Relación de las distracciones, las características sociodemográficas y contextuales con las prácticas seguras de inyecciones durante la práctica clínica del enfermero / Relationship of distractions, sociodemographic and contextual characteristics with safe injection practices during nurses' clinical practice

Objetivo: Analizar la relación entre las distracciones, las características sociodemográficas y contextuales con la realización de las prácticas seguras de inyecciones realizadas por el enfermero durante la preparación y administración de los medicamentos en los servicios de hospitalización y terapia intensiva de adultos. Método: Estudio cuantitativo, transversal y correlacional que utilizó la observación estructurada guiada por listas de chequeo, con un muestreo no probabilístico a propósito de 446 prácticas de inyecciones. Se realizó un análisis univariado y bivariado según el nivel de medición de las variables (correlación de Spearman, punto biserial y coeficiente Eta) en el paquete estadístico IBM SPSS Statistics 24.0 y un análisis de covarianza en el paquete estadístico Statgraphic XVII. Resultados: Se observaron 448 prácticas de inyecciones ejecutadas por 26 enfermeros con 5 años de experiencia, una mediana de 4 pacientes por turno y 3 medicamentos por ronda de medicación. Las distracciones fueron más frecuentes en la fase de preparación (67,9%), siendo las comunicaciones profesionales y sociales las más comunes con relevancias opuestas según la fase del proceso de medicación. La estrategia de manejo más usada fue "multitareas". Las prácticas de inyecciones conservaron la regla "un medicamento, una aguja, una jeringa, un solo diluyente por única vez" por paciente. El porcentaje total de ítems realizados de la lista de chequeo osciló entre el 47,3% y el 84,2%. Las variables de género (femenino p=0,028, IC 95%=0,051; 0,895), familia del medicamento (antiinfectivos: p=0,000, IC 95%=3,711; 5,568; preparaciones hormonales: p=0,000, IC 95%=1,197; 5,050 y sistema musculoesquelético: p=0,000, IC 95%=-2,046; 2,822), tipo de inyección (intravenosa: p=0,000, IC 95%=-0,749; 2,060), día de la semana (fin de semana: p=0,000, IC 95%=0,358; 1,404), servicio (hospitalización: p=0,001, IC 95%=6,613; 7,925) y turno (mañana: p=0,003, IC 95%=-0,227; 0,885) explicaron en un 81,67% la práctica segura de inyecciones. Conclusiones: Las distracciones (p=0,567, IC 95%=-0,742; 0,567) no fueron una variable que explicara la práctica segura de inyecciones a diferencia de las ocho características sociodemográficas y contextuales (turno, procedimiento e insumos) del enfermero.

Objective: Analyze the relationship between distractions, sociodemographic and contextual characteristics with the accomplishment of safe injection practices performed by the nurse during the preparation and administration of medications in hospitalization and adult intensive care services. Method: Quantitative, cross-sectional, correlational study that used structured observation guided by checklists, with a non-probabilistic sampling of 446 injection practices. A univariate and bivariate analysis was performed according to the level of measurement of the variables (spearman correlation, biserial point and eta coefficient) in the IBM SPSS Statistics 24.0 statistical package and an analysis of covariance in the Statgraphic XVII statistical package. Results: 448 injection practices were observed, carried out by 26 nurses with 5 years of experience, a median of 4 patients per shift and 3 medications per round of medication. Distractions were more frequent in the preparation phase (67.9%), the professional and social communications are the most common with opposite relevance according to the phase of the medication process and the most used management strategy was "multitasking". The injection practices kept the rule "one medicine, one needle, one syringe, one diluent at a time" per patient. The total percentage of items made from the checklist ranged between 47.3% and 84.2%. Gender variables (female p=0.028, 95% CI=0.051; 0.895), drug family (anti-infectives: p=0.000, 95% CI=3.711; 5.568, hormonal preparations: p=0.000, 95% CI=1.197; 5.050 and system musculoskeletal: p=0.000, 95% CI =-2.046; 2.822), type of injection (intravenous: p=0.000, 95% CI=-0.749; 2.060), day of the week (weekend: p=0.000, 95% CI=0.358; 1.404), service (hospitalization: p=0.001, 95% CI =6.613; 7.925) and shift (morning: p=0.003, 95% CI =-0.227; 0.885) explained the safe practice of injections by 81.67%. Conclusions: Distractions (p=0.567, 95% CI =-0.742; 0.567) were not a variable that explained the safe practice of injection, unlike the eight sociodemographic and contextual characteristics (shift, procedure, and supplies) of the nurse.

