Effectiveness of Clinical Nurses’ interventions in reducing medication errors in a paediatric ward

Abstract

Aims and objectives To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses’ medication administration practice. Background Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. Design An Action Research (AR) three‐phase quantitative study. Methods Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. Results Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. Conclusion Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empowers them to find solutions that are tailored to their own practice culture and environment.

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

“…Champions are those healthcare professionals who are committed to implementing change, act as a role model for the intended change and are enthusiastic in convincing others in the organisation of the necessity of change [ 69 , 82 , 86 , 89 , 101 , 103 , 109 ]. Two kinds of champions were identified, those that initiated an audit [ 36 , 49 , 54 , 59 , 69 , 74 , 82 , 89 ] and those nominated by the leadership of an organisation and given responsibility for carrying the audit forward [ 43 , 47 , 53 , 57 , 85 , 86 , 90 , 91 , 95 , 101 , 103 , 104 , 109 , 119 ]. In successful audits champions challenge, educate and lead their colleagues to improve the quality of care [ 69 , 90 , 91 , 95 , 101 , 119 ].…”

“…Two kinds of champions were identified, those that initiated an audit [ 36 , 49 , 54 , 59 , 69 , 74 , 82 , 89 ] and those nominated by the leadership of an organisation and given responsibility for carrying the audit forward [ 43 , 47 , 53 , 57 , 85 , 86 , 90 , 91 , 95 , 101 , 103 , 104 , 109 , 119 ]. In successful audits champions challenge, educate and lead their colleagues to improve the quality of care [ 69 , 90 , 91 , 95 , 101 , 119 ]. Furthermore, healthcare professionals consider an audit more relevant if one of their peers is the driving force, and this fosters trust [ 36 ].…”

“…In bottom-up initiated audits, healthcare professionals take the lead. These healthcare professionals work closely together to define appropriate improvements for their own local situation, and this ownership helps developing informal social ties and ensuring the acceptance of sustainable improvements in practice [ 53 , 57 , 59 , 60 , 80 , 91 ]. For example, during an audit about medication registration errors, nursing teams were empowered to develop their own strategies to improve practice [ 91 ].…”

“…These healthcare professionals work closely together to define appropriate improvements for their own local situation, and this ownership helps developing informal social ties and ensuring the acceptance of sustainable improvements in practice [ 53 , 57 , 59 , 60 , 80 , 91 ]. For example, during an audit about medication registration errors, nursing teams were empowered to develop their own strategies to improve practice [ 91 ]. Healthcare professionals are able to collaborate to improve the quality of care because they respect each other’s competences and are sensitive to each other’s work and needs [ 53 , 57 , 59 ].…”

Correlation between safety attitudes and early adoption of cognitive aids in the German culture sphere: a multicenter survey study

“…aviation, nuclear) several instruments have been developed for its quantification [14]. Of these the Safety and Attitudes Questionnaire (SAQ) has been used most commonly in the context of cognitive aids in healthcare [15][16][17][18]. Originally developed as the Flight Management Attitudes Questionnaire to asses safety culture in aviation, multiple versions of the SAQ have been developed for different clinical surroundings (e.g.…”