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STAFF NURSE’S PERCEPTION OF MEDICATION ERRORS,
           PERCEIVED CAUSES, AND REPORTING BEHAVIORS




                  ...
CHAPTER I

                       THE PROBLEM AND ITS SCOPE



Background of the Study

      A nurse is an integral part ...
medication errors. Patient stays associated with medication errors also increased

by 4.6 days, with a resulting cost incr...
Theoretical Framework


      This study is anchored on two nursing theories: Patricia Benner’s Model of

Skill Acquisitio...
The Benner model has been used extensively as a rationale for career

development and continuing education in nursing (May...
Beginner, Competence, Proficiency, and Expertise (From:
              http://visiblenurse.com.).

       Margaret Newman (...
Conceptual Framework

      This section presents the conceptual framework of the study. The

framework of this study is f...
EXTRANEOUS VARIABLES
           Demographic Profile:            - Self-rated Proficiency in
           - Age              ...
1.2 Sex;

          1.3 Civil status;

          1.4 Highest level of education;

          1.5 Work schedule;

          ...
Hypotheses

      Ho1: There is no significant relationship between the staff nurses’ profile

and their perception of med...
Scope and Limitation

       The study will look into the respondents’ perception of medication errors,

their perceived c...
Employment Status – refers to the status of the staff nurses employment;

          either regular, contractual, reliever,...
Sources of Information – refers to the nurses’ source of information regarding

          medication errors.

Work Schedul...
CHAPTER II

                REVIEW OF RELATED LITERATURE AND STUDIES



       This chapter discusses the related literatu...
outcome of the prescribed therapy in restoring and maintaining the client’s health.

In the acute care setting, nurses spe...
may be confused and think that they are having a new medication. If in doubt,

consult the BNF for the generic and trade n...
Related Studies



Perceptions about Medication Errors: Analysis of Answers by the Nursing Team

(Bohomol, E. and Ramos, L...
pharmacy. A retrospective review of 200 chemotherapy administrations found

only one clear MAE, a miscalculated dose that ...
administered. The most common route for medications errors was PO or “by

mouth”.

Factors influencing paediatric nurses’ ...
CHAPTER III

                         RESEARCH METHODOLOGY



       This chapter presents the methods of research used in...
cities on Mindanao. A small airport has interisland commercial service. The total

area of the city (378 sq km/146 sq mi) ...
Center, with 100-bed capacity, and is located at Alano cor. Cabrera Sts. The rest

of the hospitals are secondary. Jamelar...
reliability using the test-retest method (0.78) in their sample. The Modified

Gladstone was revised by the researcher and...
Statistical Treatment

       The frequency of the respondents profile and answers to the questions will

be treated using...
REFERENCES

Books

Berman, A., Synder, S.J., Kozier, B., Erb, G.L., Kozier & Erb’s Fundamentals of
     Nursing: Concepts,...
Hume, M. (1999) Changing hospital culture, systems reduce drug errors.
          Excellent Solution Healthcare Management....
QUESTIONNAIRE

                         Nurse’s Perception of Medication Errors,
                        Perceived Causes,...
a. Drug error?                               Yes         No
                     b. Notify physician?                     ...
the Nurse Manager.
     5. Some medication errors are not reported because
        nurses are afraid of the reaction they ...
10. What is your PRIMARY hospital work setting? (Please choose one.)
       ________ General Ward                  _______...
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Staff nurses' perception of medication errors, perceived causes, and reporting behaviors