Análisis de las habilidades matemáticas para el cálculo de dosis de medicamentos en estudiantes de enfermería / Analysis of mathematical skills for the calculation of medicines doses in nursing students

INTRODUCCIÓN: Los estudiantes de enfermería deben desarrollar habilidades matemáticas para una vez que sean profesionales de esta disciplina no tengan obstáculos con la dosificación de medicamentos, que es una de las funciones que deben desarrollar en el ámbito clínico, y cuya equivocación podría poner en riesgo la seguridad y vida del paciente. OBJETIVO: Analizar de qué manera las habilidades para las matemáticas básicas afecta la realización del cálculo de las dosis de medicamentos por parte de los estudiantes de enfermería en una institución universitaria. MATERIALES Y MÉTODOS: investigación descriptiva transversal realizada a través del instrumento "Habilidad matemática para el cálculo de las dosis de medicamentos" compuesto por 13 preguntas abiertas y aplicado a 256 estudiantes de los ocho semestres que componen un programa de enfermería. RESULTADOS: El estudio evidenció serias deficiencias en la resolución de situaciones que involucran distintas habilidades matemáticas básicas que debe poseer un estudiante de enfermería. Solo el 30,7% de los estudiantes pudo resolver las situaciones clínicas en las cuales tenía que realizar el cálculo de las dosis de medicamentos; también en el manejo de los porcentajes se encontró dificultades, ya que apenas el 42% logró resolver la situación planteada. La interpretación de conceptos matemáticos básicos mediante la utilización de gráficos fue interpretada adecuadamente por el 50,2%. CONCLUSIÓN: Los hallazgos de la presente investigación, mostraron que deben buscar estrategias de aprendizaje que mejoren las habilidades de los estudiantes de enfermería para la dosificación de medicamentos.

INTRODUCTION: Nursing students must develop mathematical skills so that once they are professionals in this discipline, they do not have obstacles with the dosage of medications, which is one of the functions that they must develop in the clinical field, and whose error could put at risk the safety and life of the patient. OBJECTIVE: To analyze how the skills for basic mathematics affect the calculation of medicine doses by nursing students in a university institution. MATERIALS AND METHODS: descriptive cross-sectional research, carried out through the instrument "Mathematical ability to calculate drug doses" made up of 13 open-ended questions and applied to 256 students from the eight semesters that make up a nursing program. RESULTS: The study showed serious deficiencies in the resolution of situations that involve different basic mathematical skills that a nursing student must possess. Only 30.7% of the students were able to resolve the clinical situations in which they had to perform the calculation of the drug doses; Difficulties were also found in managing the percentages, since only 42% managed to resolve the situation. The interpretation of basic mathematical concepts using graphics was adequately interpreted by 50.2%. CONCLUSION: The findings of the present investigation showed that they should seek learning strategies that improve the skills of nursing students for the dosage of medications.

Effectiveness of Clinical Nurses' interventions in reducing medication errors in a paediatric ward.

AIMS AND OBJECTIVES: To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses' medication administration practice. BACKGROUND: Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. DESIGN: An Action Research (AR) three-phase quantitative study. METHODS: Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. RESULTS: Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. CONCLUSION: Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empowers them to find solutions that are tailored to their own practice culture and environment.

Measuring knowledge, attitudes and behavior of nurses in medication management: cross-cultural comparisons in Italy and Malta.

OBJECTIVE: Medication errors are one of the most common causes of negative events affecting patient safety all over the world.  Scientific literature divides the factors that contribute to the occurrence of harmful events into factors related to the characteristics of the healthcare workers and factors related to the organization of the drug management process. The aim of the study was to examine the knowledge, attitudes and behaviours related to medication errors among Italian and Maltese nurses. SUBJECTS AND METHODS: Cross-sectional survey of nurses working in Intensive Care settings in Italian and Maltese hospitals was conducted. A valid and reliable questionnaire used in previous studies was adapted for online use. Despite improved reporting, The Strengthening the Reporting of Observational Studies in Epidemiology was used. RESULTS: Findings showed good psychometric properties and reliability. MANOVA demonstrated significant differences in nurses' perception of the pharmacist presence during medication process and of the use of computerized provider order entry. MANOVA also demonstrated significant differences in the control of vital parameters and the application of the 8 right. CONCLUSIONS: These findings support the contention that knowledge, attitude and behaviour of nurses is similar across different contexts in different countries wherein nurse training is harmonised and regulated through a transnational directive.

