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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

Spaghetti diagram showing non-linear travel by one nurse during night-time drug round at site B (map of ward not drawn to scale).Nurse started the drug round by logging on to the tablet computer next to the drug trolleys at 21:05, placed tablet computer on drug trolley and wheeled it to each patient starting in C-bay. Nurse went to the nurse base station area 13 times during the drug round: to look for master key to patient’s bedside medication locker (2 times), to look for medicines in stock cupboard (4), to access desktop computer to view and/or sign patient medication orders (5), to take a telephone call (1), and to prepare from the controlled drugs cupboard (2). Nurse ended the drug round at the nurse base station double checking on the electronic prescribing and medication administration system that all the relevant doses had been signed. S02, site code; DR022, drug round code; N18, nurse code. Letters refer to ward bay areas.
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pone.0128958.g004: Spaghetti diagram showing non-linear travel by one nurse during night-time drug round at site B (map of ward not drawn to scale).Nurse started the drug round by logging on to the tablet computer next to the drug trolleys at 21:05, placed tablet computer on drug trolley and wheeled it to each patient starting in C-bay. Nurse went to the nurse base station area 13 times during the drug round: to look for master key to patient’s bedside medication locker (2 times), to look for medicines in stock cupboard (4), to access desktop computer to view and/or sign patient medication orders (5), to take a telephone call (1), and to prepare from the controlled drugs cupboard (2). Nurse ended the drug round at the nurse base station double checking on the electronic prescribing and medication administration system that all the relevant doses had been signed. S02, site code; DR022, drug round code; N18, nurse code. Letters refer to ward bay areas.


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)

Spaghetti diagram showing non-linear travel by one nurse during night-time drug round at site B (map of ward not drawn to scale).Nurse started the drug round by logging on to the tablet computer next to the drug trolleys at 21:05, placed tablet computer on drug trolley and wheeled it to each patient starting in C-bay. Nurse went to the nurse base station area 13 times during the drug round: to look for master key to patient’s bedside medication locker (2 times), to look for medicines in stock cupboard (4), to access desktop computer to view and/or sign patient medication orders (5), to take a telephone call (1), and to prepare from the controlled drugs cupboard (2). Nurse ended the drug round at the nurse base station double checking on the electronic prescribing and medication administration system that all the relevant doses had been signed. S02, site code; DR022, drug round code; N18, nurse code. Letters refer to ward bay areas.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0128958.g004: Spaghetti diagram showing non-linear travel by one nurse during night-time drug round at site B (map of ward not drawn to scale).Nurse started the drug round by logging on to the tablet computer next to the drug trolleys at 21:05, placed tablet computer on drug trolley and wheeled it to each patient starting in C-bay. Nurse went to the nurse base station area 13 times during the drug round: to look for master key to patient’s bedside medication locker (2 times), to look for medicines in stock cupboard (4), to access desktop computer to view and/or sign patient medication orders (5), to take a telephone call (1), and to prepare from the controlled drugs cupboard (2). Nurse ended the drug round at the nurse base station double checking on the electronic prescribing and medication administration system that all the relevant doses had been signed. S02, site code; DR022, drug round code; N18, nurse code. Letters refer to ward bay areas.
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