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.

Cost-effectiveness of infusion pumps to reduce errors in a Pediatric ICU.

OBJECTIVE: To analyze cost-effectiveness and to calculate incremental cost-effectiveness ratio of the use of infusion pumps with drug library to reduce errors in intravenous drug administration in pediatric and neonatal patients in Intensive Care Units. METHODS: Mathematical modeling for economic analysis of the decision tree type. The base case was composed of reference and alternative settings. The target population was neonates and pediatric patients hospitalized in Pediatric and Neonatal Intensive Care Units, comprising a cohort of 15,034 patients. The cost estimate was based on the bottom-up and top-down approaches. RESULTS: The decision tree, after RollBack, showed that the infusion pump with drug library may be the best strategy to avoid errors in intravenous drugs administration. CONCLUSION: The analysis revealed that the conventional pump, although it has the lowest cost, also has lower effectiveness.

Cost-effectiveness of infusion pumps to reduce errors in a Pediatric ICU / El costo-efectividad de bombas de infusión para la reducción de errores en una UTI Pediátrica / Custo-efetividade de bombas de infusão para a redução de erros em uma UTI Pediátrica

ABSTRACT Objective: To analyze cost-effectiveness and to calculate incremental cost-effectiveness ratio of the use of infusion pumps with drug library to reduce errors in intravenous drug administration in pediatric and neonatal patients in Intensive Care Units. Methods: Mathematical modeling for economic analysis of the decision tree type. The base case was composed of reference and alternative settings. The target population was neonates and pediatric patients hospitalized in Pediatric and Neonatal Intensive Care Units, comprising a cohort of 15,034 patients. The cost estimate was based on the bottom-up and top-down approaches. Results: The decision tree, after RollBack, showed that the infusion pump with drug library may be the best strategy to avoid errors in intravenous drugs administration. Conclusion: The analysis revealed that the conventional pump, although it has the lowest cost, also has lower effectiveness.

RESUMEN Objetivo: Analizar el costo-efectividad y calcular la razón de costo-efectividad incremental del uso de bombas de infusión con una biblioteca de fármacos para reducir errores en la administración de medicamentos por vía intravenosa, en pacientes pediátricos y neonatales en unidades de terapia intensiva. Método: Modelaje matemático para el análisis económico, del tipo árbol de decisión. El caso base se compone de escenarios de referencia y alternativo. La población objetivo fueron pacientes neonatos y pediátricos internados en unidades de terapia intensiva pediátrica y neonatal, componiendo una cohorte de 15.034 pacientes. La estimación de costos se basó en los enfoques bottom-up y top-down. Resultados: El árbol de decisión, después de Roll Back, mostró que la bomba de infusión con biblioteca de fármacos puede ser la mejor estrategia para evitar errores en la administración de medicamentos intravenosos. Conclusión: El análisis reveló que la bomba convencional, aunque tiene el menor costo, tiene también menor efectividad.

RESUMO Objetivo: Analisar o custo-efetividade e calcular a razão de custo-efetividade incremental do uso de bombas de infusão com biblioteca de fármacos para reduzir erros na administração de medicamento pela via intravenosa, em pacientes pediátricos e neonatais em Unidades de Terapia Intensiva. Método: Modelagem matemática para análise econômica, do tipo árvore de decisão. O caso-base foi composto pelos cenários de referência e alternativo. A população alvo foram pacientes neonatos e pediátricos internados em Unidades de Terapia Intensiva pediátrica e neonatal, compondo uma coorte de 15.034 pacientes. A estimativa de custos foi baseada nas abordagens bottom-up e top-down. Resultados: A árvore de decisão, após RollBack, mostrou que a bomba de infusão com biblioteca de fármacos pode ser a melhor estratégia para evitar erros na administração de medicamentos intravenosos. Conclusão: A análise revelou que a bomba convencional, embora tenha o menor custo, tem também menor efetividade.

Nurses' Safety Motivation: Examining Predictors of Nurses' Willingness to Report Medication Errors.

Medication errors are common in health care settings. Safety motivation, such as willingness to report error, is needed to contain medication errors. Limited evidence exists about measures to enforce nurses' safety motivation. The purpose of this study was to test a proposed model explaining the mechanism by which organizational and social factors influence nurses' safety motivation. Survey for this cross-sectional study was mailed to a random sample of 500 acute care nurses. Data collection started in January 2014 and lasted 6 months. Path analysis results showed a good fitting final model with 15% of explained variance on nurses' safety motivation. Safety climate dimensions of error feedback (ß = .38, p ⩽ .00) and nonpunitive response to errors (ß = .22, p = .01) significantly predicted the outcome. There is a need for both organizational and social factors to motivate nurses to report errors. Leadership practices emphasizing safety as a priority is needed to enhance nurses' safety motivation.