  1. 1. STAFF NURSE’S PERCEPTION OF MEDICATION ERRORS, PERCEIVED CAUSES, AND REPORTING BEHAVIORS A Research Paper Submitted to Dr. Cynthia M. Superable Graduate School Misamis University Ozamiz City In partial fulfillment of the requirements in NR 213 (Research Methods in Nursing) REYNEL DAN L. GALICINAO May 2011
  2. 2. CHAPTER I THE PROBLEM AND ITS SCOPE Background of the Study A nurse is an integral part of the health care profession. They perform various duties in delivering nursing care to their patients. Among this is administering medications. Nurses drug administration forms a major part of the clinical nurse's role. Medication administration by the nurse is only one part of a process that also involves doctors and pharmacists (Betz & Levy, 1985). In giving medications, some untoward incident may happen and medication errors may occur. Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. These events are not infrequent. Medication errors represent the largest single cause of errors in the hospital setting. The Institute of Medicine reports 44,000 to 98,000 people die in hospitals annually as a result of medical errors that could have been prevented (Kohn, Corrigan, & Donaldson, 2000). Medication errors accounted for 7,391 deaths in 1993, compared to 2,876 deaths in 1983 (Kohn et al., 2000). Ten to 18% of all reported hospital injuries have been attributed to medication errors (Hume, 1999). Hospital medication error rates can be as high as 1.9 per patient per day (Fontan, Maneglier, Nguyen, Loirat, and Brion, 2003). United States of America data from 1993 indicates that 7,391 patients died from 2
  3. 3. medication errors. Patient stays associated with medication errors also increased by 4.6 days, with a resulting cost increase of $4,685 per patient (Hume, 1999). There are various causes of medication errors. Errors may occur at any of the process steps: prescription, transcription, dispensing, or administration. According to O’shea (1999), mathematical ability of nurses, nurse's knowledge of medications, workload, length of nursing experience, and length of nursing shift are all contributing factors to medication errors. It is also believed that there is underreporting of medication errors. Most error-reporting systems rely on voluntary self-reporting and are imbedded into what remain largely punitive management systems. Nurses widely report reluctance to disclose medication errors, particularly if an error does not result in patient harm (Wakefield, Wakefield, Uden-Holman, & Blegen, 1996; Walker & Lowe, 1998). According to Hume (1999), it is estimated that 95% of medication errors are not reported because staff fear punishment. There is a lack of research in the Philippines regarding medication errors. There is also a lack of statistics as to its frequency in the hospitals in the Philippines. Moreover, the researcher realizes this fact and has chosen to examine this subject to enhance understanding of medication errors in the country. The main purpose of this study is to examine the perception of medication errors, perceived causes, and reporting behaviors among nurses in the Philippines. 3
  4. 4. Theoretical Framework This study is anchored on two nursing theories: Patricia Benner’s Model of Skill Acquisition in Nursing and Margaret Newman’s Health as Expanding Consciousness Theory. Patricia Benner’s Model of Skill Acquisition in Nursing (1948), which applies the Dreyfus Model of Skill Acquisition (1980) to nursing, was first published in 1982 entitled “From Novice to Expert”. The model outlines five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert. However, her work is much more encompassing about nursing domains and specific functions and interventions (McEwen, 2007). Expertise develops when the clinician tests and refines propositions, hypotheses, and principle- based expectations in actual practice situations (Benner, 2001). Figure #. Patricia Benner’s Model of Skill Acquisition in Nursing. This model describes five levels of skill acquisition and development: (1) novice, (2) advanced beginner, (3) competent, (4) proficient, and (5) expert (From: http://visiblenurse.com.) 4
  5. 5. The Benner model has been used extensively as a rationale for career development and continuing education in nursing (Maynarde, 1996; Garland, 1996; Fuller and Conner, 1997; Cusson and Viggiano, 2002; Reynolds, 2002; Gallaher, 1999). As such, this study will use Benner’s theory as the basis for determining registered nurses’ perception of medication errors, perceived causes and reporting behaviors and their relationship to the length of work experience. DREYFUS MODEL OF SKILL ACQUISITION Figure 2. Dreyfus Model of skill acquisition describes five stages through which one must pass on the path to mastery. It is originally based on a report created by Hubert and Stuart Dreyfus in 1980 during their research in the area of Artificial Intelligence. The study was updated and popularized by Dr Patricia Benner in the mid Eighties in her work on the Nursing Crisis in the US and effectively applied for training everyone from pilots, nurses, software engineers, and foreign language learners. Five stages of skill acquisition through experience of a subject are Novice, Advanced 5
