Factors Influencing Medication Safety Among Nurses In Selected Hospitals In Oyo

Project and Seminar Material for Nursing (Science)

Factors Influencing Medication Safety Among Nurses In Selected Hospitals In Oyo


Abstract


The study examined the factors influencing medication safety among nurses in selected hospitals in Oyo. Health care has been largely susceptible to occurrences of medical mistakes and grave errors, some of which may have led to permanent disability and loss of life for the patients. 65% of medication errors detected had meaningful effect on patient’s health. Medication related deaths are estimated to be about 7000 each year. Failure to identify errors leads to repetition of mistakes and deteriorating patient safety in healthcare organizations. Although the error reporting system is the most commonly used method for identifying medication errors, there is significant under-reporting. The study design was cross sectional survey design. The study population included medical officers and nurses. A total of 110 staff were sampled for a self-administered questionnaire survey with a response rate of 96.4%. Survey questionnaire responses was analyzed using Statistical Package for Social Science (SPSS) version 20.0. The study found that both organizational factors and individual factors contribute to underreporting of medication errors. Fear of punishment and being labelled as incompetent influenced individuals decision on not reporting a medication error when it happened. Lack of a clearly defined institutional system for medication safety reporting and poor feedback mechanisms also contributed to poor reporting of medical errors in the hospital. Further research should be conducted to assess medication safety rates and severity of the problem. Data on medical error reporting in various public and private institutions should be assessed in order to give a more generalizable report on medical errors and patient safety.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

Medication administration involves providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or condition (Gupta et al, 2007). There are various ways in which medication can be administered by nurses. These methods include topical (application to the skin), parenteral (injections), inhalational and oral medication. Of the various ways of drug administration, oral medication is commonly used for paediatric outpatient clinics because of its convenience, ease of use and cost containment. Oral drugs come in various forms; they can either be in liquid or in solid forms (Kristine 2002).On the other hand, parenteral medication is the commonest method of drug administration for paediatric inpatients.
When infants and children are admitted in hospital, parents entrust their care and safety to the medical personnel mainly the pediatric nursing team. Pediatric nurses provide holistic care to the sick children by employing several procedures. One of these procedures is medication management. The management of medication in the ward by pediatric nurses involves ordering of the medicines from the pharmacy, storage of the drugs in a safe place in the ward, preparation of some medication for the patient, administering the medication to the patient and monitoring the patients‟ progress after taking the medication. This involvement of the nurse has led many nursing scholars to conclude that administration of medication is the chief responsibility of the nurse (Kristine 2002).

Pediatric nurses ensure sick children take their medicines as prescribed and with strict adherence to the five factors usually referred to as the „six rights‟ the nurses are trained to observe viz:-at the right time, right dosage, right route ,right drug, right patient and right documentation (Downie et al, 2002). Any measure of deviation from right procedure of medication for nurses has traditionally been based on the five rights‟. However despite the 6 rights of medication administration, medication errors still occur as a result of other factors. Smelter (2007) notes that the five rights fail to acknowledge that human factors and system weaknesses contribute to errors and therefore pediatric nurses‟ duty should not be so much to achieve the five rights but to follow the procedural rules set by organization to produce the outcomes.

The failure to administer medication as per the laid down procedure may lead to medication errors. According to Mosby‟s medical dictionary a medication error can be defined as any incorrect or wrongful administration of a medication, such as a mistake in dosage or route of administration, failure to prescribe or administer the correct drug or formulation for a particular disease or condition, use of outdated drugs, failure to observe the correct time for administration of the drug, or lack of awareness of adverse effects of certain drug combinations (Mosby 2009).Administration of medication is thus an important aspect of the practice of nursing. Nurses have an important role in detection and prevention of potential and actual medication errors promoting positive patient outcomes (Benner et al, 2002)


1.2 Statement of the Problem

The type and frequency of errors in the administration of drugs is a reflection of the quality of the nursing care system (Barker & Allan, 1995).This means that drug administration procedure if carried out right, one would be right to assume that nursing care is generally sound. Furthermore, according to Armitage and Knapman (2003) nurses spend 40% of their time doing drug administration which is a significant amount of time dedicated to one procedure in delivery of care by nurses. It would therefore be apt if the procedure for administration of medication was done in the right manner given the trust patients put in medication for the healing of their ailments. However, in the course of carrying out these procedures, nurses may be forced by some factors to ignore set standards. These factors maybe within or outside nurses‟ control.

The problem of non adherence to set drug administration guidelines by paediatric nurses has been attributed to these shortfalls. In a study done in Singapore on quality assurance on the administration of medication by nurses in neonatal intensive care unit ,non compliance with the standard practice of medication administration by paediatric nurses was shown to be common (Raja et al, 2009). In addition, health workers surveyed in a study in Tanzania were also found to rarely adhere to guidelines for integrated management of childhood infections leading the researcher to recommend a paradigm shift to focus on the reasons for health worker non adherence to guidelines (Walter et al, 2009). A study conducted on determination of the daily nursing procedures performed to children, drug administration was established as one of the procedures carried out on a daily basis (Makworo, 2010). Makworo (2010) also established that oral drug administration procedure as set out in the Nursing Council Manual was not adhered to by all the nurses observed. The researcher‟s experience, having worked in the paediatric medical wards in National Hospital (2003-2009) is that there have been perpetual complaints on the decline in the quality of nursing care, especially on drug administration in several meetings attended prompting the hospital management to start looking for ways of addressing the problems. Nurses working in the hospital have also anecdotally alleged that medication administration procedure in children is challenging. Key informants (doctors and nurse managers) at KNH pediatric wards have also expressed concerns over general decline in standards of nursing care especially medication practice.

