1) The study evaluated the potential severity of medication administration errors detected by a bar-code medication administration (BCMA) system in six hospitals. 2) The majority (91%) of errors reviewed were evaluated as having minor severity potential, while 9% were evaluated as moderate to severe. 3) "No order" errors, where there was no corresponding order entered, were significantly more likely to be evaluated as moderate or severe than other error types.

1. Novice Nurses versus Experienced Nurses: Barriers to Medication Administration
By:
Jennifer Allred
Amanda Bufkin
Andrea Davis
Earika Flemings
Rachel Hicks
Christina Mortenson
Kristen Pippin
Mary Sears
Stephany Vance
Under the Direction of:
Dr. Tammie McCoy
Bachelor of Science in Nursing Program
Mississippi University for Women
March 7, 2014

2. i
Abstract
The research problem statement asked, “Do novice nurses or experienced nurses
have more barriers to safe medication administration in the healthcare setting?” The
research hypothesis stated that experienced nurses have more barriers to safe medication
administration than novice nurses in the healthcare setting. The null hypothesis was there
is no significant difference in the number of barriers to safe medication administration
between novice nurses and experienced nurses in the healthcare setting. A non-
experimental comparative research design was utilized to collect data from previously
registered nurses who were also students at a small, rural university in the southeast USA.
Through an online convenience sample, 44 participants completed The Barriers to Safe
Medication Administration Questionnaire. The questionnaire contained 19 questions, four
of which were demographics, and 15 of which used the semantic differential scale to
determine the prevalence of barriers during medication administration. The data collected
was coded and interpreted by the Spearman Rank Order Correlation with a preset
confidence level of 0.05. With a 0.131 correlation and p-value of p = 0.198, the student
researchers failed to reject the null hypothesis. There was no statistical data available to
support that nurses with more years of practice, experience more barriers to medication
administration than did new nurses. On the other hand, with a 0.355 correlation and p-
value of p = 0.009, the student researchers found a moderate correlation between the
number of perceived barriers reported and unit of employment. The abundant presence of
barriers during medication administration prompted the student researchers to study
which barriers licensed nurses perceived to be predominant. This study found that the
most prevalent barriers reported most frequently were understaffing, interruptions, lack of

3. ii
time, and errors in communication. This study implicates nursing because nurses were
able to identify barriers to safe medication administration. By identifying these barriers
that could potentially cause errors, this study will then allow for measures to be put in
place to minimize the occurrence of barriers that nurses face during the process of
medication administration. In future studies, researchers should expand the sample size,
allow more time for participants to access the questionnaire, and focus a new
questionnaire on the barriers which were more prevalent. Future studies should expand
on the research to determine ways to reduce the occurrence of the more prevalent
barriers.

4. Table of Contents
Page
Abstract ……………………………………………………………………….. i-ii
CHAPTER
I. INTRODUCTION ………………….………………………………... 1-6
a. Brief Background …………………………..……..…….….… 1
b. Clinical Observation ………………………………………….. 2
c. Significance of the Research …………………………………. 3
d. Problem Statement ………………………………………….... 4
e. Purpose Statement …….…………….…………...................... 4
f. Null Hypothesis ……….………………………....................... 4
g. Research Hypothesis …..…..…………….………………….... 5
h. Definitions …………….…………………………………….... 5
i. Assumptions …………………………….……………………. 5
II. LITERATURE REVIEW ……………………….………………….... 7-22
a. Introduction ……………………………………………….….. 7
b. Importance of Safe Medication Administration ……..………. 7
c. Barriers to Safe Medication Administration ……………….… 12
d. Prevention of Medication Errors ……………………….…….. 17
e. Conclusion ……………………………………………….….... 20
III. RESEARCH DESIGN AND METHODOLOGY ……………….…… 23-26
a. Research Design …………………………………………...…. 23
b. Variables ……………………………………….………......…. 23
c. Subjects and Setting ……………………………..…………… 23

