Interventions to support safe medication administration by emergency department nurses: An integrative review

To collate and synthesise current research evidence related to interventions that support safe medication administration by nurses in emergency departments (ED).

Medications are associated with a higher incidence of adverse events than other healthcare interventions and they remain one of the most common causes of accidental harm to health consumers. Between 5 and 10% of medications administered to acutely unwell patients may include some form of medication administration error. The error rate is particularly high during emergency admissions; perhaps associated with concomitant factors including an increased use of high-risk medications, patient acuity and the high rate of patient turnover.

Five databases were systematically searched to identify studies that described medication administration interventions designed to support ED nurses. 85 studies were identified and screened; 13 were selected for inclusion and quality assessment by two independent reviewers. The studies were analysed using a thematic analysis method and the quality of studies was assessed using the Mixed Methods Assessment Tool v 2011.

11 primary studies and 2 reviews met the inclusion criteria. Types of interventions clustered around four themes: protocols/standardisation (n = 5), education (n = 1), technology (n = 4) and intervention bundles (n = 1). The described interventions were largely context specific with weakness in internal and/or internal validity apparent in most included studies.

A very small number of studies have provided evidence for task-specific interventions. However, this review highlights a surprising lack of published evidence describing interventions that can help ED nurses to improve medication administration safety and it identifies a clear need for further research in this speciality area.