Using incident reports to inform the prevention of medication administration errors

• Published in: Journal of clinical nursing 2017-11, Vol.26 (21-22), p.3486-3499
• Main Authors: Härkänen, Marja, Saano, Susanna, Vehviläinen‐Julkunen, Katri
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Content analysis; Drug administration; Finland; Health Personnel - organization & administration; hospital; Humans; Medical errors; Medical personnel; medication error; Medication Errors - prevention & control; medication management; nurses; Nursing; Nursing Process - organization & administration; Qualitative Research; Risk Management - methods; thematic analysis; Work environment
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.13713

Aims and objectives To describe ways of preventing medication administration errors based on reporters' views expressed in medication administration incident reports. Background Medication administration errors are very common, and nurses play important roles in committing and in preventing such errors. Thus far, incident reporters’ perceptions of how to prevent medication administration errors have rarely been analysed. Design and Methods This is a qualitative, descriptive study using an inductive content analysis of the incident reports related to medication administration errors (n = 1012). These free‐text descriptions include reporters’ views on preventing the reoccurrence of medication administration errors. The data were collected from two hospitals in Finland and pertain to incidents that were reported between 1 January 2013 and 31 December 2014. Results Reporters’ views on preventing medication administration errors were divided into three main categories related to individuals (health professionals), teams and organisations. The following categories related to individuals in preventing medication administration errors were identified: (1) accuracy and preciseness; (2) verification; and (3) following the guidelines, responsibility and attitude towards work. The team categories were as follows: (1) distribution of work; (2) flow of information and cooperation; and (3) documenting and marking the drug information. The categories related to organisation were as follows: (1) work environment; (2) resources; (3) training; (4) guidelines; and (5) development of the work. Conclusions Health professionals should administer medication with a high moral awareness and an attempt to concentrate on the task. Nonetheless, the system should support health professionals by providing a reasonable work environment and encouraging collaboration among the providers to facilitate the safe administration of medication. Relevance to clinical practice Although there are numerous approaches to supporting medication safety, approaches that support the ability of individual health professionals to manage daily medications should be prioritised.