5. d. Data Collection Instruments …………………………….…… 24
e. Data Collection Procedures .….………….…………………… 24
f. Analysis Method …………………………………….….….… 25
g. Limitations ………………………………………….…….….. 25
IV. RESULTS ………………………………………………………….… 27-33
a. Summary ……………………………………………………... 27
b. Statistical Analysis …………………………………………... 28
c. Serendipitous Findings …………………………………….… 30
d. Alterations …………………………………………………… 31
e. Limitations ……………………………………………….…... 32
f. Similar Findings …………………………….……………….. 32
g. Contradictory Findings ……………………………………… 32
h. Conclusion ………………………………………………...… 33
V. CONCLUSIONS ……………………………………………………. 34-36
a. Summary of the Study ………………………………………. 34
b. Conclusions of the Study …………………………………… 34
c. Implications for Nursing ……………………………………. 35
d. Recommendations …………………………………………... 35
VI. Appendices ………………………………………………………….. 37
a. Appendix A …………………………………………………. 37
b. Appendix B …………………………………………………. 38
VII. References ………………………….…………..…………………… 41

6. 1
Chapter I
Introduction
Brief Background
Nurses administer medications on a daily basis. A leading cause of medical harm
in hospitalized patients stems from medication errors (DeYoung, VanderKooi, &
Barletta, 2009). A medication error can be described as an omitted dose; administering
the incorrect dose; administering a dose that is not ordered; administration of medication
to the wrong patient; improper technique with administration of medication;
administration of an expired medication or the wrong medication (Taylor, Lillis,
LeMone, & Lynn, 2011). An error could lead to an adverse event, causing harm to the
patient and costing the hospital extra expenses. According to the National Coordinating
Council for Medication Error Reporting and Prevention (2012), 98,000 deaths occur
annually in United States hospitals because of healthcare errors with a substantial number
of deaths due to medication errors. Therefore, nurses are encouraged to pay close
attention while administering medication in order to enhance patient safety.
A barrier has been defined as any realistic or perceived deterrent which could
impede safe nursing practice during medication administration. Nursing related barriers
can include lack of knowledge or understanding of pharmacology, time and work
pressures, nursing shortages, and multiple patients’ medications scheduled at the same
time (Dilles, Elselviers, Van Rompaey, & Vander, 2011). Medication management is
complex; errors can occur in all stages of the process and different professionals can be
involved (physicians, pharmacists, and nurses) (Dilles et al., 2011). The nursing staff is a
critical line of defense in order to prevent medication errors. A clinical environment can

7. 2
become a focal point for medication errors because of the multiple barriers in place.
Considering these observations, nurses need to be aware of barriers to safe medication
administration so as to ultimately reduce the amount of medication error occurrences.
Clinical Observation
Medication administration is a foundation of nursing care. As an essential element
of optimal nursing care, medication administration should enhance the health of the
patient (Taylor et al., 2011). Unfortunately, the health and safety of the patient comes in
to question when medication errors are made in the clinical environment (Aspden,
Wolcott, Bootman, & Cronenwett, 2006). On a routine basis, the student researchers
observed medication administration and identified the barriers to medication
administration that arise with clinical practice. Throughout various clinical settings, the
student researchers witnessed lenient standards of medication administration
contradicting the fundamentally safe clinical practice of the five rights of medication
administration. With these relaxed practices, the student researchers noticed increased
opportunities for medication error in addition to an increased number of reported
medication errors. For example, while observing a registered nurse, the student
researchers viewed the nurse bypassing patient identification. The nurse did not confirm
the patient’s name or the date of birth in order to avoid arousing the patient and using
excess time in the patient’s room. She continued to hang the intravenous medication
without performing the final safety checks. In this incident, a medication error was not
made, but the nurse showed a willful disregard for proper safety protocol, thus
endangering the patient.

8. 3
Furthermore, the student researchers witnessed the improper medication dose
being administered to a patient. While preparing multiple patients’ medications, the nurse
extracted the wrong dose of a patient’s medication. The vial of medication was 0.25 mg,
the dose was 0.125 mg, and the nurse withdrew the full 0.25 mg. In this example, the
number of patients that the nurse was required to care for created a barrier to the nurse’s
clinical judgment. Regardless of the nurse’s experiences and level of comfort, a
medication error was still made.
Patient safety, through medication administration, is a priority and should be an
objective of every nurse (Taylor et al., 2011). Clinical practice can generate barriers that
can cause even the most experienced of nurses to make errors. The observations of these
barriers to medication administration fostered further examination and analysis of this
portion of healthcare.
Significance of the Problem
Medication administration is important in clinical practice because medications
are used with a majority of patients in the hospital setting. Errors account for 40% of
adverse events that occur in a hospital setting (Cortelyou-Ward, Swain, & Yeung, 2012).
According to Fowler, Sohler, and Zarillo (2009), administration of medication takes up to
40% of a nurses’ time in providing patient care. If 40% of a nurses shift time is spent on
administering medications and nurses account for 40% of medication errors, then it could
be assumed that not enough time is spent on preventing medication errors. Most cases of
medication errors occur because a nurse would have bypassed at least one of the five
rights of medication administration.

