Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019 / One of the most important issues in the provision of healthcare services which threaten the patient's safety, is medication administration errors. These could compromise patient safety and may lead to patient disability or even death, besides the financial cost of these errors. Nurses are responsible for administering medication to numerous patients. They thus are the last defence line against medication administration errors. All student nurses are trained very early in their courses on how to administer medication and all the complications and implications that accompany this important procedure. Although lecturers spend time and effort in teaching nursing students about protocols for safe medication administration, nurses still commit medication administration errors. The aim of the study was to determine awareness and perception of the occurrence and reporting of medication administration errors (MAEs) among nursing students. A descriptive quantitative design was employed. A questionnaire was used to collect data. Responses were collected from 291 nursing students at a higher education institution in the Western Cape, South Africa. Nonprobability proportional quota sampling was used in this study for data collection. Data was analysed with IBM SPSS® software. Data was presented in graphs, percentages, means, and standard deviation, while inferential statistics were conducted. The findings of the study reveal that 85.2% of the respondents were aware of MAE occurrence, but 40.1% were unaware of reporting of these errors. The top and most significant subscale for MAE occurrence was the physician communication subscale, while the top and only significant barrier to reporting these errors was the fear subscale. In conclusion, most of the respondents were aware of MAE occurrence, while more than a third were unaware of the reporting of these errors. The study recommended building non-punitive blame-free reporting systems to emphasise the importance of reporting errors.

Class of 2012 Abstract / Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records. Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May 2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded. Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully (p=0.03). Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went down even though the amount of scheduling errors did not decrease.

Medication errors are a global concern that may affect patients' hospital stays, patients' lives after discharge, treatment costs, and mortality rates. Understanding medication errors among nursing students may help in preventing these errors as nurses are responsible for safe medication administration. The purpose of this descriptive phenomenological study was to examine upper-level nursing students' understanding of and experiences with medication administration and patient safety. Benner's nursing theory of novice to expert and Dreyfus's model of skill acquisition comprised the conceptual framework. Research questions focused on students' perceptions of safe medication administration. Face-to-face interviews were conducted with 7 upper-level nursing students from a baccalaureate nursing program in the Southeastern U.S. utilizing convenience sampling. Colaizzi's analysis strategy was followed in determining themes and clustering data into categories. Three major themes emerged from the data that included learning curve referring to the rigor of the pharmacology course, gaining self-confidence, and reliance on preceptor. Two sub-themes were identified from the theme learning curve, which included fear of making a mistake causing harm to a patient, and appreciating the complexity of the working environment and the intricacy of the patients. Using study findings, a hybrid pharmacology and medication administration course for nursing students was developed. The course may improve nursing students' confidence in their skills and knowledge and enable them to provide a safer environment for patients. Implications for positive social change include a potential reduction in medication errors and related adverse outcomes experienced by patients and their families and by health care organization.

