Human factors causing medication administration errors as self-reported by registered professional nurses

Thesis (MCur)--Stellenbosch University, 2016.ENGLISH ABSTRACT: Medication administration is a core function of the registered professional nurse, yet multiple human factors cause errors to happen in the administration process, with a negative impact on patient safety. The aim of this study was to determine the human factors as self-reported by registered professional nurses which cause medication administration errors. The study objectives were set to determine what are the human factors the registered professional nurses report to be the cause of medication administration errors in their own practice; determine whether a lack of knowledge and skills contributed to medication administration errors; establish the current orientation and in-service training related to medication administration and describe the availability of policies related to medication administration and the frequency of monitoring and evaluation practices. The research question asked was “What are the human factors that cause medication administration errors amongst registered professional nurses?” A non-experimental, descriptive design with a quantitative approach was applied. The total population of N=120 registered professional nurses working in units that administer medications in a public health care institution, were invited to participate in the study. A structured, self-administered questionnaire was used for data collection. Reliability and validity were assured through means of a pilot study, consultation with nursing and pharmacy experts, the study supervisor, co-supervisor and a statistician. Reliability was further assured by applying the Cronbach’s alpha coefficient test with the coefficients being 0,78 – 0,95. Ethical approval was obtained from the Health Research Ethics Committee of the University of Stellenbosch (S14/08/161). Permission for access to the healthcare institution was obtained from the Provincial Department of Health and a public healthcare institution. Informed consent was obtained from the participants before data collection took place over a three-week period. A response rate of n=88(73.3%) was obtained. Descriptive and inferential analyses were performed with the support of the statistician by utilising the SPSS version 22 (IBM) program. Results are presented in bar graphs, histograms and tables. Comparisons of variables were done with the application of the Spearman correlation test, Mann-Whitney U tests, Kruskal-Wallis H tests and Pearson chi-square tests. The results indicated the following main human factors that cause medication administration errors: medicine knowledge deficits (67%) and lack of training about adverse drug effects (60.8%), work pressure (75%) and high nurse to patient ratio’s (63%), distractions (69%) and non-adherence to medication administration policies (64%). Results showed an increase in age (p<0.01; r=-.314), level of experience as a registered professional nurse (RPN) and experience in administering medication (p<0.01; r=-.325) resulted in a decrease in the number of nurses who reported to make errors due to work pressure. An increase in experience as a RPN (p=0.01; r=-.258) and in administering medication (p<0.01; r=-.284) resulted in decreasing the number of mistakes despite high patient/nurse ratios. Recommendations include the development of adequate quality processes and riskmanagement strategies. Furthermore, it includes strengthening of the ‘five rights’ principle of medication administration and the introduction of the continuing professional development model, with the focus on establishment of a medication skills laboratory, which may assist in the reduction of medication administration errors to improve patient safety.AFRIKAANSE OPSOMMING: verpleegkundige, tog veroorsaak verskeie menslike faktore dat foute gebeur in die toedieningsproses met ‘n negatiewe impak op die veiligheid van pasiënte. Die doel van die studie was om te bepaal wat die menslike faktore is wat medikasie-toedieningsfoute veroorsaak soos self gerapporteer deur geregistreerde professionele verpleegkundiges. Die doelwitte van die studie was gestel om te bepaal watter menslike faktore word gerapporteer deur die geregistreerde professionele verpleegkundiges wat die oorsaak is van medikasietoedieningsfoute in hul eie praktyk; om te bepaal of ‘n gebrek aan kennis en vaardighede bygedra het tot medikasie-toedieningsfoute; om die huidige oriëntasie en indiensopleiding rakende medkasie-toedieningsfoute te bepaal en om die beskikbaarheid van beleide rakende medikasie-toediening en die frekwensie van monitoring en evaluering praktyke te beskryf. Die navorsingsvraag wat gevra was is, "Watter menslike faktore veroorsaak medikasie-toedieningsfoute onder geregistreerde professionele verpleegkundiges?” ’n Nie-eksperimentele, beskrywende ontwerp met ‘n kwantitatiewe benadering is gebruik. Die totale bevolking van N=120 geregistreerde professionele verpleegkundiges werksaam in eenhede wat medikasie toedien in ‘n openbare gesondheidsorginstelling is genooi om deel te neem aan die studie. ’n Gestruktureerde, self-toegediende vraelys is gebruik om data in te samel. Betroubaarheid en geldigheid is verseker deur middel van ‘n loodsstudie, in oorlegpleging met verpleeg- en apteekkenners, die studie toesighouer, medetoesighouer en ‘n statistikus. Betroubaarheid is verder verseker deur die toepassing van die Cronbach Alfakoëffisiënttoets met die koëffisiënte van 0,78 – 0,95. Etiese goedkeuring is verkry van die Etiese Navorsingskomitee vir Gesondheid van die Universiteit Stellenbosch (S14/08/161). Toestemming vir toegang tot die gesondheidsorginstelling is verkry van die Provinsiale Departement van Gesondheid en die openbare gesondheidsorginstelling. Ingeligte toestemming is verkry van die deelnemers voordat data insameling oor ‘n periode van 3 weke plaasgevind het. ’n Reaksie-koers van n=88(73.3%) is verkry. Beskrywende en inferensiële ontledings is gedoen met die hulp van die statistikus deur gebruik te maak van die SPSS weergawe 22 (IBM) program en word verduidelik deur middel van staafgrafieke, histogramme en tabelle. Die veranderlikes is vergelyk deur die toepassing van Spearmen korrelasietoetse, Mann- Whitney U-toetse, Kruskal-Wallis H H-toetse en Pearson Chi-vierkanttoetse. Die resultate het die volgende menslike faktore uitgewys wat medikasie-toedieningsfoute veroorsaak: gebrek aan medikasie kennis (67%) en gebrek aan opleiding oor nadelige medikasie effekte (60.8%), werksdruk (75%) en hoë verpleegkundige pasiëntverhoudings (63%), afleidings (69%) en nie-nakoming van medikasie-administrasie beleide (64%). Beduidende resultate het aangedui dat ‘n toename in ouderdom (p<0.01; r=-.314), ondervinding as geregistreerde professionele verpleegkundiges en in die toediening van medikasie (p<0.01; r=-.325) gelei het tot ‘n afname in verpleegkundiges wat gerapporteer het dat hul foute gemaak het vanweë werksdruk. ‘n Toename in ondervinding as geregistreerde professionele verpleegkundiges (p=0.01; r=-.258) en in die toediening van medikasie (p<0.01; r=-.284) het gelei tot ‘n afname in foute ten spyte van ‘n hoë pasiënt/verpleegkundige verhouding. Aanbevelings sluit die ontwikkeling van voldoende kwaliteitprosesse en risikobestuurstrategieë in. Verder sluit dit in die versterking van die “vyf regte” beginsel van medikasie-toediening en bekendstelling van die voortgesette professionele ontwikkelingsmodel, met die fokus om ‘n medikasie-vaardigheidslabarotorium te ontwikkel wat mag help met die vermindering van medikasie-toedieningsfoute ter verbetering van pasiëntveiligheid.