The concerns raised by these studies require solutions and lay the basis of my study. In my literature search no published study was found to have been conducted on factors influencing quality management of medication in children by paediatric nurses in Oyo. This study is aimed at determining the factors which could hinder or enhance the achievement of quality management of medication to children probably impacting negatively or positively on their health. Ultimately the goal of the study is to contribute in mitigation of the reported nursing errors attributed to drug administration and improve the quality of drug administration by the paediatric nursing staff in general hospital Oyo.


1.3 Objectives of the Study

The study sought to determine the factors influencing medication safety among nurses in selected hospitals in Oyo.

  1. To determine nurse characteristics that influence quality medication administration in Oyo.
  2. To assess the awareness of the standard medication administration procedures by nurses in accordance with the Nursing Council.
  3. To evaluate the environment within which nurses administer medication to children.
  4. To determine the role of caregiver in medication administration practice.
  5. To establish the challenges encountered by nurses during medication administration procedures.
  6. To determine patient/caretaker characteristics that influence quality medication administration in children.

1.4 Research Questions

  1. What are the nurse characteristics that enhance quality medication management?
  2. What challenges do nurses encounter when administering medication to children?
  3. To what extent are patients/ caregiver involved in drug administration by paediatric nurses?
  4. What are the patients /caregiver characteristics that influence drug administration?

1.5 Hypothesis of the Study

Ho: medication safety by nurses is not related to nurses‟ demographic factors, experience and level of education.


1.6 Significance of the Study

This study is being conducted at a time when the burden of disease in Oyo is reported to be on the increase. While the increased disease burden may not entirely be attributed to medication administration practice by paediatric nurses alone, studies have shown that lack of proper medication management including treatment and non compliance may play a significant role in the development of resistance of micro organisms to available medications.

Paediatric nurses work in complex environments. They take care of their primary patients the children and secondary patient the family. Understanding the complexity of delivering pediatric nursing care is essential for making changes that effectively promote the health worker environment especially in pediatric department. To achieve the intended outcomes of healthy work environments (quality care, safe patient outcomes and nurse satisfaction), it is important that attention is directed to factors that complicate or support the paediatric nursing work. Literature search did not find any published study conducted on factors that influence proper management of medication by paediatric nurses as an aspect of quality care despite information pointing to drug administration problems in government institutions.

Understanding the factors that influence pediatric nurses‟ delivery of care including drug administration practice is an important step towards improvement of the quality of drug administration. This allows clinical paediatric nurses and administration systems to eliminate situations that promote errors and to incorporate changes that minimize them, creating a safer patient environment.

It is hoped the study findings will enhance adherence to the six rights of drug administration and to the laid down procedures of medication administration. This will lead to health preservation through quality pediatric care. The results also will provide reference material for evidence – based practice, nursing education and will be used to strengthen drug administration policies. It is also presumed that adherence to drug administration procedure will minimize wastage of drugs.


1.7 Scope of the Study

The study will analyze the factors influencing medication safety among nurses in selected hospitals in Oyo. The study is limited to some selected hospitals in Oyo. Hence, the respondents for this study will be obtained from selected hospitals in Oyo.


1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.


1.9 Definition of Terms

Adverse Drug Reaction:

A response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function

Adverse Event:

Medical occurrence temporally associated with the use of a medicinal product, but not necessarily causally related.

Medical Error:

Any preventable adverse outcome that results from improper medical management.

Medication Error:

Unintentional errors in the prescribing, dispensing, administration or monitoring of a medicine while under the control of a healthcare professional, patient, or consumer.

Patient Safety:

Patient safety is the prevention of avoidable errors and adverse effects to patients associated with health care.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  1. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  2. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  3. Chapter three deals on the research design and methodology adopted in the study.
  4. Chapter four concentrate on the data collection and analysis and presentation of finding.
  5. Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Conclusion and Recommendation

5.0 Introduction

This chapter summarizes findings from the study conducted on factors influencing medication safety among nurses in selected hospitals in Oyo. The objective of the study was to identify organizational factors that contribute to medication safety among nurses in selected hospitals in Oyo and analyze staff perception to the barrier to effective medication safety among nurses in selected hospitals in Oyo.


5.1 Conclusion

Medication delivery is a complex, multi-disciplinary process. Errors can occur at any step of the medication delivery process. Errors must be reported in order to identify system failures and individual causes leading to the errors. Medication error reporting helps prevent error recurrence and thus reduces rate of medical errors that will occur in the future.

System factors such as lack of hospital management support, unavailability of reference material, lack of clinical protocols etc. and human factors such as level of experience, low morale, illegible handwriting, lack of teamwork and fatigue contribute to medication errors. These factors must be addressed in a nonpunitive manner that encourages staff to embrace a culture of reporting.

Leadership and managerial support plays a critical role in increasing the rate of medication error reporting. Fear of repercussion, damage to an individual’s reputation, fear of punishment, lack of feedback mechanism and fear of being blamed if medication error is reported prevents many staff from reporting. Error reporting is closely related to quality improvement in hospitals thus all staff should be encouraged to voluntarily report errors.


5.2 Recommendations

The results of this study can be used to carry out further research on medical errors. It is suggested further review should be carried on medication error rates and their severity in public hospitals and suggestions on reducing them be provided. A detailed review on barriers to reporting medication errors and providing solutions to reduce these barriers should be done.

Staff perception to poor medication error reporting should be addressed through training and continuous sensitization on importance of reporting errors. Voluntary self- reporting of errors is the best method of collecting data related to errors but with poor reporting of errors it might be necessary for the hospital to design an instrument for measuring medication errors in the hospital. Close monitoring and evaluation is necessary in the field of medical errors.

Future research should examine healthcare workers in various public and private institutions in order to deliver comprehensive results in medication error reporting and patient safety in the country.


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