Assessment of the preparation and administration of oral medications to institutionalized children.

OBJECTIVE: to evaluate the preparation and administration of oral medications to institutionalized children by nursing professionals. METHOD: quantitative study, developed from August to September 2016, in a shelter in Fortaleza, Ceará. 323 observations of preparation and administration of oral drugs were carried out. Interview and non-participant direct observation of the process of drug administration were performed, whose data were analyzed through descriptive statistics. RESULTS: Of the 29 actions of preparation and administration of the drugs, ten were considered satisfactory. Sanitizing of hands before touching the pills occurred in only 5.2% of the observations and cleansing of the bottle for liquid drugs was performed in 23.8%. The actions "check the right child"; "checking medication with the prescription", and "check the right dose" obtained percentages below 15%. CONCLUSION: measures recommended by the literature for the administration of medication were not, in their clear majority, followed, making specific training and protocols necessary.

Barriers to medication error reporting among hospital nurses.

AIMS AND OBJECTIVES: The study purpose was to report medication error reporting barriers among hospital nurses, and to determine validity and reliability of an existing medication error reporting barriers questionnaire. BACKGROUND: Hospital medication errors typically occur between ordering of a medication to its receipt by the patient with subsequent staff monitoring. To decrease medication errors, factors surrounding medication errors must be understood; this requires reporting by employees. Under-reporting can compromise patient safety by disabling improvement efforts. DESIGN: This 2017 descriptive study was part of a larger workforce engagement study at a faith-based Magnet® -accredited community hospital in California (United States). METHODS: Registered nurses (~1,000) were invited to participate in the online survey via email. Reported here are sample demographics (n = 357) and responses to the 20-item medication error reporting barriers questionnaire. Using factor analysis, four factors that accounted for 67.5% of the variance were extracted. These factors (subscales) were labelled Fear, Cultural Barriers, Lack of Knowledge/Feedback and Practical/Utility Barriers; each demonstrated excellent internal consistency. RESULTS: The medication error reporting barriers questionnaire, originally developed in long-term care, demonstrated good validity and excellent reliability among hospital nurses. Substantial proportions of American hospital nurses (11%-48%) considered specific factors as likely reporting barriers. Average scores on most barrier items were categorised "somewhat unlikely." The highest six included two barriers concerning the time-consuming nature of medication error reporting and four related to nurses' fear of repercussions. CONCLUSIONS: Hospitals need to determine the presence of perceived barriers among nurses using questionnaires such as the medication error reporting barriers and work to encourage better reporting. RELEVANCE TO CLINICAL PRACTICE: Barriers to medication error reporting make it less likely that nurses will report medication errors, especially errors where patient harm is not apparent or where an error might be hidden. Such under-reporting impedes collection of accurate medication error data and prevents hospitals from changing harmful practices.

Medication safety challenges in primary care: Nurses' perspective.

AIMS AND OBJECTIVES: To identify the issues surrounding medication error reporting in community nursing and improvement strategies related to medication safety. BACKGROUND: Medication-related problems have been identified from various sources in the literature. Examples of these include incident reporting by healthcare professionals, medico-legal and patient complaints and systematic identification of organisational structure. Only a few studies report on the clinicians' perceptions of medication safety in community nursing and the challenges they face within their workplace to implement medication safety initiatives. DESIGN: Qualitative design, using conversation-style interviews with experienced registered nurses in primary care roles. METHODS: Using a general iterative approach of semantic analysis, our qualitative research study was guided by an essentialist paradigm. Our method for understanding included semi-structured in-depth interviews with 10 clinicians from a large community care organisation in rural Victoria in Australia. We developed an interview guide, which included open-ended questions on clinicians' experiences, perceived barriers and facilitators, and strategies to improve medication safety. RESULTS: Several barriers have been identified by healthcare practitioners that hinder medication safety in primary care including culture differences between community and hospital setting, politics within the healthcare system, lack of clarity around the nurses' roles and lack of error reporting. Other sources of errors cited by the participants were the lack of clarity or awareness of the processes and procedures of medication incidents reporting for staff within the organisation experience. Lack of education regarding medication safety, the dilemmas associated with reporting and documentation are also significant barriers.