  6. 6. Beginner, Competence, Proficiency, and Expertise (From: http://visiblenurse.com.). Margaret Newman (1999) theorized that humans are continuously active in evolving their own pattern of the whole and are intuitive as well as cognitive and affective beings. Pattern is what identifies an individual as a person (Newman, 1994). It is a fundamental attribute of all that there is and gives unity in diversity. Newman (1994) stated that the patterns of interaction of person- environment constitute health. Accordingly, nursing education should revolve around this “pattern” to enable nursing to be an important resource for the continued development of healthcare (Newman, 1995). More importantly, Newman saw the theory, the practice, and the research as a process rather than as a separate domain of nursing discipline. With an updated contextual and practical knowledge, nurses will have the personal transformation in learning they ought to have and will be able to recognize health patterns in patients better by acting as a participant-observer of phenomena related to health (Tomey, 2002). Newman’s work has been used by nurses in a number of settings, providing care for different types of clients, and for a variety of interventions. These studies have a bearing on the present study because they all indicate that the ideal of health as expanding consciousness generates improved caring instructions in numerous populations. 6
  7. 7. Conceptual Framework This section presents the conceptual framework of the study. The framework of this study is focused on the relationship of the independent and dependent variables as well as that of the extraneous variables as shown in Figure 3. An action plan will also be proposed based on the results of the study. The proposed action plan will greatly depend upon the results of the nurses’ perception of medication errors, perceived causes, and reporting behaviors. The result may warrant a need for revision of policies, short-term training programs like continuing education and in-service education or a long-term course like advance professional education to update and enhance the knowledge on medication administration and proper reporting behaviors. The independent variable in this study is the staff nurses’ length of work experience while the dependent variable is the perception of medication errors, perceived causes, and reporting behaviors. The extraneous variables are demographic profile including age, sex, civil status, highest level of education, work schedule, employment status, length of nursing shift, and work setting. Also apart of the extraneous variables are the self-rated proficiency in medication administration, participation in short-term training regarding medication administration, and sources of information regarding medication errors. 7
  8. 8. EXTRANEOUS VARIABLES Demographic Profile: - Self-rated Proficiency in - Age Medication Administration - Sex - Participation in Short-term - Civil Status Training Regarding - Highest Level of Education Medication Administration - Work Schedule - Sources of Information - Employment Status Regarding Medication - Length of Nursing Shift Errors - Work Setting DEPENDENT VARIABLES INDEPENDENT VARIABLE Staff Nurse’s: - Perception of - Length of Work Medication Errors Experience - Perceived Causes of the Errors - Reporting Behaviors PROPOSED ACTION PLAN Figure 3. The Schema of the Study Statement of the Problem This study intends to look into the respondents’ (staff nurses in the hospitals in Pagadian City) perception of medication errors, their perceived causes, and their reporting behaviors. Specifically, it aims to answer the following questions: 1. What is the profile of the respondents in terms of: 1.1 Age; 8
  9. 9. 1.2 Sex; 1.3 Civil status; 1.4 Highest level of education; 1.5 Work schedule; 1.6 Employment status; 1.7 Length of nursing shift; 1.8 Length of work experience; 1.9 Work setting; 1.10 Self-rated proficiency in medication administration; and 1.11 Participation in short-term training regarding medication administration? 2. What are the respondents’ sources of information regarding medication errors? 3. What are the respondents’: 3.1 Perception of medication errors; 3.2 Perceived causes of medication errors; and 3.3 Reporting behaviors related to medication errors? 4. Is there a relationship between the respondents’ profile and their perception of medication errors, their perceived causes, and their reporting behaviors? 5. Is there a significant relationship between the respondents’ length of work experience and their perception of medication errors, their perceived causes, and their reporting behaviors? 9
