Safe Practice in Medication Administration

Abstract

Background/Rationale The problems of medication safety are globally recognised by nursing as a healthcare profession (Sulosaari, Suhonen & Leino-Kilpi, 2010). As the prominent discipline who have the final check in the medication process (Ulamino, O’Leary-Kelley, & Connolly, 2007) nurses are often targeted with the responsibility in the prevention of medication errors (Kim, Kwon, Kim, & Cho, 2011). A key driver for the current study was to turn the focus of exploration from error or harm to a positive viewpoint of valuing safe medication practice. Factors influencing medication safety are complex. As an organisation Counties Manukau District Health Board (CMDHB) needs to have broader intelligence of its environments, systems and processes to ensure that quality improvement and resulting safer medication administration is understood. Exploring enablers and barriers to achieve medication safety at a local level will provide information that is important, relevant and valued by the nurses in this District Health Board. Aim The aim of this research portfolio was to explore safe practice in medication administration. The research question, aims and objectives were proposed based on aspects of enquiry from the field of medication safety and quality improvement. The objectives were to review data already collected, to establish what nurses believe safe practice to be whilst administering medications, to explore the implications for practice and to establish what processes or strategies could be put in place to manage safe medication administration practice. Methods A mixed method study approach was used to explore this topic of enquiry. For the quantitative methods, retrospective audits of three data sets for 2012 were reviewed. For the qualitative methods, three focus group discussions with twenty three registered nurse participants from the Division of Medicine and of Surgery were analysed. Results The findings from each of the data methods used in this portfolio are presented. The quantitative data sets provided quantified information in relation to 718 incidents, 5 serious and sentinel events and 57 adverse drug events. When collectively reviewed, the data showed patterns of information as well as conflicts. The focus group discussions analysed in the qualitative methods provided a consistent picture of nurses’ beliefs. Two themes with eight key categories were presented in this study as part of a framework. A significant finding of this study was the lack of consistent data between both the quantitative and qualitative methods with only a few links being found. Implications for Nursing Practice Findings from this study strengthen contributing factors identified in the literature and extend on this field of enquiry. A conceptual framework emerged from the study findings in this portfolio which provided a basis for discussion in light of current literature and the implications the framework and quantitative results have for practice, policy and research. A key implication for nursing practice is that this framework can be used to inform change in data collection or explore linkages or disparities across the health care sector, informing medication safety from a wider context. Such detailed findings provide CMDHB with important local information that could be used to address safe practice in medication administration.