Bar Code Medication Administration (BCMA) is a technology-supported nursing tool that has become the standard of practice for medication administration. When used effectively and efficiently, this tool has the potential to reduce medication errors in acute care settings. In a pediatric unit at a major urban hospital in the northeast region of the United States, the absence of a BCMA nursing staff educational module affected the use of this safety tool leading to an increase of medication errors. The purpose of this DNP project was to develop a comprehensive educational module to promote BCMA in the pediatric unit of the hospital. Two theories were used to guide the translation of research into practice. Lewin's theory of planned change was used as a conceptual model to understand human behavior related to change management. Also employed was Benner's novice to expert theory to define the learning process. The research question for this project involved whether a staff education module of BCMA would optimize the medication administration process and prevent medication errors. The research design included an expert panel that used a 5-point Likert scale to evaluate the BCMA education module for clearness, effectiveness, relevance and utilization in practice. Subsequently, the effectiveness of the module was determined through a descriptive analysis. Findings that resulted from the analysis of the evidence revealed 80% percent felt the education module will increase BCMA compliance and all agreed the education module would help identify areas of needed improvement with the current process. The social change of this study will impact nurses to deliver medications safely with the use of BCMA resulting in improved patient outcomes and safe medication administration.

Quality of care is important in health care systems, and reducing medication errors is an effective approach to improve health care quality because medication errors are not rare and can cause adverse patient outcomes. Current researchers have adopted contextual, macro level methods to study the medication administration process, but the association between cognitive factors and nurses’ abilities to identify medication errors during this process remains unclear. In this research, I tested whether methods for analyzing visual scanning patterns are applicable to the study of health care processes, specifically how nurses complete the medication administration process. The data used in this study was collected during three experiments wherein nurse participants wore an eye tracking device to record their eye movements while they performed a medication administration process, with some trials containing an embedded patient identification error. The three experiments included: Nurses administering medications in a simulated setting Nurses using barcoding technology to administer medication in a simulated setting Nurses using barcoding technology to administer medication in a real clinical setting I focused on four types of visual scanning patterns when analyzing the eye tracking data: 1) nurses’ eye fixation distributions, 2) nurses’ maximum consecutive eye fixations, 3) nurses’ eye gaze transition ratios, and 4) nurses’ two gaze scanpaths. By using the aforementioned methods, I was able to distinguish visual scanning patterns between groups of nurses who identified and did not identify a patient identity error, assessed how barcode technology influenced nurses’ visual scanning patterns, and assessed how nurses’ visual scanning patterns differed in simulated and real clinical environments. These findings may have implications for the design of medication administration protocols, nurse training, and technology design.

Aim: The aim of this study was to examine if student nurse participation in root cause analysis has the potential to reduce harm to patients from medication errors by increasing student nurse sensitivity to signal and responder bias. Background: Schools of nursing have traditionally relied on strategies that focus on individual characteristics and responsibility to prevent harm to patients. The modern patient safety movement encourages utilization of systems theory strategies like Root Cause Analysis (RCA). The Patient Risk Detection Theory (Despins, Scott-Cawiezell, & Rouder, 2010) supports the use of nurse training to reduce harm to patients. Method. Descriptive and inferential analyses of the demographic and major study variables were conducted. Validity and reliability assessments for the instruments were performed. The Safe Administration of Medications-Revised Scale (Bravo, 2014) was used to measure sensitivity to signal. The Safety Attitudes Questionnaire (SAQ; Sexton et al., 2006) was used to assess responder bias; this was the first use of this instrument with nursing students. Results: The sample consisted of 125 senior-level nursing students from three universities in the southeastern United States. The SAQ was found to be a valid and reliable test of safety attitudes in nursing students. Further support for the validity and reliability of the SAM-R was provided. A significant difference in safety climate between schools was observed. There were no differences detected between the variables. Conclusion: The results of this study provide support for the use of the SAQ and the SAM-R to further test the PRDT, and to explore methods to improve nursing student ability to administer medications safely.

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Attention should be paid to pharmacotherapy in the orthopedic department mainly because patients at this department make up a risky group, they are older and often tend to use more types of drugs at the same time. Nursing at the orthopedic department is both mentally and physically demanding. Nurses administer medication to patients throughout the whole day, that is why lack of certain medication may occur in this department, the same way they would with all routine procedures. Be it conscious or unconscious. The thesis sets its objective to map out the issue of pharmacotherapy in the orthopedic department. Further, to map out factors that may influence the origin of complications when administering medication to patients in the orthopedic deartment, and suggest improvements in the process of pharmacotherapy in the orthopedic department. A qualitative research via participant observation and semi-structured interviews carried out with the nurses and patients of the orthopedic department, was used. The results of this survey prove that nurses do have basic theoretical knowledge in the area of pharmacotherapy. At the same time certain shortcomings were discovered, i.e. this theoretical knowledge is not being applied in practice. Most surprising were the results in the area of patient identification before administering medication, this step not always being abode by the nurses as a part of medical error prevention. Quite on the contrary, it can be said, based on the results, that nurses do have excellent knowledge and skills in pain reduction. This is proven by both participant observation and the happiness of patients themselves. Partial results have been presented at a seminar in the orthopedic department, and they have been passed on to the management of this department. The resulting shortcomings have been used as aid material. The diploma thesis was written so as to serve as material of information to beginner or existing nurses at the orthopedic department as well.

