Document Detail

Self-reported violations during medication administration in two paediatric hospitals.
MedLine Citation:
PMID:  22447818     Owner:  NLM     Status:  MEDLINE    
CONTENT: Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
OBJECTIVE: To assess the extent of violations in the medication administration process among nurses.
DESIGN, SETTING AND PARTICIPANTS: Participants were 199 nurses from two US urban, academic, tertiary care, free-standing paediatric hospitals who worked in a paediatric intensive care unit (PICU), a haematology-oncology-transplant (HOT) unit or a medical-surgical (Med/Surg) unit. In a cross-sectional survey, nurses were asked about violations in routine or emergency situations in three steps of the medication administration process.
MAIN OUTCOME MEASURE: Self-reported violations of three medication administration protocols were made using a seven-point 0-6 scale from 'not at all' to 'a great deal'.
RESULTS: Analysis of variance identified that violation reports were highest for emergency situations, rather than for routine operations, highest by HOT unit nurses, followed by PICU nurses and then Med/Surg unit nurses, and highest during patient identification checking, followed by matching a medication to a medication administration record, and then documenting an administration. There was also a significant three-way interaction among violation situation, step in the process, and unit.
CONCLUSIONS: Protocol violations occur throughout the medication administration process and their prevalence varies as a function of hospital unit, step in the process, and violation situation. Further research is required to determine whether these violations improve or worsen safety, and for those that worsen safety, how to redesign the system of administration to reduce the need to violate protocol to accomplish job tasks.
Samuel J Alper; Richard J Holden; Matthew C Scanlon; Neal Patel; Rainu Kaushal; Kathleen Skibinski; Roger L Brown; Ben-Tzion Karsh
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2012-03-23
Journal Detail:
Title:  BMJ quality & safety     Volume:  21     ISSN:  2044-5423     ISO Abbreviation:  BMJ Qual Saf     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-20     Completed Date:  2012-08-27     Revised Date:  2014-10-16    
Medline Journal Info:
Nlm Unique ID:  101546984     Medline TA:  BMJ Qual Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  408-15     Citation Subset:  H    
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MeSH Terms
Cross-Sectional Studies
Educational Status
Emergencies / psychology*
Hospitals, Pediatric / statistics & numerical data*
Intensive Care Units / standards
Intensive Care Units, Pediatric / standards
Medication Errors / statistics & numerical data*
Middle Aged
Nurse's Practice Patterns / statistics & numerical data*
Nurses / psychology*,  statistics & numerical data
Quality Assurance, Health Care*
Self Report
United States
Urban Health Services
Grant Support
(5 T32 HS000083-11/HS/AHRQ HHS; 1 TL1 RR025013-01/RR/NCRR NIH HHS; R01 HS013610/HS/AHRQ HHS; UL1 RR025011/RR/NCRR NIH HHS; UL1 TR000427/TR/NCATS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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