Medication administration errors by nurses: adherence to guidelines.

Area of Science:

• Patient safety
• Nursing practice
• Medication administration

Background:

• Medication administration errors are a significant patient safety issue.
• Previous studies on error frequency relied on surveys, potentially undercounting errors.
• Robust methods are needed to accurately assess medication administration practices.

Purpose of the Study:

• To investigate the rate of medication administration errors using direct observation.
• To evaluate clinical nurses' adherence to medication administration guidelines.

Main Methods:

• Developed and validated a checklist based on medication guidelines (Five Rights, infection control, recording).
• Conducted direct observation of 293 medication administration activities by clinical nurses.
• Calculated adherence and violation rates for specific guideline items.

Main Results:

• Low adherence observed: only 45.6% verified medication amounts, 6.5% checked patient wristbands.
• Correct time administration observed in 41.0% of cases.
• Hand washing adherence varied significantly (4.5% for oral/external, 96.6% for IV); overall, 17.2 items followed vs. 5.7 violated per nurse.

Conclusions:

• Overall adherence to medication administration guidelines is low, with significant violations noted.
• Key adherence gaps identified in 'Five Rights' and other critical areas.
• Findings suggest a need for more practical guidelines to improve clinical nurse adherence.