Risk of Patient Harm Related to Unnecessary Dilution of Ready-to-Administer Prefilled Syringes: A Literature Review.

Unnecessary dilution of ready-to-administer (RTA) syringes could increase the risk of patient harm attributed to errors related to incorrect dose, improper labeling, and the potential for microbial contamination. Although published guidelines endorse the use of commercially available RTA syringes, recent surveys indicate that best practices are not always implemented. The purpose of this article is to review the existing literature and to assess the incidence and nature of errors related to the unnecessary dilution of RTA intravenous (IV) push medications in the inpatient clinical setting. The PubMed database was searched to identify studies of errors related to the use of RTA syringes for IV push medications within the last 10 years. An additional search was conducted using other search engines to identify relevant articles in the grey literature. This literature review concludes that unnecessary dilution of IV push medication in RTA syringes is an unsafe practice that occurs routinely. This practice increases the risk of patient harm through errors related to incorrect dose, improper labeling of syringes, and the potential for microbial contamination of the product. Greater awareness of the risks associated with unnecessary dilution of RTA syringes is still needed to eliminate this unsafe IV push medication administration practice and to thereby further improve outcomes.

Dilution is no solution.

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.

Medication errors in prescription and administration in critically ill patients.

AIM: To determine the prevalence and magnitude of medication errors and their association with patients' sociodemographic and clinical characteristics and nurses' work conditions. DESIGN: An observational, analytical, cross-sectional and ambispective study was conducted in critically ill adult patients. METHODS: Data concerning prescription errors were collected retrospectively from medical records and administration errors were identified through direct observation of nurses during drug administration. Those data were collected between April and July 2015. RESULTS: A total of 650 prescription errors were identified for 961 drugs in 90 patients (mean error 7[SD 4.1] per patient) and prevalence of 47.1% (95% CI 44-50). The most frequent error was omission of the prescribed medication. Intensive care unit stay was a risk factor associated with omission error (OR 2.14; 1.46-3.14: p < .01). A total of 294 administration errors were identified for 249 drugs in 52 patients (mean error 6 [SD 6.7] per patient) and prevalence of 73.5% (95% CI 68-79). The most frequent error was interruption during drug administration. Admission to the intensive care unit (OR 0.37; 0.21-0.66: p < .01), nurses' morning shift (OR 2.15; 1.10-4.18: p = .02) and workload perception (OR 3.64; 2.09-6.35: p < .01) were risk factors associated with interruption. CONCLUSIONS: Medication errors in prescription and administration were frequent. Timely detection of errors and promotion of a medication safety culture are necessary to reduce them and ensure the quality of care in critically ill patients. IMPACT: Medication errors occur frequently in the intensive care unit but are not always identified. Due to the vulnerability of seriously ill patients and the specialized care they require, an error can result in serious adverse events. The study shows that medication errors in prescription and administration are recurrent but preventable. These findings contribute to promote awareness in the proper use of medications and guarantee the quality of nursing care.

Nurses' knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses' agency inside ruling.

This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a 'mere' tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses' knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as 'deliberations'.

Back to Basics: Medication Safety.

Perioperative nurses administer some medications but are primarily responsible for obtaining, preparing, and documenting medications. Unlike personnel in many other patient care areas, perioperative personnel may not have immediate access to a pharmacist; this lack of pharmacy support can complicate medication administration processes. A variety of medication errors occur in the perioperative setting and can negatively affect patients and personnel. Perioperative nurses should review regulatory information and professional organization guidance documents when they work with other health care team members to address medication safety issues. Some recommendations include submitting clear medication orders, using aseptic technique when transferring medications to the sterile field, and using standardized labeling. In addition, perioperative nurses should obtain only one patient's medications from a dispensing unit at a time and prepare one medication at a time. After reviewing this article and the supporting literature, perioperative nurses should have increased knowledge about medication safety.

Nurse management of vasoactive medications in intensive care: A systematic review.