9. 4
Nurses have been taught that patient safety is priority from the first day of nursing
school. Yet, in the clinical setting, nurses use alternative practices that place the patient at
risk for preventable accidents. In 2005, the overall combined reporting of sentinel events,
unexpected occurrence involving death or serious physical or psychological injury, or
risk thereof, revealed that almost 10% of sentinel events were due to medication errors
(Maiden, Georges, & Connelly, 2011). According to the Institute of Medicine,
medication errors injure 1.5 million Americans each year and cost 3.5 billion dollars in
lost productivity, wages, and additional medical expenses (Aspden et al., 2006). The high
cost of adverse events should encourage a reduction in medication errors through
development of new standards produced by evidence based practice for safe medication
administration. The data gathered from various sources suggest that although new
research is available, the number of medication errors continue to thrive in the clinical
setting. The student researchers believe that although it may take the nurse longer to
administer medications following the five rights of medication administration, it is of
utmost importance that these precautions be taken to protect the patient from unnecessary
harm, therefore improving overall care.
Problem Statement
Do novice nurses or experienced nurses have more barriers to safe medication
administration in the healthcare setting?
Purpose of the Study
The purpose of this study is to determine whether there is a difference in the
number of barriers to safe medication administration between novice nurses and
experienced nurses in the healthcare setting.

10. 5
Null Hypothesis
There is no significant difference between the number of barriers to safe
medication administration between novice nurses and experienced nurses in the
healthcare setting.
Research Hypothesis
Experienced nurses have more barriers to safe medication administration than
novice nurses in the healthcare setting.
Definitions
For the purpose of the research study, the following terms are defined:
Novice nurse. A registered nurse who has less than two years of experience.
Experienced nurse. A registered nurse who has two or more years of experience.
Barrier. Any condition or occurrence, which impedes the ability to achieve an
objective (Venes, 2009).
Safe medication administration. Administering medications ensuring the right
medication is given to the right patient in the right dosage via the right route at the right
time (Taylor et al., 2011).
Assumptions
For the purpose of this study, the following assumptions were made:
1. The participants have had experience with medication administration and the barriers
to medication administration.
2. The participants are taught the importance of safe medication administration.
3. Medications are administered to patients.
4. The questionnaire accurately measures barriers to medication administration.

11. 6
5. The participants answered the questionnaire truthfully and without any resources other
than their knowledge and previous experience.
6. The participants’ answers in this study were not manipulated.

12. 7
Chapter II
Literature Review
Introduction
Medication errors have been studied for many years. The importance of safe
medication administration has been clarified; barriers to safe medication administration
have been identified, and methods to prevent medication errors have been determined.
The literature supports the assumption that nurses have barriers to safe medication
administration. The following nine research studies were reviewed and indicated the need
for further research on medication administration. This study aims to expand the body of
knowledge on medication administration barriers by comparing the number of barriers
presented in novice nurses versus experienced nurses.
Importance of Safe Medication Administration
Sakowski, Newman, and Dozier (2008) determined the severity of medication
administration errors detected by bar-code medication administration (BCMA) system.
The purpose of the study was to evaluate the potential severity of medication
administration errors detected by a BCMA system. In addition, Sakowski et al. (2008)
studied the potential severity of medication errors occurring from various types of
medication administration events, including different classes of drugs, and whether these
errors were prevented or observed.
Sakowski et al. (2008) implemented a method of scenarios to guide the research.
Six hospitals within the same healthcare system in Northern California were studied. A
panel of multidisciplinary clinicians reviewed a series of error scenarios and evaluated
their potential severity on a scale of zero (no effect) to ten (death), using a previously

