Enhancing patient safety: The importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing students

Reid‐Searl K, Moxham L, Happell B. International Journal of Nursing Practice 2010; 16 : 225–232
Enhancing patient safety: The importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing students Medication errors have been the focus of considerable research attention in nursing; however, the extent to which nursing students might contribute to errors has not been researched. Using a grounded theory approach, in‐depth semi‐structured interviews were conducted with undergraduate nursing students based in a university in Queensland to explore their experiences of administering medication in the clinical setting. Almost a third of the participants reported making an actual medication error or a near miss. Where medication errors occurred, participants described not receiving direct and appropriate supervision by a registered nurse. Medication errors by nursing students have the potential to impact significantly on patient safety, quality of health care, and on nursing students' perceptions of their professional competence. Ensuring direct supervision is provided at all times must become an urgent priority for undergraduate nursing education.     

Nurses' medication administration practices at two Singaporean acute care hospitals

This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.     

护士发生给药错误的特点及原因分析

目的分析护士给药错误发生的特点和原因,探讨如何预防给药错误的发生。方法回顾性分析某三级甲等医院2010年至2012年自愿非惩罚报告系统中上报的给药错误137例,分析护士给药错误的类别、特点及原因。结果给药错误主要发生在综合科室占31.39%,外科占24.82%;患者身份识别错误、药物遗漏、给药技术性错误是给药错误的主要类别;发生给药错误的药物种类,占前2位的分别是抗生素和心血管系统用药;在发生给药错误的原因中,操作过程中没有认真执行查对制度占48.91%。结论护理管理者应根据给药错误的特点制订相应的管理措施,加强护士药物知识的培训,严格执行查对制度,降低给药错误的发生。     

Improving patient safety using the sterile cockpit principle during medication administration: a collaborative,unit-based project

Aim To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors. Background While some studies have described the importance of reducing interruptions as a tactic to reduce medication errors, work is needed to assess the impact on patient outcomes. Methods Data regarding the type and frequency of distractions were collected during the first 11 weeks of implementation. Medication error rates were tracked 1 year before and after 1 year implementation. Results Simple regression analysis showed a decrease in the mean number of distractions, (β = −0.193, P = 0.02) over time. The medication error rate decreased by 42.78% (P = 0.04) after implementation of the sterile cockpit principle. Conclusions The use of crew resource management techniques, including the sterile cockpit principle, applied to medication administration has a significant impact on patient safety. Implications for nursing management Applying the sterile cockpit principle to inpatient medical units is a feasible approach to reduce the number of distractions during the administration of medication, thus, reducing the likelihood of medication error. ‘Do Not Disturb’ signs and vests are inexpensive, simple interventions that can be used as reminders to decrease distractions.     

The uptake of technologies designed to influence medication safety in Canadian hospitals

Background There are many technologies designed to improve medication safety. Although limited evidence supports their use, there are pressures to implement them. Objective To determine the uptake of technologies designed to improve medication safety, plans for adopting technologies, attitudes towards technology use, and perceptions of medication error. Methods We performed a cross‐sectional survey of pharmacy directors at Canada’s 100 largest acute‐care hospitals. Results Seventy‐eight per cent of surveyed hospitals responded. Responding hospitals averaged 499 beds and 29% were teaching facilities. Hospital frequently used clinical pharmacy services (97% of hospitals), pharmacy‐based intravenous admixture services (81%), computerized decision support modules for pharmacy order entry systems (77%), unit‐dose drug distribution systems (75%) and computerized medication administration records (67%). Hospitals infrequently used bar‐coding (9% of hospitals) and computerized physician order entry (9%). A majority of respondents and hospitals favoured expanded use of new technologies and planned for increased uptake. Respondents chose as their hospital’s next investment: automated dispensing (33%), bar‐coding (25%) and computerized physician order entry (12%). Conclusion Canadian hospitals appear poised to make sizeable investments in poorly evaluated technologies that address medication safety.     

临床护理人员用药安全管理的现状与策略

分析临床护理人员用药安全管理现状及其影响因素,提出护理用药安全管理策略在于落实各项制度、完善工作流程、合理配置护理人力、开展用药安全在职培训。     

流程管理在护士给药安全管理中的应用与效果

目的 探讨流程管理在给药管理中的应用与效果.方法 运用流程管理的先进理念和方法,对医院给药系统的关键流程进行分析、再造、优化,重点对病房口服给药及急诊输液流程进行了改造;建立住院患者用药调配中心;强化高危药物的安全管理.结果 患者对口服给药及输液的满意度提高,摆药差错发生率降低,并有效避免了医嘱差错,差异具有统计学意义...     

Supervising nursing students administering medication: a perspective from registered nurses

Aims. To explore the attitudes, experiences and opinions of registered nurses regarding supervision of undergraduate nursing students while administering medication in the healthcare setting. Background. Medication errors present a considerable risk to safety in the healthcare setting. By virtue of their role in the administration of medication, registered nurses are considered as major contributors to this problem. Undergraduate nursing students administer medication in the clinical setting, but little attention has been paid to the implications for patient safety. Design. This research was conducted using exploratory qualitative methodology. Methods. Focus group interviews were conducted with 13 registered nurses. The participants were asked to describe their experiences and opinions regarding the supervision of undergraduate nursing students. Data were analysed using the framework approach. Results. Three main themes from this work are presented in this paper: ‘standard of supervision’, ‘a beneficial experience’ and ‘preparation’. Conclusions. The participants regarded supervision as an important process in fostering student learning and ensuring safety. Preparation on the part of the healthcare facility, students and the university were essential to maximise the benefits for all concerned. Relevance to clinical practice. The ability to administer medication safely is an important skill for all registered nurses. Nursing students need the opportunity to develop these skills as part of their undergraduate educational programme. Registered nurses must supervise students in a rigorous and supportive manner to enhance learning and to promote quality care.     

128起给药错误分析

目的:描述给药错误的分类、给患者造成的后果、造成给药错误的原因。方法:对128起给药错误事件进行回顾性分析。结果:护士给药错误占所有给药错误的69.6%,护士转录错误占16.4%。给药错误的分类中,剂量错误占34.5%,其次为药物错误,占19.4%。96.1%的给药错误未对患者造成伤害。造成给药错误的原因中,医护人员个人因素占67.9%,其中违反操作规则,疏忽、粗心,转录错误为主要原因;组织系统因素占17.7%,其中工作频繁被打断、注意力分散、安排没有经验的员工为主要原因。结论:管理者应鼓励医护人员主动上报所有的给药错误,对给药错误的资料进行分析,对组织系统因素进行改善。