  10. 10. Hypotheses Ho1: There is no significant relationship between the staff nurses’ profile and their perception of medication errors, their perceived causes, and their reporting behaviors. Ho2: There is no significant relationship between the staff nurses’ length of work experience and their perception of medication errors, their perceived causes, and their reporting behaviors. Significance of the Study The study will be beneficial to the following persons and institutions: Nurses and the Nursing Profession The nurses would benefit from this study since their perceptions and reporting behaviors regarding medication errors would be known, their concerns would be addressed. The results of the study would also help in formulating new guidelines to prevent medication errors and improve hasten reporting procedure. Hospital Administrators The hospital administrators will benefit from this study since through the results of this study, they will be informed as to how the staff nurses perceive medication errors. Based on the findings, they can revise their present policies or formulate new ones regarding medication errors and reporting behavior. Future Researchers This study will serve as a reference and guide for future researchers who will be conducting a study on medication errors. 10
  11. 11. Scope and Limitation The study will look into the respondents’ perception of medication errors, their perceived causes, and their reporting behaviors. It will also identify the respondents’ profile and sources of information regarding medication errors. The study will also determine the relationship between the respondents profile and their perception of medication errors, perceived causes, and reporting behaviors. The respondents will be Bachelor of Science in Nursing (BSN) graduate, a Registered Nurse (RN) in the Philippines, and working as a staff nurse in the identified hospitals in Pagadian City. The hospitals are Pagadian City Medical Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon General Hospital, and J. Cabahug Hospital. Convenience sampling will be used. After securing approval from the hospital administrators, a survey questionnaire will be distributed to the nurse’s stations and will be collected after one week. The study will be conducted from April to June 2012. Definition of Terms The following terms are defined operationally to project the functional meaning of the words for the purpose of clarity and ease of comprehension in this study. Age – refers to the length of time since the respondent’s birth up to present; expressed in years. Civil Status – refers to the state of being single, married, separated, or widow/widower. 11
  12. 12. Employment Status – refers to the status of the staff nurses employment; either regular, contractual, reliever, or volunteer. Highest Level of Education – refers to the highest level of education attained by the respondents; either bachelor’s degree, master’s degree, or doctorate degree. Length of Nursing Shift – refers to the length of time of each nursing shift as expressed in hours; usually eight or twelve hours. Length of Work Experience – refers to the nurses’ length of time working as a staff nurse. Medication Error – refers to the erroneous administration of medication; either wrong patient, time, dose, route, Self-rated Efficiency in Medication Administration – refers to how the nurses rate their efficiency in administering medications; either Expert, Proficient, Competent, Advance beginner, or Novice. Sex – refers to the gender; either male or female. Staff Nurse – refers to the nurses’ working in any area of the hospital with at least Bachelor’s of Science in Nursing degree and a Registered Nurse in the Philippines. Perceived Cause of Medication Error – refers to what the nurses perceive as the usual causes of medication errors. Reporting Behavior – refers to whether the nurses perceive a medication error as reportable to the physician and nurse manager through an incident report. 12
  13. 13. Sources of Information – refers to the nurses’ source of information regarding medication errors. Work Schedule – refers to the schedule of the nurses’ duty; either on a full- time or part-time basis. Work Setting – refers to the nurses’ area of duty in the hospital; either ward or the special areas. 13
  14. 14. CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES This chapter discusses the related literature and studies that were reviewed about medication errors, its causes, and reporting behaviors to give clarity to the present study. Related Literature Medication Administration (Delaune and Ladner, 2002) Medication management requires the collaborative efforts of many health care providers. Medications may be prescribed by a physician, dentist, or other authorized prescriber such as advanced practice registered nurses as determined by individual state licensing bodies. Pharmacists are licensed to prepare and dispense medications. Nurses are responsible for administering medications. Dietitians are often involved in identifying possible food and drug interactions. Nurses play an essential role in the administration of, education about, and evaluation of the effectiveness of prescribed medications. The nurse’s role changes with the setting of the client. In the home ore community setting, referred to as primary care, clients take their own medication as prescribed by the health care practitioner. Nurses are responsible for educating the client about his or her medications and its possible side effects as well as for evaluating the 14
