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Validity and reliability of observational methods for studying medication administration errors
1Pharmacy Unit, Hammersmith Hospitals NHS Trust, London, England. bryony@cua.ulsop.ac.uk
Abstract:
The validity and reliability of observational methods for studying medication administration errors (MAEs) were studied. Between January and June 1998, two pharmacists observed consecutive drug administration rounds by nurses on two wards in a U.K. hospital and recorded all MAEs identified. The observers intervened in cases of potentially harmful errors. MAE records were audited to determine the percentage of omitted doses for which a corresponding reason was documented for the observation periods and for nonobservation periods. Error rates for each drug administration round were analyzed according to whether they were for the nurse's first, second, third (and so on) observed round. Error rates were calculated before and after the first intervention with nurses for whom an intervention was made. Observer reliability was calculated by comparing the rates of errors identified by the two observers. There was no difference between the observation and nonobservation periods in the percentage of omitted doses for which a reason was documented, and there was no change in the error rate with repeated observations. There was no difference in error rates before and after the first intervention for each nurse. There was also no difference in error detection between the two observers and no change with increasing duration of observation. Observation of nurses during drug administration at a U.K. hospital did not significantly affect the MAE rate; nor did tactful interventions by the observers. Observer reliability was high. Concerns about the validity and reliability of observational methods for identifying MAEs may be unfounded.
Insights
Observational methods accurately assess medication administration errors (MAEs) without altering error rates. This study found high observer reliability, suggesting these methods are valid for MAE research.
Area of Science:
- Healthcare Quality and Safety
- Nursing Practice
- Clinical Pharmacy
Background:
- Observational methods are frequently used to study medication administration errors (MAEs).
- Concerns exist regarding the potential for observation to influence behavior and affect the validity and reliability of findings.
- The impact of observer presence and intervention on MAE rates requires thorough investigation.
Purpose of the Study:
- To assess the validity and reliability of observational methods in studying MAEs.
- To determine if observation or tactful interventions influence medication administration error rates.
- To evaluate observer agreement in identifying MAEs.
Main Methods:
- Two pharmacists observed nurses administering medications on two U.K. hospital wards over six months.
- Medication administration errors (MAEs) were recorded, and potentially harmful errors led to interventions.
- Data were analyzed to compare error rates during observation vs. non-observation periods, with repeated observations, and before/after interventions. Observer reliability was calculated.
Main Results:
- No significant difference was found in the documentation of omitted doses between observation and non-observation periods.
- Medication administration error rates did not change with repeated observations or after initial interventions.
- High observer reliability was demonstrated, with no significant difference in error detection between observers or with increased observation duration.
Conclusions:
- Observational methods appear valid and reliable for studying medication administration errors (MAEs).
- The presence of observers and tactful interventions did not significantly alter MAE rates in this study.
- Concerns regarding the impact of observational methods on MAE rates may be unfounded, supporting their continued use in research.