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.