'Single-checked' Patient Group Directions during initial nurse assessment within paediatric emergency departments of the UK and Ireland.

OBJECTIVE: Double checking medications at initial assessment within paediatric emergency departments (EDs) has the potential to delay patient flow, and doubt has been cast on the efficacy of double checking in all but high-risk medications. We aimed to benchmark current practice for the use of Patient Group Direction (PGD) medications at initial assessment in EDs within the Paediatric Emergency Research UK and Ireland (PERUKI) network, with a focus on the use of 'single-checker' PGDs. METHODS: Online survey was distributed to the research representative at each PERUKI site. The survey was open for 5 weeks (from March 2015 to April 2015) and was completed by any appropriate clinician within the site. RESULTS: The response rate was 84% (36/43 EDs). From these, 22 out of 36 (61%) EDs were using single-checker PGDs. The commonest single-checked medications in use were paracetamol and ibuprofen for pain. Among PERUKI sites, 21.9% of EDs reported drug errors related to standard (double-checked) PGDs, whereas 13.6% of those with single-checked PGDs reported drug errors (Fisher's exact test with significance level of 0.05, P=0.501). The commonest errors reported were duplicated dose, incorrect weight, incorrect volume drawn up, contraindication missed. CONCLUSION: Single-checker PGDs are currently in use in nearly two-thirds of PERUKI sites. No evidence of increased medication errors was reported with this practice; however, more detailed studies are required to support this finding and to inform best practice.

Wrong-patient incidents during medication administrations.

AIMS AND OBJECTIVES: To describe the factors pertaining to medication being administered to the wrong patient and to describe how patient identification is mentioned in wrong-patient incident reports. BACKGROUND: Although patient identification has been given high priority to improve patient safety, patient misidentifications occur, and wrong-patient incidents are common. DESIGN: A descriptive content analysis. METHODS: Incident reports related to medication administration (n = 1,012) were collected from two hospitals in Finland between 1 January 2013-31 December 2014. Of those, only incidents involving wrong-patient medication administration (n = 103) were included in this study. RESULTS: Wrong-patient incidents occurred due for many reasons, including nurse-related factors (such as tiredness, a lack of skills or negligence) but also system-related factors (such as rushing or heavy workloads). In 77% (n = 79) of wrong-patient incident reports, the process of identifying of the patient was not described at all. CONCLUSIONS: There is need to pay more attention to and increase training in correct identification processes to prevent wrong-patient incidents, and it is important to adjust system factors to support nurses. RELEVANCE TO CLINICAL PRACTICE: Active patient identification procedures, double-checking and verification at each stage of the medication process should be implemented. More attention should also be paid to organisational factors, such as division of work, rushing and workload, as well as to correct communication. The active participation of nurses in handling incidents could increase risk awareness and facilitate useful protection actions.

Thematic Analysis of Obstetric Anesthesia Cases From the AANA Foundation Closed Claims Database.

Maternal morbidity and mortality in the United States continues to be high. Understanding parturient complications and causes of death is critical to determine corrective actions. Analysis of closed malpractice claims evaluates patient care, identifies preventable morbidity and mortality, and offers recommendations for improvement. A review of obstetric anesthesia malpractice claims filed against nurse anesthetists (N = 21), extracted from the American Association of Nurse Anesthetists Foundation Closed Claims database, was completed. The malpractice claims included 18 maternal claims and 3 neonatal claims. The most common adverse maternal outcomes were maternal death (8/18) and nerve injury (4/18). Hemorrhage accounted for the greatest number of maternal deaths (3/8) followed by cardiovascular failure, emboli, and neuraxial opioid overdose. All neonatal claims (3/3) involved hypoxic encephalopathy resulting in 1 neonatal death and 2 cases of neonatal permanent brain injury. The majority of maternal cases were identified as nonemergent (15/18) and involved relatively healthy patients (15 identified as ASA physical status 2). Qualitative analysis of closed claims provides the opportunity to identify patterns of injuries, precipitating events, and interventions to improve care. Themes related to poor outcomes in this study include care delays, failed communication, incomplete documentation, maternal hemorrhage, and lack of provider vigilance.

Medication Errors Involving Nursing Students: A Systematic Review.

The purpose of this study was to synthesize the available empirical evidence on prelicensure nursing students' medication errors. A systematic literature review of original research publications was carried out. After the selection process, only 19 articles complied with all the requirements for inclusion in this review. The findings showed that few studies to date have analyzed errors and near misses involving nursing students, and the current evidence suggests that the incidence of them is high.

