporting processes. J Am Pharm Assoc (2003) 2012; 52:498-506, 2 p following 506. [PMID: 22825230 DOI: 10.1331/japha.2012.11004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine how staff assessment of key quality-related event (QRE) reporting process characteristics (e.g., ease of use, time to use) and QRE learning (e.g., extent that continuous improvement occurs) differ in community pharmacies in which the QRE reporting process is manual versus computerized. DESIGN Cross-sectional study. SETTING Nova Scotia, Canada, in 2010. PARTICIPANTS 121 questionnaires completed by eligible respondents in pharmacies with a formal QRE reporting process. INTERVENTION Mail-based survey. MAIN OUTCOME MEASURES A list of key QRE process characteristics that affect error reporting was identified based on a review of the health care literature and piloted in 2009. The "learning from incidents" construct, as captured by Ashcroft and Parker, was used to assess QRE learning. RESULTS Regardless of process type, the key strengths of existing QRE reporting systems appear to be that they are cost effective, easy to complete, and involve low risk to operations. However, for almost all reporting and learning characteristics, staff assessments were different between the two pharmacy types (manual versus computerized QRE reporting process), with assessments being higher from staff working in pharmacies with a computerized reporting process. CONCLUSION A QRE reporting process with a notable computer or automated component may result in more positive staff assessment of various aspects of the reporting process and QRE learning.
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Affiliation(s)
- Todd A Boyle
- Gerald Schwartz School of Business, St. Francis Xavier University, 1 West St., Antigonish, Nova Scotia, Canada.
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CUTTER JAYNE, JORDAN SUE. The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre. J Nurs Manag 2012; 21:989-1000. [DOI: 10.1111/j.1365-2834.2012.01435.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gill F, Corkish V, Robertson J, Samson J, Simmons B, Stewart D. An exploration of pediatric nurses' compliance with a medication checking and administration protocol. J SPEC PEDIATR NURS 2012; 17:136-46. [PMID: 22463474 DOI: 10.1111/j.1744-6155.2012.00331.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined nurses' reported compliance with the medication administration protocol and explored reasons for noncompliance. DESIGN AND METHOD A mixed-methods design incorporated a questionnaire (n= 72) and focus groups (n= 24). RESULTS Differences were found between the level of experience and protocol compliance. Noncompliance was widespread in the checking of identification bands and double-checking medications. Key factors influencing compliance were ward culture, type of drug, familiarity with patient and drug, and workload. The reported realities of practice were found to influence compliance with the medication administration protocol. PRACTICE IMPLICATIONS The discrepancies between protocol and practice in this setting underscore the need to more widely investigate compliance with medication administration protocols in other settings.
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Affiliation(s)
- Fenella Gill
- Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia.
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Dougherty L, Sque M, Crouch R. Decision-making processes used by nurses during intravenous drug preparation and administration. J Adv Nurs 2011; 68:1302-11. [PMID: 21999334 DOI: 10.1111/j.1365-2648.2011.05838.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to explore the decision-making processes that nurses use during intravenous drug administration and how this influences risk taking and errors. BACKGROUND Intravenous drug errors have been estimated to be a third of all drug errors. Previous drug error research has focused on observation of nurses and errors they make but has not attempted to understand the decision-making processes used during the preparation and administration of intravenous drugs. METHOD A three-phased ethnographic study was carried out in a specialist cancer hospital in 2007 using focus groups, observation and interviews. This article is concerned with the observation and interview phase. Observation took place on two wards, each over a week. Twenty nurses were observed preparing and administering intravenous drugs; then interviewed about their procedure. Data analysis was carried out using a five stage approach. FINDINGS Major themes identified include: interruptions; identification and knowing the patient; routinized behaviour, prevention of errors. These represent the findings of the observation and interviews with the nurses. One key finding was the lack of checking of patient identity prior to IV drug administration, which appeared to be based on nurses feeling they knew the patient well enough, although this was in contrast to how they checked even familiar drugs. This article will focus on identification and knowing the patient. CONCLUSION Implications for practice included: exploring new and effective methods of education based on behavioural theories; involving staff in updating policies and procedures; formal assessment of staff during intravenous preparation and administration.
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Kelly J, Wright D. Medicine administration errors and their severity in secondary care older persons' ward: a multi-centre observational study. J Clin Nurs 2011; 21:1806-15. [PMID: 21733025 DOI: 10.1111/j.1365-2702.2011.03760.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM AND OBJECTIVES To assess the severity of medicine administration errors to older patients. BACKGROUND Severity of medicine administration errors has been determined in a variety of settings but not in care-of-older-person wards, which this study aims to do. DESIGN Undisguised observational study. PARTICIPANTS Sixty-two nurses were observed administering oral medicines to 625 patients. INTERVENTIONS Data were collected on the preparation and administration of oral medicines. Thirty-five cases of error were selected and analysed for their severity. RESULTS In the 65 drug rounds observed 2129 potential drug administrations were made to 625 patients, of which 817 doses (38.4%) were given incorrectly (95% CI = 36.3-40.4). The overall mean harm score of the 35 incidents analysed was 4.1 (range 1.1-8.6, SD 1.8) on a scale of 0-10. CONCLUSIONS The number and severity of MAEs observed is high compared with previous studies. RELEVANCE TO CLINICAL PRACTICE There is a need to decrease the number and severity of MAEs, by increasing nurse awareness and error reporting.
