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Self-reported violations during medication administration in two paediatric hospitals.
Samuel J Alper1, Richard J Holden, Matthew C Scanlon
1Human Factors Practice, Exponent Failure Analysis Associates, Chicago, IL USA.
BMJ Quality & Safety
|March 27, 2012
Summary
Nurses report medication administration protocol violations, particularly in emergency situations and on specialized units. These violations vary by situation, process step, and unit, necessitating further safety research.
Area of Science:
- Nursing Practice and Patient Safety
- Healthcare Quality Improvement
- Medication Administration Protocols
Background:
- Safety protocol violations are a significant risk factor for adverse events, yet existing safety efforts inadequately address them.
- This study focuses on nurses' self-reported violations within the critical medication administration process.
Purpose of the Study:
- To quantify the extent of protocol violations during medication administration among nurses.
- To identify variations in violation prevalence based on situation, process step, and hospital unit.
Main Methods:
- A cross-sectional survey was administered to 199 nurses in pediatric intensive care, hematology-oncology-transplant, and medical-surgical units at two academic children's hospitals.
- Nurses self-reported violations using a seven-point scale for routine and emergency situations across three medication administration steps.
- Data were analyzed using analysis of variance to identify significant factors influencing violation rates.
Main Results:
- Violation reports were significantly higher in emergency situations compared to routine operations.
- Nurses in hematology-oncology-transplant units reported the most violations, followed by pediatric intensive care and then medical-surgical units.
- Patient identification checking had the highest violation rate, followed by medication matching and administration documentation, with a significant three-way interaction observed.
Conclusions:
- Protocol violations are prevalent across the medication administration process, with rates influenced by hospital unit, process stage, and situational context.
- Further research is crucial to determine the impact of these violations on patient safety.
- System redesign is needed to mitigate violations that compromise safety and reduce the necessity for nurses to bypass protocols.
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