AIM AND OBJECTIVE: To investigate how intensive care nurses prepare, initiate, administer, titrate, and wean vasoactive medications. BACKGROUND: The management of vasoactive medications is core business for intensive care nurses, but little is known on how nurses manage these ubiquitous and potentially harmful medications. DESIGN: A systematic review of the literature with narrative synthesis of data. METHODS: The databases CINAHL Complete, Medline Complete and EMBASE were searched from 1965 to January 2019 with keywords under five concept headings and in a variety of configurations. This systematic review was conducted according to the PRISMA guidelines. Studies were assessed for quality and bias, and a modified narrative synthesis was used to analyse data, investigate findings and explore relationships within and between studies. RESULTS: The review identified 13 studies: two observational studies, two pre and post intervention studies, four survey studies, two quasi-experimental studies, one longitudinal time series, one prospective controlled trial, and one interview incorporating content analysis. Four studies on preparing and initiating vasoactive medications described a lack of standardisation in infusion preparation and inconsistencies in dosing units and patient weights. Five of six studies on vasoactive medication administration examined nurses' use of syringe changeovers to reduce patient haemodynamic compromise and there were three studies on titration and weaning. CONCLUSION: Further research on nurse management of vasoactive medications is needed to develop an evidence base for specialist education and standardised practices aimed at reducing risk for patient harm. RELEVANCE TO CLINICAL PRACTICE: Nurses working in intensive care units in many parts of the world are responsible for the management of vasoactive medications. There is great variation in practices that include preparation, initiation, administration, titration and weaning of vasoactive medications, which increases the risk for medication errors and adverse events in a vulnerable population of critically ill patients.

Medication error encouragement training: A quasi-experimental study.

BACKGROUND: Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings students face-to-face with potential errors in the medication process, in a safe environment where they are encouraged to understand both the error and the context in which it occurred. OBJECTIVES: The study aimed to examine the effects of a MEET intervention on medication safety confidence among nursing undergraduates. DESIGN: This was a quasi-experimental study with a nonequivalent control group design. PARTICIPANTS: Our sample was recruited from the nursing education department of a university, with 47 participants randomly assigned to the experimental group, and 50 to the control group. METHODS: Both groups received theoretical training, followed by applied training. The experimental group received the MEET intervention developed specifically for this study, while the control group received traditional error avoidance training. Participants' medication administration confidence was measured pre- and post-intervention. RESULTS: Following training, the experimental group's confidence was significantly higher than that of the control group. With regard to individual medication administration procedures, the experimental groups' medication safety confidence increased significantly after training compared to the control group in patient identification, drug information confirmation, and drug preparation. CONCLUSIONS: Introducing MEET into nursing curricula could reduce medication errors and related complications in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions, as well as the generalizability of our findings.

Desdobramentos judiciais do erro na enfermagem / Despliegue judicial de errores en enfermería / Judicial deployment of nursing error

Resumo Objetivo: Caracterizar processos com decisões judiciais por erros envolvendo profissionais de enfermagem. Métodos: Estudo documental, com os casos julgados e concluídos, que versavam sobre erro envolvendo profissionais de enfermagem. O levantamento foi realizado nos meses de maio e junho de 2018, no sítio online do Tribunal de Justiça do Paraná. As informações de interesse foram: local da ocorrência, profissionais envolvidos, características das vítimas, do erro e o desfecho da investigação. Para análise os dados foram submetidos à estatística descritiva. Resultados: Foram identificados 31 casos julgados, cuja maioria ocorreu em ambiente hospitalar (90,32%), com indivíduos adultos (64,71%). Em oito casos a vítima foi a óbito, em metade deles apresentou incapacidade temporária (17=50%) e sete pessoas apresentaram incapacidade permanente. O erro mais frequente envolveu a administração de medicamentos (38,71%), seguido por erro de assistência ao parto (19,35%). Em mais da metade dos casos o boletim de ocorrência foi registrado pela própria vítima (58,06%) e somente um perito médico foi consultado durante o processo (61,29%). Em 22 casos o profissional foi condenado. Destes, 20 foram condenações cíveis e duas criminais. Em média, os processos cíveis geraram ressarcimento de R$ 42.614,30 reais e nos processos criminais, a média de tempo de reclusão, convertidos em serviços comunitários foi de 18 meses. Conclusão: Os processos judiciais culminaram em condenações. Além disso, apontam à necessidade de melhor estrutura e apoio aos profissionais que passam pela experiência jurídica.