  15. 15. outcome of the prescribed therapy in restoring and maintaining the client’s health. In the acute care setting, nurses spend a great deal of time administering medications and evaluating their effectiveness. Nurses are responsible for teaching clients how to take their medications safely when they are discharged. Medication administration requires specialized knowledge, judgment, and nursing skill based on the principles of pharmacology. The Five Rights (5 Rs) of Drug Administration (Workmann And Bennett, 2003) The responsibility for administering medication safely is one which nurses take seriously, and to assist in this procedure the five Rights (5 Rs) of drug administration have been devised: Right patient Check the identity of the patient with his identification band, using hospital number or date of birth as additional verification. If patients are long-stay residents, identification may be by photograph, rather than an impersonal name band (Williams 1996). In the home setting you should satisfy yourself that you have identified the right patient for medication by asking them their full name or date of birth to verify against the prescription. Right drug Drug names can be complex, and have similarities between names. Check for clearly written prescriptions, matching the name on the medication container. In hospital, drugs are prescribed by their generic names, and patients 15
  16. 16. may be confused and think that they are having a new medication. If in doubt, consult the BNF for the generic and trade name of the drug. Check three times during the procedure: when you take the drug from the cupboard or trolley, before you pour it into the medication receiver, matching it to the drug name on the prescription sheet, as you return it to the cupboard or trolley. Right dose This should be clearly written on the prescription sheet. If the dose is very small, then micrograms should be written out in full (BNF). Calculate the dose carefully and check to see if there is a drug with the same name but dispensed in different strengths. Right time Most drugs are designed to be given with an interval of several hours apart to provide a consistent therapeutic blood level. If given haphazardly, then the medication will be less effective or may cause the patient to develop unwanted side effects. Therefore, it is essential to give doses at prescribed intervals and to record the actual time of administration. Right route Medications are given licences for specific routes of administration. It is possible to give medication by the wrong route, for example, an intramuscular injection may be given intravenously if sited in the wrong place. 16
  17. 17. Related Studies Perceptions about Medication Errors: Analysis of Answers by the Nursing Team (Bohomol, E. and Ramos, L.H., 2006) This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution. Study of Medication Errors on a Community Hospital Oncology Ward (Ford, C.D., Killebrew, J., Fugitt,P., Jacobsen, J. and Prystas, E.M., 2006) Our nurses reported 141 medication administration errors during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the 17
  18. 18. pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted. Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits. Medication Errors In Relation To Education & Medication Errors In Relation To Years of Nursing Experience (Bailey, C.G., Engel, B.S., Luescher, J.N., and Taylor, M.L., 2008) The results of the study suggested that there is a direct relationship between education and medication errors, rather than an inverse relationship, wherein as education increased number of errors decreased. The study showed that Licensed Practical Nurses (LPN) made the least number of medications errors followed by Registered Nurses with Associate Degrees, with BSN Registered Nurses having the highest incidence of medication errors. The results indicate that as the education level increased so did the number of medication errors. The study showed that nurses made the most medication errors either in their first five years of nursing experience or after twenty years of nursing.This study also indicated that giving medication at the wrong time was the most common type of medication error made by the participants.The shift that reported having the most medication errors was 7 am-7 pm, when most medications are 18
  19. 19. administered. The most common route for medications errors was PO or “by mouth”. Factors influencing paediatric nurses’ responses to medication administration (Davis, L., Ware, R.S., McCann,D., Keogh,S. and Watson, K., 2011) Double checking the patient, double checking the drug and checking the legality of the prescription were the three strongest predictors of nurses’ actions regarding medication administration. Policy factors, and not contextual factors, drive nurses’ judgement in response to hypothetical scenarios. 19