Assessment of the preparation and administration of oral medications to institutionalized children / Evaluación del preparo y de la administración de medicinas orales a los niños institucionalizados / Avaliação do preparo e da administração de medicamentos orais às crianças institucionalizadas

ABSTRACT Objective: to evaluate the preparation and administration of oral medications to institutionalized children by nursing professionals. Method: quantitative study, developed from August to September 2016, in a shelter in Fortaleza, Ceará. 323 observations of preparation and administration of oral drugs were carried out. Interview and non-participant direct observation of the process of drug administration were performed, whose data were analyzed through descriptive statistics. Results: Of the 29 actions of preparation and administration of the drugs, ten were considered satisfactory. Sanitizing of hands before touching the pills occurred in only 5.2% of the observations and cleansing of the bottle for liquid drugs was performed in 23.8%. The actions "check the right child"; "checking medication with the prescription", and "check the right dose" obtained percentages below 15%. Conclusion: measures recommended by the literature for the administration of medication were not, in their clear majority, followed, making specific training and protocols necessary.

RESUMEN Objetivo: evaluar el preparo y la administración de medicinas orales por profesionales de enfermería a niños institucionalizados. Método: estudio cuantitativo desarrollado en agosto y septiembre de 2016, en un refugio de niños de Fortaleza, Ceará. Fueron realizadas 323 observaciones del preparo y de la administración de medicinas. Se realizaron encuesta y observación directa en el participante del proceso de administración de las medicinas, cuyos datos fueron evaluados por la estadística descriptiva. Resultados: de entre las 29 acciones del preparo y de la administración de las medicinas, diez fueron consideradas satisfactorias. La higienización de las manos antes de manosear las pastillas ocurrió en el 5,2% de las observaciones y la limpieza de los frascos de medicinas se dio en el 23,8%. Las acciones "verificar el niño bien"; "verificar la medicina con la prescripción" y "certificar la dosis correcta" obtuvieron porcentuales inferiores al 15%. Conclusión: medidas recomendadas por la literatura para administración de medicinas no fueron, en su gran parte, adoptadas, convirtiéndose necesarias las capacitaciones y los protocolos específicos.

RESUMO Objetivo: avaliar o preparo e a administração de medicamentos orais por profissionais de enfermagem a crianças institucionalizadas. Método: estudo quantitativo desenvolvido em agosto e setembro de 2016, em um abrigo de Fortaleza, Ceará. Foram realizadas 323 observações do preparo e da administração de medicamentos. Realizaram-se entrevista e observação direta não participante do processo de administração dos medicamentos, cujos dados foram avaliados pela estatística descritiva. Resultados: dentre as 29 ações do preparo e da administração dos medicamentos, dez foram consideradas satisfatórias. A higienização das mãos antes de tocar em comprimidos ocorreu em 5,2% das observações e a limpeza dos frascos de medicamentos deu-se em 23,8%. As ações "conferir a criança certa"; "conferir o medicamento com a prescrição" e "verificar a dose certa" obtiveram percentuais inferiores a 15%. Conclusão: medidas recomendadas pela literatura para administração de medicamentos não foram, em maioria, adotadas, tornando-se necessários treinamentos e protocolos específicos.

Reporting of medication administration errors by nurses in South Korean hospitals.

OBJECTIVE: To identify differences in what nurses consider as medication administration errors, to examine their willingness to report these errors and to identify barriers to reporting medication errors by hospital type. DESIGN: Cross-sectional, descriptive design. The questionnaire comprised six medication administration error scenarios and items related to the reasons for not reporting medication errors. SETTING: Two tertiary and three general hospitals in a metropolitan area, and five general hospitals in K province, in South Korea. PARTICIPANTS: Registered nurses working at tertiary and general hospitals in South Korea (n = 467). MAIN OUTCOME MEASURES: Consideration of medication administration errors, intention to report medication errors and reasoning for not file an incident report. RESULTS: There were no significant differences in what nurses considered as medication administration errors between nurses working different in hospital types. The rate of incident reporting was very low; it ranged from 6.3% to 29.9%, regardless of hospital type. Korean nurses were more likely to report an error to a physician than file an incident report. The primary reason for not reporting medication errors was fear of the negative consequences of reporting the error and subsequent legal action. CONCLUSIONS: The rate of filing an incident report among nurses was very low, regardless of hospital type or whether nurses perceived the incident as a medication administration error. These results may have significant implications for improving medication safety in hospitals, and more efforts are needed at the organizational level to improve incident reporting by nurses.