Many dangerous or tragic events such as airplane crashes and medical errors are often the result of human errors, and these errors are often the result of a professional worker being interrupted during a critical task. Although their impact can be serious, the ways that interruptions are affected by the physical environment have rarely been examined in the study of architecture. Therefore, this thesis investigates how the physical environment helps manage the interruptions by observing the process of medication administration by nurses in hospital units. Nurse shadowing observation data showed that the level of visibility of work areas in and around nurse stations significantly contributed to the number of interruptions initiated by others. Therefore, this thesis concludes that the physical environment affects interruption events and discusses the design implications of observation-based findings and the potential impact of the physical environment on major clinical errors. As for future directions for investigation, this thesis suggests that interruptions become a more prominent subject for consideration in architecture, and the physical environment as a subject for analyzing interruption and performance in human factors and health care.

Sammanfattning Syftet med föreliggande arbete var att studera förekomsten av felaktiga läkemedelsordinationer på en pediatrisk avdelning. Metoden bestod i journalgranskning av läkemedelsordinationer av inskrivna patienter (n = 94) under två månader, 2012. Journalgranskningen utfördes i journaldatabasen Cosmic och omfattade 543 läkemedelsordinationer vilka granskades utifrån flertalet variabler. Resultatet visade att 174 av 543 (32 %) ordinationslistor var felaktiga. Läkemedelsnamn samt hänvisning till speciallista var angivet i samtliga ordinationer. Läkemedelsform var angivet i majoriteten av läkemedelsordinationerna. Styrka var ej angivet i 1 %, dos var ej angivet i 2 %, administrationssätt var felaktigt angivet i 6 % och var ej angivet i 9 %, administrationstidpunkt var ej angivet i 2 %. Maxdos för vid behovsläkemedel var ej angivet i 35 % och spädningsschema eller hänvisning till spädningsschema var ej angivet i 10 % av läkemedelsordinationerna. Slutsatsen visar att de vanligaste felaktigheterna bestod i administrationssätt, maxdos för vid behovsläkemedel samt spädningsschema eller hänvisning till spädningsschema. Alla felaktigheter i läkemedelsordinationen har påverkan på arbetssituationen för sjuksköterskan i såväl handhavandet av läkemedel, tidsåtgång samt resurser inom vården, vilket äventyrar patientsäkerheten. / Abstract The aim of the study was to investigate the incidence of drug prescription errors at a pediatric ward facility. The method used consisted of medical record review of drug prescription errors of enrolled patients (n = 94) for two months during 2012. Medical record review was performed and included 543 drug prescriptions, which were evaluated. The results showed that 174 of 543 (32 %) of prescription lists were incorrect, based on information given with the medication. The study found that drug name and reference to the specialist were always provided. However, errors included: dosage form not specified in 0.4%, strength was not specified in 1.1%, dose was not specified in 1.6%, route of administration was incorrectly stated in 5.9% and was not specified in 8.8%, administration time was not specified in 1.7%. Maximum dose for range order was not specified in 34.9% and dilution scheme or reference to dilution scheme was not specified in 9.6%. The conclusion of the study was that the most common prescription errors consisted of route of administration, the maximum dose if necessary drugs and dilution scheme or reference to dilution scheme. Prescription errors have effects in the workplace for nurses in the administration of drugs, which threatens patient safety.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-02-06T16:24:03Z No. of bitstreams: 2 Dissertação - Alba Valéria Sales Fortes - 2017.pdf: 2107907 bytes, checksum: 20ddc75af9d0330bcb42022d19b65776 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Rejected by Luciana Ferreira (lucgeral@gmail.com), reason: Júlio a data na citação está trocada. No guia está registrado: Obs.2: o primeiro ano da referência é o ano que vem na folha-de-rosto do documento e o segundo é o ano da defesa. Muitas vezes esses anos são os mesmos, quando não for, tomar cuidado para inserir no final da referência o ano da defesa. O sistema coloca de forma automática o ano de defesa, como sendo o que vem na folha-de-rosto do documento, mas se não for o mesmo deve-se corrigir. on 2017-02-08T10:29:59Z (GMT) / Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-02-08T15:43:55Z No. of bitstreams: 2 Dissertação - Alba Valéria Sales Fortes - 2017.pdf: 2107907 bytes, checksum: 20ddc75af9d0330bcb42022d19b65776 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-02-09T10:37:53Z (GMT) No. of bitstreams: 2 Dissertação - Alba Valéria Sales Fortes - 2017.pdf: 2107907 bytes, checksum: 20ddc75af9d0330bcb42022d19b65776 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-02-09T10:37:53Z (GMT). No. of bitstreams: 2 Dissertação - Alba Valéria Sales Fortes - 2017.pdf: 2107907 bytes, checksum: 20ddc75af9d0330bcb42022d19b65776 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-15 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / This paper aims to draw up a protocol on safe administration of medication intramuscularly to be made available to nursing staff. Methodology: descriptive study focused on the development of protocol for safe medication administration intramuscularly which were formulated based on the standards set by the scientific community, following pre-existing technical guidance grounded in clinical evidence, which were collected through a integrative literature review the following topics emerged: theoretical concepts related to anatomical issues for each drug administration region intramuscularly, as well as their graphic representations; factors that interfere directly and / or indirectly in making the decision as the best region of choice for the administration of injection; advantages and disadvantages of each region for drug administration and drug application techniques in the recommended intramuscular regions, with illustrations of them. Results: Prepared protocol with guidance on safe practices for administering medication intramuscularly, which includes the detailed description of the technique, images of anatomic regions, as well as key recommendations to this procedure, such as the correct choice of the site to be accessed, following recommended safety order, age, size of the needle, maximum volume to be injected. Conclusions: The activity of care, as well as complex, requires reliability to the assistance provided through insurance procedures and in this light, the construction of the protocol is notorious for carrying out the activities in which nursing is involved, since it is configured as a guiding instrument of care, promoting the work process of the nursing team regarding the safe administration of medications. The use of this instrument can help the practitioner to maximize therapeutic effects of administered medication, minimizing or eliminating injury to the patient and discomfort associated with intramuscular injections. / Este trabalho objetiva elaborar um protocolo sobre administração segura de medicamentos por via intramuscular a ser disponibilizado às equipes de enfermagem. Metodologia: Estudo descritivo voltado para a elaboração de protocolo para administração segura de medicamentos por via intramuscular os quais foram formulados com base nos padrões estabelecidos pela comunidade científica, seguindo orientações técnicas pré-existentes alicerçadas em evidências clínicas, as quais foram coletadas por meio de uma revisão integrativa da literatura que emergiu os seguintes tópicos: conceitos teóricos relacionados a questões anatômicas referentes a cada região de administração de medicamentos por via intramuscular, bem como suas representações gráficas; fatores que interferem direta e/ou indiretamente na tomada de decisão quanto a melhor região de escolha para administração de injetáveis; vantagens e desvantagens de cada região para administração medicamentosa e técnicas de aplicação de fármacos nas regiões intramusculares preconizadas, com ilustrações das mesmas. Resultados: Elaborado protocolo com orientações acerca de práticas seguras para administração de medicamentos por via intramuscular, o qual contempla a descrição minuciosa da técnica, imagens das regiões anatômicas, bem como recomendações essenciais a este procedimento, tais como escolha correta do local a ser acessado, seguindo ordem de segurança preconizada, faixa etária, tamanho da agulha, volume máximo a ser injetado. Conclusões: A atividade do cuidar, além de complexa, exige confiabilidade à assistência prestada por meio de procedimentos seguros e sob essa ótica, a construção do protocolo é notória para a execução das ações nas quais a enfermagem está envolvida, uma vez que se configura como um instrumento norteador da assistência prestada, favorecendo o processo de trabalho das equipes de enfermagem no tocante a administração segura de medicamentos. O uso deste instrumento pode ajudar o profissional a maximizar os efeitos terapêuticos da medicação administrada, minimizando ou eliminando lesões ao paciente e o desconforto associado com as injeções intramusculares.