  20. 20. CHAPTER III RESEARCH METHODOLOGY This chapter presents the methods of research used in this study. It includes the research design, research setting, research respondents, research instruments, data gathering procedure and statistical treatment. Research Design This non-experimental research will utilize the descriptive survey and descriptive-correlational designs. The purpose these design is to describe the variables and examine the relationships among these variables. No attempt will be made to control or manipulate the situation. An anonymous, self-report survey method will be applied using a questionnaire checklist in gathering the needed data for the study. Research Setting This study will be conducted at in the hospitals of Pagadian City. Pagadian is a chartered city in the southwestern Philippines, capital of Zamboanga del Sur Province, on the island of Mindanao, on the south coast of the Zamboanga Peninsula. Pagadian is a port on Pagadian Bay, a part of the much larger Illana Bay. Pagadian is an important processing center for rice, maize (corn), and coconuts produced in the surrounding area. Fishing is also a major economic activity, as is lumber processing due to the peninsula's excellent stands of Philippine hardwood trees. National roads connect Pagadian with most other 20
  21. 21. cities on Mindanao. A small airport has interisland commercial service. The total area of the city (378 sq km/146 sq mi) includes a large portion of farmland. Its population (2000) is 143,000. (Microsoft Encarta 2009) Figure #. The Map of Pagadian City (Google Maps 2011) Five hospitals will be included in this study. They are Pagadian City Medical Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon General Hospital, and J. Cabahug Hospital. Four of which are secondary and one tertiary hospital. Four of these hospitals are privately owned and only one is a government- owned hospital. The only tertiary hospital the city is the Pagadian City Medical 21
  22. 22. Center, with 100-bed capacity, and is located at Alano cor. Cabrera Sts. The rest of the hospitals are secondary. Jamelarin Hospital has a 40-bed capacity situated at Balangasan Dist. Borbon General Hospital is located at Rizal Ave., Sta. Lucia Dist. and has 15-bed capacity. J. Cabahug Hospital has 10-bed capacity and is situated at Rizal Ave., San Pedro Dist. The only public hospital is the Zamboanga del Sur Medical Center, with 130-bed capacity located at Barangay Dao. These hospitals are all accessible by local transportation such as tricycle or public utility jeepney. These hospitals cater the health needs of the people. Research Respondents The target population will be Bachelor of Science in Nursing graduates and are Registered Nurses (RN’s) in the Philippines who are staff of the chosen hospitals in Pagadian City. All of the staff nurses in Pagadian City Medical Center, Zamboanga del Sur Medical Center, Jamelarin Hospital, Borbon General Hospital, and J. Cabahug Hospital will be given the questionnaire and will be instructed to return it to the researcher as soon as they complete the survey- questionnaire. Convenience sampling will be used by providing questionnaire to each nurse’s station and leaving it to be completed within one week. Research Instrument The instrument to be used in this study is the Modified Gladstone (2001). Instrument content validity was determined acceptable by Osborne, Blais, and Hayes (1999) and Goldstone (1995). In addition, Osborne et al established 22
  23. 23. reliability using the test-retest method (0.78) in their sample. The Modified Gladstone was revised by the researcher and added additional items to suit the objectives of this study. This instrument measured (1) nurses’ perceived causes of medication errors – 10 items; (2) estimated percentage of drug errors reported to nurse managers – 1 item; (3) types of incidents that would be classified as (a) medication errors, (b) reportable to physicians, or (c) reportable using an incident report – 6 items; (4) nurses’ views about reporting medication errors – 8 items; (5) nurses’ demographic data – 12 items; and (6) nurses’ source(s) of information regarding medication errors – 2 items. Data Gathering Procedure Written permission to conduct the study will be obtained from the chief nurses and medical directors of the respective hospitals. A letter to the respondent stating the study’s purpose and significance will be attached to the front page of each questionnaire to obtain a free and informed consent. Participants will be assured that their responses would remain confidential, any information that may reveal their identity would not be recorded, and only aggregated data will be communicated. The questionnaires will be placed on each nurse’s station in a labeled envelope with instructions concerning the survey. The researcher will collect the completed surveys after one week. The results will be compiled and analyzed. 23