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

BACKGROUND: Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. OBJECTIVES: The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. METHODS: We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. RESULTS: MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. DISCUSSION: Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

The effectiveness of interventions designed to reduce medication administration errors: a synthesis of findings from systematic reviews.

AIM: The aim of this overview was to examine the effectiveness of interventions designed to improve patient safety by reducing medication administration errors using data from systematic reviews. BACKGROUND: Medication administration errors remain unacceptably high despite the introduction of a range of interventions aimed at enhancing patient safety. Systematic reviews of strategies designed to improve medication safety report contradictory findings. A critical appraisal and synthesis of these findings are, therefore, warranted. METHODS: A comprehensive three-step search strategy was employed to search across 10 electronic databases. Two reviewers independently examined the methodological rigour and scientific quality of included systematic reviews using the Assessment of Multiple Systematic Reviews protocol. RESULTS: Sixteen systematic reviews were eligible for inclusion. Evidence suggest that multifaceted approaches involving a combination education and risk management strategies and the use of bar code technology are effective in reducing medication errors. CONCLUSION: More research is needed to determine the benefits of routine double-checking of medications during administration by nurses, outcomes of self-administration of medications by capable patients, and associations between interruptions and medications errors. IMPLICATIONS FOR NURSING MANAGEMENT: Medication-related incidents must be captured in a way that facilitates meaningful categorisation including contributing factors, potential and actual/risk of harm and contextual information on the incident.

Medication errors.

Medication errors are one of the most common causes of preventable harm to patients, and result in a financial burden on the NHS.

Validation of a questionnaire for ICU nurses to assess knowledge, attitudes and behaviours towards medication errors.

AIM: Medication errors are dangerous for the patients in an intensive care unit (ICU). Little is known about knowledge, attitudes and professional behaviour of nurses towards prevention of errors and clinical risk management can reduce errors during the preparation and administration phases of intravenous drugs. In this study we have evaluated the reliability and validity of the questionnaire to examine knowledge, attitudes and professional behaviour of ICU nurses. METHODS: Reliability analysis was tested and content validity evaluated using Cronbach's alpha to check internal consistency with the intention to obtain no misunderstanding with the results. The questionnaire composed of seven sections for a total of 36 items, was administrated among ICU nurses working in a university hospital in Rome, Italy. Data were collected in October 2015. Statistical analysis was performed with the statistical software for Windows SPSS, version 22.0. RESULTS: The questionnaire was administered to 30 ICU nurses' in anonymous, voluntary and self-administered form with close-ended type of questions, except for the socio-demographic characteristics. The highest value of Cronbach's alpha resulted on 19 items (alpha= 0,776) meaning that the questionnaire has a satisfactory internal validity. The study highlights that nurses (80%) are aware that appropriate knowledge on the calculation of medication's dose is essential to reduce medication errors during the phase of drugs'preparation. CONCLUSION: This study demonstrated that a short version of the questionnaire has very good reliability properties in the study and this needs to be taken into account for future studies.

Nurses' attitudes and perceived barriers to the reporting of medication administration errors.

AIMS: (1) To explore the attitudes and perceived barriers to reporting medication administration errors and (2) to understand the characteristics of - and nurses' feelings - about error reports. BACKGROUND: Under-reporting of medication administration errors is a global concern related to the safety of patient care. Understanding nurses' attitudes and perceived barriers to error reporting is the initial step to increasing the reporting rate. METHODS: A cross-sectional, descriptive survey with a self-administered questionnaire was completed by the nurses of a medical centre hospital in Taiwan. RESULTS: A total of 306 nurses participated in the study. Nurses' attitudes towards medication administration error reporting were inclined towards positive. The major perceived barrier was fear of the consequences after reporting. The results demonstrated that 88.9% of medication administration errors were reported orally, whereas 19.0% were reported through the hospital internet system. Self-recrimination was the common feeling of nurses after the commission of an medication administration error. CONCLUSIONS: Even if hospital management encourages errors to be reported without recrimination, nurses' attitudes toward medication administration error reporting are not very positive and fear is the most prominent barrier contributing to underreporting. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should establish anonymous reporting systems and counselling classes to create a secure atmosphere to reduce nurses' fear and provide incentives to encourage reporting.