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Affiliation(s)
- Jennifer Kelly
- Department of Dermatology, Queen Elizabeth Hospital, Norfolk, UK.
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Abstract
Usually, the circulating registered nurse assists with anesthesia induction, but other personnel tend to interrupt the process to ask questions that are unrelated to the induction process. Interruptions and distractions can lead to loss of focus and result in medication errors if a certified registered nurse anesthetist (CRNA) swaps syringes during anesthesia induction. In this study, 8 CRNAs and cycles of anesthesia induction were observed, and the number of interruptions and distractions recorded. Results showed that most were from other personnel (M = 3 ± 0.53), conversation (M = 3 ± 1.19), and noise (M = 1.5 ± 1.3). With an average of 7.5 total interruptions per 9 min, these results indicate that CRNAs may experience 68 interruptions and distractions per hour. In another setting, this number is likely to be different. We have chosen to publish this provocative article to stimulate other similar studies of interruptions and distractions in the surgical setting. More research may show whether silence during induction is upheld as a safety measure, and what might be solutions to distractions and interruptions.
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Affiliation(s)
- Theresa M Pape
- Texas Woman's University College of Nursing, Denton, TX 76204, USA.
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Popescu A, Currey J, Botti M. Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context. Worldviews Evid Based Nurs 2011; 8:15-24. [PMID: 21210951 DOI: 10.1111/j.1741-6787.2010.00212.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care. APPROACH An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n=30). Observations focused on nurses' interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses. FINDINGS Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration. IMPLICATIONS Nurses' abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error. CONCLUSIONS Nurses displayed behaviours that increased medication administration quality and safety; however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.
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Kelly J, Eggleton A, Wright D. An analysis of two incidents of medicine administration to a patient with dysphagia. J Clin Nurs 2010; 20:146-55. [PMID: 20875061 DOI: 10.1111/j.1365-2702.2010.03457.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVES To compare medicine administration by two nurses to a patient with swallowing difficulties and: To assess the safety of medication administration to a patient with dysphagia. To explore possible system changes to ensure safety standards are understood and adhered to. BACKGROUND Administering medicines to patients with dysphagia is complex and nurses need to understand the complexities and safety issues of administering polypharmacy. DESIGN Undisguised observational study. METHOD Undisguised observation was used to collect data on two nurses giving medicines to one patient on separate occasions. Root cause analysis was used to compare and contrast the two incidents to gain an understanding of how nurses interpret and administer multiple medicines to a patient with dysphagia. RESULTS Administration of medicines by both nurses was not optimal. Several factors conspired to cause this, in particular insufficient staff numbers and skill mix together with inadequate knowledge of how to administer medicines safely to patients with dysphagia. CONCLUSIONS The findings identify the need for continuing professional development (CPD) in medicine administration to provide greater understanding of the contraindications of combining medications and of the legal implications of altering formulations. RELEVANCE TO CLINICAL PRACTICE Administering medicines to patients with dysphagia is complex and requires knowledgeable understanding and attention to detail. Clinical areas caring for this client group must be well staffed with skilled, knowledgeable staff if medicines are to be given safely. This requires CPD in administering multiple medications to ensure legal and safety aspects are adhered to.
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Affiliation(s)
- Jennifer Kelly
- Dermatology Clinic, Queen Elizabeth Hospital, Kings Lynn, Norfolk, UK.
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Sulosaari V, Suhonen R, Leino-Kilpi H. An integrative review of the literature on registered nurses’ medication competence. J Clin Nurs 2010; 20:464-78. [DOI: 10.1111/j.1365-2702.2010.03228.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dickinson A, McCall E, Twomey B, James N. Paediatric nurses' understanding of the process and procedure of double-checking medications. J Clin Nurs 2010; 19:728-35. [PMID: 20500316 DOI: 10.1111/j.1365-2702.2009.03130.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC). BACKGROUND A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process. DESIGN A descriptive qualitative design was used. METHODS Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis. CONCLUSIONS This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients. RELEVANCE TO CLINICAL PRACTICE While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.
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Affiliation(s)
- Annette Dickinson
- Starship Children's Hospital, Division of Health Care Practice, AUT University, Auckland, New Zealand.
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The Relationship Between Incident Reporting by Nurses and Safety Management in Hospitals. Qual Manag Health Care 2010; 19:164-72. [DOI: 10.1097/qmh.0b013e3181dafe88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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