Self-reported violations during medication administration in two paediatric hospitals. BMJ Qual Saf 2012 May;21(5):408-15
Date
03/27/2012Pubmed ID
22447818Pubmed Central ID
PMC4174297DOI
10.1136/bmjqs-2011-000007Scopus ID
2-s2.0-84862803846 (requires institutional sign-in at Scopus site) 29 CitationsAbstract
CONTENT: Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
OBJECTIVE: To assess the extent of violations in the medication administration process among nurses.
DESIGN, SETTING AND PARTICIPANTS: Participants were 199 nurses from two US urban, academic, tertiary care, free-standing paediatric hospitals who worked in a paediatric intensive care unit (PICU), a haematology-oncology-transplant (HOT) unit or a medical-surgical (Med/Surg) unit. In a cross-sectional survey, nurses were asked about violations in routine or emergency situations in three steps of the medication administration process.
MAIN OUTCOME MEASURE: Self-reported violations of three medication administration protocols were made using a seven-point 0-6 scale from 'not at all' to 'a great deal'.
RESULTS: Analysis of variance identified that violation reports were highest for emergency situations, rather than for routine operations, highest by HOT unit nurses, followed by PICU nurses and then Med/Surg unit nurses, and highest during patient identification checking, followed by matching a medication to a medication administration record, and then documenting an administration. There was also a significant three-way interaction among violation situation, step in the process, and unit.
CONCLUSIONS: Protocol violations occur throughout the medication administration process and their prevalence varies as a function of hospital unit, step in the process, and violation situation. Further research is required to determine whether these violations improve or worsen safety, and for those that worsen safety, how to redesign the system of administration to reduce the need to violate protocol to accomplish job tasks.
Author List
Alper SJ, Holden RJ, Scanlon MC, Patel N, Kaushal R, Skibinski K, Brown RL, Karsh BTAuthor
Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Cross-Sectional Studies
Educational Status
Emergencies
Female
Hospitals, Pediatric
Humans
Intensive Care Units
Intensive Care Units, Pediatric
Male
Medication Errors
Middle Aged
Nurses
Practice Patterns, Nurses'
Quality Assurance, Health Care
Self Report
Surveys and Questionnaires
United States
Urban Health Services
