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Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses' Medication Administration Processes and Systems (the MAPS Study).

McLeod M, Barber N, Franklin BD - PLoS ONE (2015)

Bottom Line: However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'.We have identified practical examples of system effects on work optimisation and nurse behaviours that potentially increase medication safety, and conceptualized ways in which patient involvement can increase medication safety in hospitals.

View Article: PubMed Central - PubMed

Affiliation: The Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom, and the Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.

ABSTRACT

Context: Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.

Aim: To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions.

Methods: We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures.

Findings: Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1) system configurations and features, (2) behaviour types among nurses, and (3) patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1) an active resource of information, (2) a passive information resource, and/or (3) a 'double-checker'.

Conclusions: We have identified practical examples of system effects on work optimisation and nurse behaviours that potentially increase medication safety, and conceptualized ways in which patient involvement can increase medication safety in hospitals.

No MeSH data available.


Related in: MedlinePlus

Conceptual overview of thematic factors that influence medication administration errors, workflow, interruptions and distractions associated with the hospital medication administration process.There are three over-arching interlinked themes: structure, behaviour, and patient interactions that encompass the six main areas (numbered). Arrows indicate the direction of influence between areas. Dotted lines indicate the presence of the observer as an artefact of the research directly on nursing staff behaviour, and on interruptions and distractions.
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pone.0128958.g001: Conceptual overview of thematic factors that influence medication administration errors, workflow, interruptions and distractions associated with the hospital medication administration process.There are three over-arching interlinked themes: structure, behaviour, and patient interactions that encompass the six main areas (numbered). Arrows indicate the direction of influence between areas. Dotted lines indicate the presence of the observer as an artefact of the research directly on nursing staff behaviour, and on interruptions and distractions.

Mentions: We identified three inter-related themes that encompassed the five main areas in our initial thematic framework; a sixth, ‘observer-related effects’, was added to reflect actual and potential effects of having an observer on both nurse and patient behaviour (Fig 1). The three inter-related themes were: (1) structure—related to configurations and features of the medication systems, (2) behaviour—referring to different types of nursing staff behaviour, and (3) patient interactions—referring to the two-way interaction between a nurse and a patient. Structure was the foundational theme that affected different types of nurse behaviour, which in turn, incited different types of patient interactions; each comprised components that exerted a positive and/or negative impact on medication safety, drug round workflow, interruptions and distractions.


Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses' Medication Administration Processes and Systems (the MAPS Study).

McLeod M, Barber N, Franklin BD - PLoS ONE (2015)

Conceptual overview of thematic factors that influence medication administration errors, workflow, interruptions and distractions associated with the hospital medication administration process.There are three over-arching interlinked themes: structure, behaviour, and patient interactions that encompass the six main areas (numbered). Arrows indicate the direction of influence between areas. Dotted lines indicate the presence of the observer as an artefact of the research directly on nursing staff behaviour, and on interruptions and distractions.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476704&req=5

pone.0128958.g001: Conceptual overview of thematic factors that influence medication administration errors, workflow, interruptions and distractions associated with the hospital medication administration process.There are three over-arching interlinked themes: structure, behaviour, and patient interactions that encompass the six main areas (numbered). Arrows indicate the direction of influence between areas. Dotted lines indicate the presence of the observer as an artefact of the research directly on nursing staff behaviour, and on interruptions and distractions.
Mentions: We identified three inter-related themes that encompassed the five main areas in our initial thematic framework; a sixth, ‘observer-related effects’, was added to reflect actual and potential effects of having an observer on both nurse and patient behaviour (Fig 1). The three inter-related themes were: (1) structure—related to configurations and features of the medication systems, (2) behaviour—referring to different types of nursing staff behaviour, and (3) patient interactions—referring to the two-way interaction between a nurse and a patient. Structure was the foundational theme that affected different types of nurse behaviour, which in turn, incited different types of patient interactions; each comprised components that exerted a positive and/or negative impact on medication safety, drug round workflow, interruptions and distractions.

Bottom Line: However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'.We have identified practical examples of system effects on work optimisation and nurse behaviours that potentially increase medication safety, and conceptualized ways in which patient involvement can increase medication safety in hospitals.

View Article: PubMed Central - PubMed

Affiliation: The Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom, and the Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.

ABSTRACT

Context: Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.

Aim: To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions.

Methods: We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures.

Findings: Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1) system configurations and features, (2) behaviour types among nurses, and (3) patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1) an active resource of information, (2) a passive information resource, and/or (3) a 'double-checker'.

Conclusions: We have identified practical examples of system effects on work optimisation and nurse behaviours that potentially increase medication safety, and conceptualized ways in which patient involvement can increase medication safety in hospitals.

No MeSH data available.


Related in: MedlinePlus