  24. 24. Statistical Treatment The frequency of the respondents profile and answers to the questions will be treated using the following formula. To provide an average picture of the data, the sample mean will be determined using this formula: ∑ ̅ Where: ̅= mean; ∑ = sum of observations; and n= number of observations. To determine the percentage, this formula will be used : Where: P = percentage; ƒ = frequency; and n = number of samples. The chi-square test will be used to determine if significant relationships exist between the variables. This is the formula of chi-square test: ( ) ∑ Where: x2 = the test statistic that asymptotically approaches a x2 distribution; Oi = an observed frequency; Ei = an expected frequency, asserted by the null hypothesis; and n = the number of possible outcomes of each event. 24
  25. 25. REFERENCES Books Berman, A., Synder, S.J., Kozier, B., Erb, G.L., Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed. Singapore: Pearson Education South Asia Pte. Ltd., 2008. DeLaune, S.C., Ladner, P.K., Fundamentals of Nursing: Standards and Practice, 2nd Ed. United States of America: Thomson Learning, Inc., 1998. Ignatavicius, D., Workman, M., Medical-Surgical Nursing: Critical Thinking for Collaborative Care 5th Ed. Philadelphia: W.B. Saunders, 2006. Lehne, R.A., Pharmacology for Nursing Care 5th Ed. Singapore: Elsevier Pte Ltd, 2005. Nettina, S.M., Mills, E.J., Lippincott Manual of Nursing Practice, 8th Ed. United States of America: Lippincott, Williams & Wilkins, 2006. Potter, P., Perry, A., Fundamentals of Nursing 6th Ed. St. Louis: Mosby, 2005. Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. United States of America: Lippincott Williams and Wilkins, 2008. Workman, B.A., Bennett, C. L. Key Nursing Skills. London, England: Whurr Publishers, Ltd., 2003. Journals Betz R. & Levy B. (1985) An interdisciplinary method of classifying and monitoring medication errors. American Journal of Hospital Pharmacy 42(8), 1724-1732. Fontan, J., Maneglier, V., Nguyen, V.X., Loirat, C., and Brion, F. (2003) Medication errors in hospitals: computerized unit drug dispensing systems versus ward stock distribution system. Pharmacy World Science. 25(3):112–117. 25
  26. 26. Hume, M. (1999) Changing hospital culture, systems reduce drug errors. Excellent Solution Healthcare Management. 2(4): 4–9. Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Osborne, J., Blais, K., and Hayes, J.,S.(1999) Nurses’ perceptions: when is it a medication error? Journal of Nursing Administration. 29(4):33–38. O'shes, E. (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing (8), 496-504. Wakefield, D.S., Wakefield, B.J., Uden-Holman, T., & Blegen, M.A. (1996). Perceived barriers in reporting medication administration errors. Best Practices and Benchmarking in Healthcare, 1(4), 191-197. Internet Reources Microsoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation. Google Maps 2011 http://visiblenurse.com 26
  27. 27. QUESTIONNAIRE Nurse’s Perception of Medication Errors, Perceived Causes, and Reporting Behaviors (Revised from Modified Gladstone 2001) I. Why do you think medication errors occur? The following ten statements are all possible causes of medication errors. Please read them carefully and rank 1 to 10. (Where 1 is the most frequent and 10 the least frequent.) a. Drug errors occur when the nurse fails to check the patient’s name band with the Medication Administration Record (MAR). __________ b. Drug errors occur when the physician’s writing on the doctor’s order form is difficult to read or illegible. __________ c. Drug errors occur when the medication labels/packaging are of poor quality or damaged. __________ d. Drug errors occur when there is confusion between two drugs with similar names. __________ e. Drug errors occur when the physician prescribes the wrong dose. __________ f. Drug errors occur when the nurse miscalculates the dose. __________ g. Drug errors occur when the nurse sets up or adjusts an infusion device incorrectly. __________ h. Drug errors occur when nurses are confused by the different types and functions of infusion devices. __________ i. Drug errors occur when nurses are distracted by other patients, coworkers or events on the unit. __________ j. Drug errors occur when nurses are tired and exhausted. __________ II. In your estimate, what percentage of all drug errors is reported to the Nurse Manager by the completion of an incident report? (Please mark an “X” on the line that corresponds most closely to your estimation.) ______________________________________________________________________ 1% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% III. It is not always clear to nurses whether what they view as a minor drug discrepancy should be reported as a medication error. In the following examples you are asked to indicate: a. Whether or not a medication error occurred. b. Whether or not the physician should be notified. c. Whether or not an incident report should be completed. Please check YES or NO for each of the following statements: 1. A patient missed his midday dose of oral Ampicillin because he was in X-ray for 3 hours. 27
