Original Research: Exploring Medication Safety Practices from the Nurse's Perspective.
Journal
The American journal of nursing
ISSN: 1538-7488
Titre abrégé: Am J Nurs
Pays: United States
ID NLM: 0372646
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
22
11
2023
pubmed:
7
11
2023
entrez:
7
11
2023
Statut:
ppublish
Résumé
Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so. The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors. A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis. A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be. The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
Sections du résumé
BACKGROUND
Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.
PURPOSE
The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.
METHODS
A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.
RESULTS
A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.
CONCLUSIONS
The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
Identifiants
pubmed: 37934872
doi: 10.1097/01.NAJ.0000996552.02491.7d
pii: 00000446-990000000-00029
doi:
Substances chimiques
Pharmaceutical Preparations
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
18-28Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Ali L, et al. Nurses' perceptions toward factors that cause medication errors in Jordan: a qualitative study. Perspect Psychiatr Care 2021;57(3):1417–24.
Martyn JA, Paliadelis P. Safe medication administration: perspectives from an appreciative inquiry of the practice of registered nurses in regional Australia. Nurse Educ Pract 2019;34:111–6.
Bucknall T, et al. Nurses' decision-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting. J Adv Nurs 2019;75(6):1316–27.
Jennings BM, Sandelowski M, Mark B. The nurse's medication day. Qual Health Res 2011;21(10):1441–51.
McLeod M, Barber N, Franklin BD. Facilitators and barriers to safe medication administration to hospital inpatients: a mixed methods study of nurses' Medication Administration Processes and Systems (the MAPS study). PLoS One 2015;10(6):e0128958.
Berdot S, et al. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013;8(6):e68856.
Saghafi F, Zargarzadeh AH. Medication error detection in two major teaching hospitals: what are the types of errors. J Res Med Sci 2014;19(7):617–23.
Bravo K, Cochran G, Barrett R. Nursing strategies to increase medication safety in inpatient settings. J Nurs Care Qual 2016;31(4):335–41.
Lapkin S, et al. The effectiveness of interventions designed to reduce medication administration errors: a synthesis of findings from systematic reviews. J Nurs Manag 2016;24(7):845–58.
Yoder M, Schadewald D, Dietrich K. The effect of a safe zone on nurse interruptions, distractions, and medication administration errors. J Infus Nurs 2015;38(2):140–51.
Salar A, Kiani F, Rezaee N. Preventing the medication errors in hospitals: a qualitative study. Int J Afr Nurs Sci 2020;13:100235.
Smeulers M, et al. Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study. J Nurs Manag 2014;22(3):276–85.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15(9):1277–88.
Alomari A, et al. Pediatric nurses' perceptions of medication safety and medication error: a mixed methods study. Compr Child Adolesc Nurs 2018;41(2):94–110.
Cloete L. Reducing medication errors in nursing practice. Nurs Stand 2015;29(20):50–9.
Hayes C, et al. Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. J Clin Nurs 2015;24(21-22):3063–76.
Schroers G, Ross JG, Moriarty H. Nurses' perceived causes of medication administration errors: a qualitative systematic review. Jt Comm J Qual Patient Saf 2020 Sep 30. Online ahead of print.
Johnson M, et al. The impact of interruptions on medication errors in hospitals: an observational study of nurses. J Nurs Manag 2017;25(7):498–507.
Alteren J, et al. Conflicting priorities: observation of medicine administration. J Clin Nurs 2018;27(19-20):3613–21.
Wagner EA, et al. Interruptions then and now: impact on nurses' clinical reasoning, emotions, and medication safety. J Nurses Prof Dev 2020;36(6):338–44.
Simonsen BO, et al. Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study. BMC Health Serv Res 2014;14:580.
Kim MY, Kim YM, Kang SW. A survey and multilevel analysis of nursing unit tenure diversity and medication errors. J Nurs Manag 2016;24(5):634–45.
Salami I, et al. Medication administration errors: perceptions of Jordanian nurses. J Nurs Care Qual 2019;34(2):E7–E12.
Mahmood A, Chaudhury H, Valente M. Nurses' perceptions of how physical environment affects medication errors in acute care settings. Appl Nurs Res 2011;24(4):229–37.
Douglass AM, et al. A randomized controlled trial on the effect of a double check on the detection of medication errors. Ann Emerg Med 2018;71(1):74–82.e1.
Kellett P, Gottwald M. Double-checking high-risk medications in acute settings: a safer process. Nurs Manag (Harrow) 2015;21(9):16–22.
Koyama AK, et al. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Qual Saf 2020;29(7):595–603.
Stetina P, Groves M, Pafford L. Managing medication errors: a qualitative study. Medsurg Nurs 2005;14(3):174–8.
Hill PP, et al. Using simulation-based education to teach interruption management skills: an integrative review. Clin Simul Nurs 2022;64(1):46–57.
Thelen M. Medication competence: a concept analysis. Nurse Educ Today 2022;111:105292.
Vaismoradi M, et al. Nurses' adherence to patient safety principles: a systematic review. Int J Environ Res Public Health 2020;17(6):2028.
Alexander C, et al. A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders. J Nurs Manag 2022;30(3):694–701.