Resumen Objetivo: Caracterizar procesos con decisiones judiciales por errores donde hubo profesionales de enfermería involucrados. Métodos: Estudio documental con los casos juzgados y concluidos, referentes a errores donde hubo profesionales de enfermería involucrados. El análisis fue realizado en los meses de mayo y junio de 2018, en el sitio web del Tribunal de Justicia de Paraná. La información de interés obtenida fue: lugar del caso, profesionales involucrados, características de las víctimas y del error y desenlace de la investigación. Los datos fueron sometidos a la estadística descriptiva para su análisis. Resultados: Se identificaron 31 casos juzgados, cuya mayoría ocurrió en ambiente hospitalario (90,32%), con individuos adultos (64,71%). En 8 casos la víctima falleció, en la mitad de los casos la persona presentó incapacidad temporaria (17=50%) y 7 personas presentaron incapacidad permanente. El error más frecuente se relacionó con la administración de medicamentos (38,71%), seguido por error de atención en el parto (19,35%). En más de la mitad de los casos, la denuncia fue registrada por la propia víctima (58,06%) y se consultó solo a un perito médico durante el proceso (61,29%). En 22 casos el profesional fue condenado, de los cuales 20 fueron sentencias civiles y dos criminales. En promedio, los procesos civiles generaron indemnizaciones de R$ 42.614,30 y en los procesos criminales, el promedio de tiempo de reclusión, convertidos en servicios comunitarios, fue de 18 meses. Conclusión: Los procesos judiciales terminaron en sentencias. Además, señalan la necesidad de una mejor estructura y apoyo a los profesionales que pasan por la experiencia jurídica.

Abstract Objective: To characterize lawsuits with judicial decisions by errors involving nursing professionals. Methods: A documentary study, with cases judged and concluded that dealt with error involving nursing professionals. The survey was carried out in May and June 2018, on the online website of the Court of Justice of Paraná State. The information of interest was place of occurrence, professionals involved, characteristics of victims, error and outcome of the investigation. For analysis, the data were submitted to descriptive statistics. Results: There were 31 cases judged, most of which occurred in a hospital (90.32%) and with adults (64.71%). In eight cases, the victim died; in half, the victims had temporary disability (17.50%); seven people had permanent disability. The most frequent error involved medication administration (38.71%), followed by delivery error (19.35%). In more than half of the cases, police report card was registered by the victim (58.06%) and only one medical expert was consulted during the lawsuit (61.29%). In 22 cases, the professional was convicted. Of these, 20 were civil and two criminal convictions. On average, civil lawsuits generated reimbursement of about 10,654 US dollars. In criminal cases, the average length of imprisonment converted into community services was 18 months. Conclusion: Lawsuits culminated in convictions. In addition, they point to the need for better structure and support for professionals who undergo legal experience.

Processo de trabalho: fundamentação para compreender os erros de enfermagem / Proceso laboral: fundamentación para comprender los errores de enfermería / Work process: a basis for understanding nursing errors

RESUMO Objetivo Identificar as causas relacionadas ao processo de trabalho que estão associadas aos erros de enfermagem noticiados pelos jornais. Método Estudo documental, qualitativo, baseado na teoria do processo de trabalho e análise hermenêutica. Foram analisadas 112 notícias de 21 jornais de grande circulação no Brasil, no período de 2012 a 2016, organizadas e codificadas no software Atlas.ti. Resultados As causas associadas aos erros noticiados foram relacionadas à força de trabalho ( deficit de profissionais e capacitação, rotatividade, sobrecarga, falta de informação, imprudência, negligência e distração); aos instrumentos de trabalho (semelhança de rótulos/embalagens, armazenamento, falta de identificação e informação de produtos e prescrição médica) e ao objeto de trabalho (particularidades dos pacientes e superlotação). Conclusão A análise das possíveis causas atribuídas aos erros noticiados permitiu tornar público não somente o resultado negativo do trabalho de enfermagem, mas também os outros elementos do processo de trabalho que influenciam esse resultado. Por isso a importância de compreender esses erros para que sejam evitados, e as condições de trabalho da enfermagem, revistas, para a garantia da qualidade e da segurança.

RESUMEN Objetivo Identificar las causas relacionadas con el proceso laboral que están asociadas con los errores de enfermería noticiados por los periódicos. Método Estudio documental, cualitativo, basado en la teoría del proceso laboral y análisis hermenéutico. Fueron analizadas 112 noticias de 21 periódicos de gran circulación en Brasil, en el período de 2012 a 2016, organizadas y codificadas en el software Atlas.ti. Resultados Las causas asociadas con los errores noticiados estuvieron relacionadas con la fuerza de trabajo (déficit de profesionales y capacitación, rotatividad, sobrecarga, falta de información, imprudencia, negligencia y distracción); con los instrumentos de trabajo (semejanza de etiquetas/envases, almacenamiento, falta de identificación e información de productos y prescripción médica) y con el objeto de trabajo (particularidades de los pacientes y abarrotado). Conclusión El análisis de las posibles causas atribuidas a los errores noticiados permitió hacer público no solo el resultado negativo del trabajo de enfermería, sino también los demás elementos del proceso laboral que influencian dicho resultado. En virtud de ello, es importante comprender esos errores a fin de que se los evite y que se revisen las condiciones del trabajo enfermero, para la garantía de la calidad y la seguridad.

