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Bakgrund: sjuksköterskor hanterar läkemedel och om det blir fel i läkemedelshanteringen kan en vårdskada uppstå. Vårdskador till följd av läkemedelshanteringsfel är vanligt förkommande och patienten kan orsakas skada, lidande eller död. Det finns flera lagar som reglerar läkemedelshanteringen och hälso- och sjukvårdspersonal har skyldighet att anmäla fel, men många sjuksköterskor upplever rädsla för att rapportera begångna fel. Kunskap om risker och orsaker till att fel uppstår minskar antalet vårdskador. Syftet: med denna litteraturstudie var att beskriva sjuksköterskors uppfattningar om risker och orsaker till läkemedelshanteringsfel på sjukhus. Metod: beskrivande litteraturstudie. Databasen PubMed användes för att söka fram vetenskapliga originalstudier, som inkluderade sjuksköterskors perspektiv på risker och orsaker till läkemedelshanteringsfel. Ett av inklusionskriterierna var att deltagarna i samtliga inkluderade studier, skulle givit informerat samtycke. Resultat: sammanställning av de inkluderade studierna resulterade i fem huvudteman med risker och orsaker till läkemedelshanteringsfel. 1. Arbetsmiljömässiga och organisatoriska risker och orsaker. 2. Läkemedelsrelaterade risker och orsaker. 3. Kommunikationsbrist. 4. Mänskliga och individuella risker och orsaker. 5. Patientfaktorer. Slutsats: denna litteraturstudies resultat belyser att sjuksköterskornas uppfattningar om risker och orsaker till läkemedelshanteringsfel är komplexa. Litteraturstudieförfattarnas hypotes är att ökat förebyggande arbete gentemot fel i läkemedelshanteringen utvecklas genom kunskap kring risker och orsaker till läkemedelshanteringsfel. Det resulterar troligtvis även i att sjuksköterskans trygghet ökar vid läkemedelshanteringen, förbättrad omvårdnad och patientsäkerhet. / Background: nurses handle medication in their profession and when there is a mistake made in the medication administration, a near miss might occur. Near miss as a result of a medication error are common and can cause the patient injury, suffering or death. The medication administration process is regulated by several laws and healthcare professionals are obliged to report errors. Fear of reporting errors are experienced by many nurses. Knowledge about risk factors and causes of medication errors reduces near misses. Aim: the purpose of this literature review was to describe nurses’ perception of risk factors and causes of medication errors in hospitals.  Method: descriptive literature review. The database PubMed was used to search for scientific primary sources that included nurses’ perspectives on risk factors and causes of medication errors. One of the inclusion criteria was that the participants in all included studies had given informed consent. Result: the compilation of the included studies resulted in five main themes of risk factors and causes of medication errors. 1. Work environmental and organizational risk factors and causes. 2. Medication related risk factors and causes. 3. Lack of communication. 4. Human and individual risk factors and causes. 5. Patient related risk factors.  Conclusion: the result of this descriptive literature review illustrates that nurses’ perceptions are complex regarding risk factors and causes of medication errors. The hypothesis of the literature review authors is that knowledge about risk factors and causes of medication errors increases the preventive work against medication errors. This also might increase the safety for the nurse when handling medication as increasing the nursing care and the patient safety.

Proportional reasoning instruction is prevalent in elementary, secondary, and post-secondary schooling. The concept of proportional reasoning is used in a variety of contexts for solving real-world problems. One of these contexts is the solving of dosage calculation proportional problems in the healthcare field. On the job, nurses perform drug dosage calculations which carry fatal consequences. As a result, nursing students are required to meet minimum competencies in solving proportion problems. The goal of this research is to describe the lived experiences of nurses in connection to their use of proportional reasoning in order to impact instruction of the procedures used to solve these problems. The research begins by clarifying and defining the conceptual field of proportional reasoning. Utilizing Vergnaud*s theory of conceptual fields and synthesizing the differing organizational frameworks used in the literature on proportional reasoning, the concept is organized and explicated into three components: concepts, procedures, and situations. Through the lens of this organizational structure, data from 44 registered nurses who completed a dosage calculation proportion survey were analyzed and connected to the framework of the conceptual field of proportional reasoning. Four nurses were chosen as a focus of in-depth study based upon their procedural strategies and ability to vividly describe their experiences. These qualitative results are synthesized to describe the lived experiences of nurses related to their education and use of proportional reasoning. Procedural strategies that are supported by textbooks, instruction, and practice are developed and defined. Descriptive statistics show the distribution of procedures used by nurses on a five question dosage calculation survey. The most common procedures used are the nursing formula, cross products, and dimensional analysis. These procedures correspond to the predominate procedures found in nursing dosage calculation texts. Instructional implications focus on the transition between elementary and secondary multiplicative structures, the confusion between equality and proportionality, and the difficulty that like quantities present in dealing with proportions.

