Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study

ABSTRACT Aims To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. Background Worldw...

Full description

Saved in:
Bibliographic Details
Main Authors: Ondrej Tesar, Martin Dosedel, Ales Antonin Kubena, Katerina Mala‐Ladova, Radka Prokesova, Iva Brabcova, Hana Hajduchova, Martin Cerveny, Ivana Chloubova, Jiri Vlcek, Valerie Tothova, Josef Maly
Format: Article
Language:English
Published: Wiley 2025-01-01
Series:Nursing Open
Subjects:
Online Access:https://doi.org/10.1002/nop2.70139
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1832577740768804864
author Ondrej Tesar
Martin Dosedel
Ales Antonin Kubena
Katerina Mala‐Ladova
Radka Prokesova
Iva Brabcova
Hana Hajduchova
Martin Cerveny
Ivana Chloubova
Jiri Vlcek
Valerie Tothova
Josef Maly
author_facet Ondrej Tesar
Martin Dosedel
Ales Antonin Kubena
Katerina Mala‐Ladova
Radka Prokesova
Iva Brabcova
Hana Hajduchova
Martin Cerveny
Ivana Chloubova
Jiri Vlcek
Valerie Tothova
Josef Maly
author_sort Ondrej Tesar
collection DOAJ
description ABSTRACT Aims To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. Background Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications. Design The prospective observational study was carried out in accordance with the STROBE guidance. Methods This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow‐up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model. Results Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength). Conclusions Non‐adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered. Implication for the Profession and Patient Care The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration. Patient or Public Contribution Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.
format Article
id doaj-art-51991c3db6b14a9482c0f71756d474ba
institution Kabale University
issn 2054-1058
language English
publishDate 2025-01-01
publisher Wiley
record_format Article
series Nursing Open
spelling doaj-art-51991c3db6b14a9482c0f71756d474ba2025-01-30T16:40:37ZengWileyNursing Open2054-10582025-01-01121n/an/a10.1002/nop2.70139Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric StudyOndrej Tesar0Martin Dosedel1Ales Antonin Kubena2Katerina Mala‐Ladova3Radka Prokesova4Iva Brabcova5Hana Hajduchova6Martin Cerveny7Ivana Chloubova8Jiri Vlcek9Valerie Tothova10Josef Maly11Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicInstitute of Humanities in Helping Professions, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicInstitute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicInstitute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicInstitute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicInstitute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicInstitute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech RepublicDepartment of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove Charles University Hradec Kralove Czech RepublicABSTRACT Aims To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. Background Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications. Design The prospective observational study was carried out in accordance with the STROBE guidance. Methods This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow‐up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model. Results Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength). Conclusions Non‐adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered. Implication for the Profession and Patient Care The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration. Patient or Public Contribution Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.https://doi.org/10.1002/nop2.70139inpatientmedication administrationmedication errormultidisciplinary teamnursepatient safety
spellingShingle Ondrej Tesar
Martin Dosedel
Ales Antonin Kubena
Katerina Mala‐Ladova
Radka Prokesova
Iva Brabcova
Hana Hajduchova
Martin Cerveny
Ivana Chloubova
Jiri Vlcek
Valerie Tothova
Josef Maly
Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
Nursing Open
inpatient
medication administration
medication error
multidisciplinary team
nurse
patient safety
title Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
title_full Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
title_fullStr Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
title_full_unstemmed Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
title_short Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study
title_sort errors associated with medication administration by a nurse during hospitalisation a prospective observational multicentric study
topic inpatient
medication administration
medication error
multidisciplinary team
nurse
patient safety
url https://doi.org/10.1002/nop2.70139
work_keys_str_mv AT ondrejtesar errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT martindosedel errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT alesantoninkubena errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT katerinamalaladova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT radkaprokesova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT ivabrabcova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT hanahajduchova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT martincerveny errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT ivanachloubova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT jirivlcek errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT valerietothova errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy
AT josefmaly errorsassociatedwithmedicationadministrationbyanurseduringhospitalisationaprospectiveobservationalmulticentricstudy