Medication-related injuries are one of the major problems with today’s healthcare. Some commonmedication errors are inaccurate prescriptions by physicians, medication given to the wrongpatient or miscalculated doses. An important part of the medication administration are nurses,who spend about a quarter of their time administrating medication. Since they oversee the lastcontrol, checking that the correct medication is being administrated, they can prevent manymedication errors from occurring. Their working conditions are far from optimal, characterized bystaff shortages and overcapacity which result in a stressful work environment. This study aims to create a requirement specification of a future system for medicationadministration. The system will be used for inpatient care and by using a solution called closedloop medication, the system aims to reduce the medication errors as well as reduce the nurses’workload. Closed loop medication uses electronic verification to eliminate the errors that occurbetween prescription and administration by ascertain the five rights of medication (five R). Theseare principles that ensure that the right drug, with the right dose and right the route, is given tothe right patient, at the right time. The methods used for the investigation were observations as well as seminars. The observationsdemonstrated how the medication administration is carried out today while the seminars wereused to investigate how nurses would want the medication administration, based on closed loopmedication, to be carried out in the future. The results of the investigation show that nurses havedifferent views of how the future medication administration should be carried out. One significantrisk identified by the nurses is how to maintain an effective workflow when events in the earliersteps prior to administration does not work correctly. Based on the investigation the requirement specification was formulated. One of severalimportant requirements of the future system is that it should be adjustable to the different wardsand their needs. The final conclusion is the following: To make sure that an implementation ofclosed loop medication reaches its full potential, the system must not result in working conditionsmore stressful for nurses.

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