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

Introduction: People with Parkinson's disease require individualised medication regimens to achieve symptomatic control whilst managing complications of the treatments and the underlying disease. Patients should continue to receive their individualised regimen when they are admitted to hospital but studies have highlighted that this may not happen. There is a paucity of research about patients' perceptions of the management of anti-parkinsonian medicines during a hospital admission and the aim of this study was to explore the perceptions of Parkinson's disease patients admitted to Leeds Teaching Hospitals about the management of their anti-parkinsonian medications.Method: Grounded theory methodology was used to allow detailed exploration of patients' perceptions and to generate theory about this under-researched area. Face to face, semi-structured interviews were conducted with 13 Parkinson's disease patients during their hospital admission, fully transcribed and analysed using the constant comparative approach. Results: Categories contributing to the core category of 'patient anxiety' were identified as 'maintaining usual medication routine', 'access to anti-parkinsonian medications', 'accuracy and consistency', 'trust in healthcare professionals' and 'staff knowledge about Parkinson's disease'. Strategies used to manage the anxiety were related to the categories 'utilising expertise' in Parkinson's disease and 'patient involvement' in their care. Discussion: The theory suggests that some patients have negative perceptions about the management of their medicines during a hospital admission. Areas for practice development are presented along with areas for future research. Conclusion: This study provides new insight into the perceptions of patients with Parkinson's disease about the management of their medicines during a hospital admission.

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No / Introduction Older people in care homes are at increased risk of medication errors and adverse drug events. The effect of formulation on administration errors is not known, that is whether the medicine is a tablet or capsule, liquid or device such as an inhaler. Also, the impact on administration errors of monitored dosage systems (MDS), commonly used in UK care homes to dispense tablets and capsules, is not known. This study investigated the influence of formulation and MDS on administration errors. Methods Administration errors were identified by pharmacists (using validated definitions) observing two drug rounds of residents randomly selected from a purposive sample of UK nursing and residential homes. Errors were classified and analysed by formulation and medicine delivery system. Results The odds of administration errors by formulation, when compared with tablets and capsules in MDS, were: liquids 4.31 (95% CI 2.02 to 9.21; p=0.0002); topicals/transdermals/injections 19.61 (95% CI 6.90 to 55.73; p<0.0001); inhalers 33.58 (95% CI 12.51 to 90.19; p<0.0001). The odds of administration errors for tablets and capsules not in MDS were double those that were dispensed in MDS (adjusted OR 2.14, 95% CI 1.02 to 4.51; p=0.04). Conclusions Inhalers and liquid medicines were associated with significantly increased odds of administration errors. Training of staff in safe administration of these formulations needs implementing. Although there was some evidence that MDS reduced the odds of an administration error, the use of MDS impacts on other aspects of medicines management. Because of this, and as the primary topic of our study was not MDS, a prospective trial specifically designed to evaluate the overall impact of MDS on medicine management in care homes is needed.

Introduction: People with Parkinson's disease require individualised medication regimens to achieve symptomatic control whilst managing complications of the treatments and the underlying disease. Patients should continue to receive their individualised regimen when they are admitted to hospital but studies have highlighted that this may not happen. There is a paucity of research about patients' perceptions of the management of antiparkinsonian medicines during a hospital admission and the aim of this study was to explore the perceptions of Parkinson's disease patients admitted to Leeds Teaching Hospitals about the management of their antiparkinsonian medications.Method: Grounded theory methodology was used to allow detailed exploration of patients' perceptions and to generate theory about this under-researched area. Face to face, semi-structured interviews were conducted with 13 Parkinson's disease patients during their hospital admission, fully transcribed and analysed using the constant comparative approach. Results: Categories contributing to the core category of 'patient anxiety' were identified as 'maintaining usual medication routine', 'access to antiparkinsonian medications', 'accuracy and consistency', 'trust in healthcare professionals' and 'staff knowledge about Parkinson's disease'. Strategies used to manage the anxiety were related to the categories 'utilising expertise' in Parkinson's disease and 'patient involvement' in their care. Discussion: The theory suggests that some patients have negative perceptions about the management of their medicines during a hospital admission. Areas for practice development are presented along with areas for future research. Conclusion: This study provides new insight into the perceptions of patients with Parkinson's disease about the management of their medicines during a hospital admission.