  28. 28. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 2. Four patients on a busy surgical unit received their 6:00 pm doses of IV antibiotics 4 hours late. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 3. A patient receiving TPN feeding via an infusion pump was given 200 ml/hr instead of the correct rate of 125 ml/hr for the first three hours of the 24-hour infusion. The pump was reset to the correct rate after the change of shift at 7:00 am when the incoming nurse realized that the pump was set at the incorrect rate. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 4. A patient admitted with status asthmaticus on 04/30/2011 at 2:00 am is prescribed Ventolin nebulization every 4 hours. The nurse omitted the 6:00 am dose on 04/30/2011 as the patient is asleep. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 5. A physician ordered percocet 1-2 tabs for post-op pain every 4 hours. At 4:00 pm, the patient complained of pain, requested one pill and is medicated. At 6:30 pm the patient requested the second pain pill. The nurse administered the pill. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No 6. A patient is receiving a routine 9 am dose of digoxin every day. Yesterday’s digoxin level was 1.8 (the high side of normal). A digoxin level was drawn at 6 am today. At 9 am the nurse holds the digoxin because the lab value is not available yet. a. Drug error? Yes No b. Notify physician? Yes No c. Incident report necessary? Yes No IV. What are your views about reporting medication errors? Please check the most appropriate response: 1. I am usually sure what constitutes a medication error. Yes No 2. I am usually sure when to notify the physician in case of a medication error. Yes No 3. I am usually sure when a medication error should be reported using an incident report. Yes No 4. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from 28
  29. 29. the Nurse Manager. 5. Some medication errors are not reported because nurses are afraid of the reaction they will receive from their coworkers. Yes No 6. Have you known an incident when a coworker did not report a medication error? Yes No 7. Have you ever failed to report a drug error because you did not think the error was serious to warrant reporting? Yes No 8. Have you ever failed to report a medication error because you were afraid that you might be subject to disciplinary action or even lose your job? Yes No V. Respondent’s Profile. Please fill in the answers below. 1. Age: ________ years old 2. Sex: ________ Male ________ Female 3. Civil Status: ________ Single ________ Separated ________ Married ________ Widower/Widow 4. Highest level of education: ________ Bachelor of Science in ________ Master of Science in Nursing (BSN) Nursing (MSN) ________ Undergraduate in Master’s ________ Master, in other field: Degree _______________ ________ Master in Nursing (MN) ________ Undergraduate in Doctorate ________ Master of Arts in Nursing ________ Doctor of Nursing (DN) (MAN) ________ Doctorate, in other field: _______________ 5. How long have you been working as a nurse? _______ year(s) & _______ month(s) 6. What is your proficiency in administering medications: ________ Expert ________ Advance Beginner ________ Proficient ________ Novice ________ Competent 7. What is your work schedule? ________ Full-time ________ Part-time 8. Employment Status: ________ Regular ________ Reliever ________ Contractual ________ Volunteer 9. Length of nursing shift: _______ hours 29
  30. 30. 10. What is your PRIMARY hospital work setting? (Please choose one.) ________ General Ward ________ Operating Room (OR) ________ Surgical Ward ________ Post-Anesthesia Care ________ Medical Ward Unit/Recovery Room ________ OB-GYN Ward ________ Labor & Delivery Rooms ________ Pedia Ward (DR) ________ Intensive/Critical Care Unit ________ Neonatal Intensive Care (ICU) Unit (NICU) ________ Emergency Department ________ Out Patient Department (ER) (OPD) 11. How many medication errors do you remember making over the course of your career? (Please encircle your answer.) 0 1 2 3 4 5 6 7 8 9 10 More than ten please specify ________ 12. How many incident reports related to medication errors do you remember making over the course of your career? (Please encircle your answer.) 0 1 2 3 4 5 6 7 8 9 10 More than ten please specify ________ 13. Have you joined any short-term training program regarding medication error? ________ Yes ________ No 14. What are your source(s) of information regarding medication errors? (Please check all that applies.) ________ Nursing/Medical Journals ________ Discussions with other ________ Nursing/Medical Websites medical professionals and Blogs Others, please specify: ________ Medical Text and ________________________ Reference Books ________ Trainings/Seminars/ Symposia 30
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