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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

Sources of interruptions and distractions during drug rounds percentage of a total of 413 interruptions and distractions observed at the preparation, administration, and documentation stages of drug rounds).Median 5.5 interruptions per drug round hour, range 0 to 24; median 9.6 distractions per drug round hour, range 0 to 30; median 15.5 interruptions and distractions combined per drug round hour.
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pone.0128958.g008: Sources of interruptions and distractions during drug rounds percentage of a total of 413 interruptions and distractions observed at the preparation, administration, and documentation stages of drug rounds).Median 5.5 interruptions per drug round hour, range 0 to 24; median 9.6 distractions per drug round hour, range 0 to 30; median 15.5 interruptions and distractions combined per drug round hour.

Mentions: Given that the nurse him/herself was the third most common source of interruptions and distractions (Fig 8), it is likely that individuals’ inherent tendencies may influence the potential for MAEs. However, the ‘direction’ of influence (positive or negative) on drug round workflow and MAEs depended on the medication systems being used and the task being carried out at the time. By contrast, ‘other nurses’ were the most common source of interruptions and distractions to the nurse on the drug round. Observations suggest that these interruptions and distractions were frequently made by those who themselves were also involved in medication administration around the same time; multiple nurses administered medications simultaneously to their own individual patients on two study wards and therefore the same medication system problems were potentially affecting the nurses at the same time. The percentages of other sources of interruptions and distractions are summarized in Fig 8; the presence of the observer had a measurable effect on the number of interruptions and distractions experienced by the nurse. However, the overall percentage of observer-related interruptions and distractions was considerably less than those from patients despite the observer’s continued presence.


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)

Sources of interruptions and distractions during drug rounds percentage of a total of 413 interruptions and distractions observed at the preparation, administration, and documentation stages of drug rounds).Median 5.5 interruptions per drug round hour, range 0 to 24; median 9.6 distractions per drug round hour, range 0 to 30; median 15.5 interruptions and distractions combined per drug round hour.
© Copyright Policy
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4476704&req=5

pone.0128958.g008: Sources of interruptions and distractions during drug rounds percentage of a total of 413 interruptions and distractions observed at the preparation, administration, and documentation stages of drug rounds).Median 5.5 interruptions per drug round hour, range 0 to 24; median 9.6 distractions per drug round hour, range 0 to 30; median 15.5 interruptions and distractions combined per drug round hour.
Mentions: Given that the nurse him/herself was the third most common source of interruptions and distractions (Fig 8), it is likely that individuals’ inherent tendencies may influence the potential for MAEs. However, the ‘direction’ of influence (positive or negative) on drug round workflow and MAEs depended on the medication systems being used and the task being carried out at the time. By contrast, ‘other nurses’ were the most common source of interruptions and distractions to the nurse on the drug round. Observations suggest that these interruptions and distractions were frequently made by those who themselves were also involved in medication administration around the same time; multiple nurses administered medications simultaneously to their own individual patients on two study wards and therefore the same medication system problems were potentially affecting the nurses at the same time. The percentages of other sources of interruptions and distractions are summarized in Fig 8; the presence of the observer had a measurable effect on the number of interruptions and distractions experienced by the nurse. However, the overall percentage of observer-related interruptions and distractions was considerably less than those from patients despite the observer’s continued presence.

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