SAMMANFATTNING Bakgrund: Antipsykotika utgör grunden i behandling av psykossjukdomar. Bristande följsamhet till läkemedelsbehandlingen är dock vanligt förekommande och en stor anledning till att patienter återinsjuknar i psykos och behöver vårdas inom slutenvård. Syfte: Dels att beskriva hur patienter som vårdas inom sluten psykiatrisk psykosvård uppfattar läkemedelsadministrering och dels att beskriva om patienterna uppfattar att sjuksköterskors bemötande i samband med läkemedelsadministrering har betydelse för deras inställning till att medicinera. Metod: Kvalitativ ansats. Intervjustudie med fenomenografi som metod i datainsamling och analys. Resultat: Tio beskrivningskategorier identifierades: Läkemedel befogat och bra, tar läkemedel trots ambivalens/motstånd, läkemedelsadministrationen – ett odramatiskt moment, tvångsmedicinering, behov av information om läkemedel, att vilja ha kontroll eller överlåta ansvar, en stressig situation, belöning för medverkan i medicinering, bemötandet spelar ingen roll och bemötandet spelar stor/viss roll.  Slutsats: Patienter som vårdas inom sluten psykiatrisk psykosvård uppfattar medicinering med antipsykotika och momentet läkemedelsadministration olika. Dessa individuella uppfattningar skulle troligtvis kunna identifieras om rutiner för samtal med patienter kring dessa frågor utarbetas på avdelningar där sådan vård bedrivs. Sannolikheten för att frivilliga lösningar och en bättre individuellt anpassad vård lättare skulle kunna bedrivas borde då öka. Strävan måste vara att så långt det är möjligt undvika tvångsmedicinering och situationer och bemötande som i denna studie identifierats som mindre positiva då de kan utgöra en risk att patienter blir negativt inställda till att medicinera. Ambitionen måste vara att hitta arbetssätt som syftar till långvarig följsamhet. / ABSTRACT Background: Antipsychotics are the basis of the treatment of psychotic illnesses. Lack of adherence to medication is common and a major reason why patients recurrence of psychosis and need to be cared for in hospital. Purpose: To describe how patients with psychosis, cared for in inpatient psychiatric wards, understand medication administration and also to describe if the patients perceive that nurses treatment in the moment of medication administration has an impact on their attitudes to medicate. Method: Qualitative approach. An interview study with phenomenography as a method of data collection and analysis.  Results: Ten categories were identified: medicines justified and well, take medicine despite ambivalence/resistance, administration of medicine – an undramatic moment, coerced medication, need for information about medicines, want to have control or assign responsibility, a stressful situation, reward for participation in the medication, treatment don´t  matter and treatment play a major/some role. Conclusion: Patients with psychosis, who are cared for in inpatient psychiatric wards, understand medication with antipsychotics and the moment of drug administration different. These individual understandings would likely be identified if routines for dialogue with patients about these issues were developed at wards where such care is conducted. The probability of voluntary solutions and better individualized care should then be increased. The ambition must as far as possible be to avoid forced medication and situations identified as less positive in this study as they may pose a risk to cause negative attitudes to medication among patients.  The ambition must be to find ways of working aimed at long-term adherence.

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The purpose of this research was to offer a description of the complexity of nurses’ medication administration practices in relationships with technology. The clinical situations and circumstances in which nurses administer medications today are comprised of rapidly changing technological initiatives that are intended to support safe, efficient care. Nurses’ medication administration practices are not immune to a rapidly changing technological health care environment. Research and literature has documented medication administration occurs in complex situations and nurses apply particular knowledge that supports decision-making and clinical practices for patient safety. Praxiographic methodology was used to describe deeply embedded knowledge and values that shape and guide contemporary nursing practice. Lack of attention to knowledge and values that shape and guide nursing practice and care, may contribute to the risk that those practices may be lost as nurses retire amongst a rapidly changing healthcare environment. A highly technical Neonatal Intensive Care Unit (NICU) was the location for the study. Participants included twelve NICU nurses and a pharmacist. The research findings included the significance of understanding NICU nurses’ use of local and universal maps to navigate the complexity of medication administration. Furthermore, the research documented NICU nurses’ medication administration practices as inseparable from technology. Further practice-based research is recommended to support the development of technologies that incorporate nurses’ medication administration practices. / Graduate

Medication administration errors (MAEs) may lead to adverse drug events, patient morbidity, prolonged hospital stays, and increased readmission rates, and may contribute to major financial losses for the health system. MAEs are the most common type of error occurring within the health care setting leading to an estimated 7,000 patient deaths every year. Interventions have been designed to prevent MAEs including education for nurses who administer medications; however, little effort has been made to design systematic educational programs that are based on local needs and contexts. The purpose of this project was to identify internal and external factors related to MAEs at the practice site, develop an education program tailored to the factors contributing to MAEs, and implement the program using a pretest posttest design. The Iowa model was used to guide the project. The 26 nurse participants who responded to an initial survey indicated that nurses felt distractions and interruptions during medication administration, and hesitancy to ask for help or to report medication errors increased MAE risks. After the education program, the pretest and posttest results were analyzed and revealed improvement in knowledge and confidence of medication administration (M = 3.2 pre, M = 3.7 post, p < .05). Open-ended question responses suggested a need for dedicated time for preparation and administration of medications without interruptions. Positive social change is possible as nurses become knowledgeable and confident about medication administration safety and as patients are protected from injury secondary to MAEs.

Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals' opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.