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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

Examples of inherent behavioural tendencies and associated influences on how systems were utilized, and how medication administration related problems, interruptions, distractions, and workflow were managed.
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pone.0128958.g006: Examples of inherent behavioural tendencies and associated influences on how systems were utilized, and how medication administration related problems, interruptions, distractions, and workflow were managed.

Mentions: Broadly, nurses appeared to have an inherent tendency to be either primarily ‘task focused’ (main goal of drug round appeared to be administer drugs as efficiently as possible), or ‘patient-interaction focused’ (drug round appeared to be an opportunity for the nurse to interact with their patients in addition to administering medications). Excluding urgent tasks, task-focused individuals generally used a streamlined workflow and carried out few non-medication administration related tasks during the drug round; when the need for such tasks was identified during the round, the nurse either deferred the task to the end of the round, or carried out the task when another task took the nurse to a convenient location to carry out multiple tasks together (Fig 6). By contrast, patient-interaction focused individuals adopted a relatively less streamlined workflow, and appeared to encourage communication with patients and/or other staff during the round; the patient-interaction focused individuals either multi-tasked, carried out the non-medication administration related task shortly after they completed the primary task, or stopped the primary task to carry out the non-medication administration related task.


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)

Examples of inherent behavioural tendencies and associated influences on how systems were utilized, and how medication administration related problems, interruptions, distractions, and workflow were managed.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0128958.g006: Examples of inherent behavioural tendencies and associated influences on how systems were utilized, and how medication administration related problems, interruptions, distractions, and workflow were managed.
Mentions: Broadly, nurses appeared to have an inherent tendency to be either primarily ‘task focused’ (main goal of drug round appeared to be administer drugs as efficiently as possible), or ‘patient-interaction focused’ (drug round appeared to be an opportunity for the nurse to interact with their patients in addition to administering medications). Excluding urgent tasks, task-focused individuals generally used a streamlined workflow and carried out few non-medication administration related tasks during the drug round; when the need for such tasks was identified during the round, the nurse either deferred the task to the end of the round, or carried out the task when another task took the nurse to a convenient location to carry out multiple tasks together (Fig 6). By contrast, patient-interaction focused individuals adopted a relatively less streamlined workflow, and appeared to encourage communication with patients and/or other staff during the round; the patient-interaction focused individuals either multi-tasked, carried out the non-medication administration related task shortly after they completed the primary task, or stopped the primary task to carry out the non-medication administration related task.

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