ABSTRACT Objective To identify work process-related causes associated with nursing errors reported in newspapers. Method This was a documentary and qualitative study based on the work process theory and hermeneutic analysis that examined 112 news articles published between 2012 and 2016 in 21 high-circulation Brazilian newspapers, organized and codified using Atlas.ti software. Results The causes associated with the reported errors were associated with workforce (lack of professionals and training, turnover, work overload, lack of information, recklessness, negligence, and distraction); work instruments (similar labels or packages, storage, lack of product identification and information, and medical prescriptions); and the object of nursing work (overcrowding and specific characteristics of patient). Conclusion Analysis of the possible causes of reported errors identified the negative outcomes of nursing work, while also identifying elements of the work process that influenced these results. The findings emphasize the importance of understanding these errors so they can be avoided and of reviewing nursing work conditions to guarantee quality and safety of care.

Analysis of Medication Errors and near Misses Made by Nursing Students.

Despite extensive research and technological advancements, errors related to medication administration continue to rise annually. The body of evidence surrounding medication errors has focused largely on licensed practicing nurses. Nursing students can offer a unique perspective regarding medication administration as their foundation for professional psychomotor skills and cognitive abilities are developed. The purpose of this study was to explore the variables related to medication errors made by pre-licensure nursing students. Data were collected from 2013-2015 in a pre-licensure program. Students completed a post-error survey available in Google Forms. One hundred thirteen responses to the error report were completed. By exploring the factors related to medication errors among nursing students, teaching and learning strategies forming the foundations of medication administration can improve professional nursing practice and improve safety and quality of care.

Case Study: Using Electronic Medication Administration Record to Enhance Medication Safety and Improve Efficiency in Long-Term Care Facilities.

The electronic medication administration record (eMAR) has been used in hospitals and acute care facilities in Canada for over a decade. Unfortunately, the Canadian continuing care sector has been slow to adopt eMAR usage. Medication delivery in long-term care has traditionally been through paper-based orders and manual documentation in the paper medication administration record. The effectiveness of this manual system as it relates to medication incidents, patient safety and nursing efficiency is not well understood because most of the information is based on anecdotal evidence. Peer-reviewed scientific literature supports the premise that the eMAR, compared to the MAR, is more efficient, significantly reduces medication incidents, promotes patient safety and improves workflow efficiency. In April 2016, the Brenda Strafford Foundation committed to implementing the eMAR at each of our three long-term care facilities to improve medication delivery, reducing and eliminating medication incidents and evaluating the benefits of the electronic system. Under the direction of the clinical team, including nurses, physicians, pharmacists, and the software provider/vendor, an electronic system was developed and new processes for medication delivery were instituted within eight months of starting the project. Since the past year, the evaluation of the eMAR at the Brenda Strafford Foundation demonstrated a reduction in medication delivery time allowing for more time for direct care and a decrease in medication incidents, which directly affects resident health and safety. Nursing and the healthcare aides trained in medication management were surveyed and indicated that the eMAR provides a holistic view of the resident and provides important information readily available to improve the quality of resident care.

Nursing Students' Perceived Self-Efficacy and the Generation of Medication Errors with the Use of an Electronic Medication Administration Record (eMAR) in Clinical Simulation.

Medication errors continue to be a significant issue, posing substantial threats to the safety and well-being of patients. Through Bandura's theory of self-efficacy, nursing students' self-efficacy (confidence) related to medication administration was examined to investigate its influence on the generation of medication errors with the use of an Electronic Medication Administration Record (eMAR) in clinical simulation. This study examined the generation of medication errors and the differences that may exist based on nursing students' perceived confidence. The findings of this study demonstrated that nursing students continue to generate medication errors within clinical simulation. No differences in the generation of medication errors were found between nursing students with perceived high levels of confidence and those with perceived low levels of confidence (one exception noted). Further examination of the variables and contextual factors related to safe medication administration practices is required to inform nursing education and practice.