13. 8
validated method. The review panel consisted of three pharmacists, two registered nurses,
and one physician. Information on potential medication errors was gathered from logs
automatically created by the BCMA system. Nurses familiar with the system were used
to identify events that were actually a prevented administration error or a confirmed
discrepancy between the written order and the administration. The information was then
used to create generic “error scenario” case studies. The case studies included the drug
involved, the ordered dose, administration schedule, and any discrepancy from the
written order identified by a BCMA caution. The mean of the single ratings from the
reviewers was then calculated to determine the severity index for each of the
administration events. Chi-square and logistic regression testing were performed to form
statistical conclusions (Sakowski et al., 2008).
A total of 945 errors containing 212 drugs were included in the review. A total of
564 scenarios were studied for severity rating. Less than 10% of detected errors were
evaluated as moderate or severe. The majority of the errors reviewed, 91%, were
evaluated as having minor severity potential. The remaining 9% were evaluated as
moderate to severe. Scenarios in which the operator continued with the administration
after receiving a cautionary sign were less probable to be evaluated as moderate or severe
than scenarios in which operators stopped in response to a system caution, but this result
was not statistically significant. For the scenarios being evaluated as moderate or severe
in which operators proceeded with administration after a BCMA system caution, the odds
ratio (OR) was 0.69. The study found that “no order” errors, events that had no
corresponding order entered into the computer system connected to the administration,
were significantly more probable to be evaluated as moderate or severe than other error

14. 9
types. The OR of a “no order” error being evaluated moderate or severe was 5.8
(Sakowski et al., 2008).
Even though the study did not clearly state the hypothesis or problem statement,
the results directly reflected the purpose of the study. Some limitations to this study were:
the only medication administration errors assessed during this review were those
identified by the BCMA system; if the system did not identify the error, it was not
involved in the study; and the comparison of error importance between prevented errors
and discrepancies that did happen despite a system-generated caution. The majority of
medication administration errors identified by the BCMA system were evaluated to be
nonthreatening and posed minimal safety risks. Conversely, the numbers and severity of
medication administration errors which happened despite the use of a BCMA system
proposed that there were chances to advance BCMA systems and how the information
they produced would be used (Sakowski et al., 2008).
Sakowski et al. (2008) was important because it represented potential harm for
medication errors. All types of errors were not researched due to the use of BCMA but
expressed a need for further study of medication errors and the possibility of advancing
BCMA systems in order to provide more information and prevent future errors. Sakowski
et al. (2008) showed the importance of safe medication administration by studying the
effects of bypassing the system alerts in order to hasten the medication administration
process.
DeYoung, VanderKooi, and Barletta (2009) also conducted a research study
based on the application of BCMA, but the research evaluated the effectiveness of
BCMA rather than the severity of errors. The purpose of the study clearly stated the need

15. 10
to determine the effect of BCMA on the rate of medication errors in adult patients in a
medical intensive care unit (ICU). Adverse drug events, also known as medication errors,
were noted as a growing concern within healthcare institutions, with the incidence of
these events highest in the ICU.
DeYoung et al. (2009) research method consisted of correlational, direct
observation and convenience sampling in order to study medication error rates using
BCMA in an adult medical ICU. Certified nurses in the ICU served as the population for
the study. The type of medication error (i.e. wrong dose, wrong time, wrong route, and
wrong drug) was studied as well. A total of 1465 medication administrations to ninety-
two patients were observed in a 744-bed community teaching hospital in Grand Rapids,
Michigan.
Observation occurred 24 hours a day, during four consecutive days, one month
before, and four months after the implementation of BCMA. The observers consisted of a
small group of pharmacy residents, pharmacy specialists, and a nurse specialist. The data
collectors randomly approached nurses and asked if they could observe the nurses
administer medications. Nurses were informed that the purpose of this study was to
determine the effect of BCMA on medication safety (DeYoung et al., 2009).
The medication administration error rate was reduced 56% after the
implementation of BCMA (DeYoung et al., 2009). The reduction was seen most with
medications being administered at the wrong time. Patient safety was improved with the
use of BCMA by lowering rates of medication errors. DeYoung et al.’s (2009) research is
relevant because it expanded the knowledge and understanding of medication errors. The
research provided information on the importance of following correct medication

16. 11
administration techniques to ensure patient safety. Also, proof of proper use of assistive
technology was identified as a method to reduce medication errors as a whole.
Similar to the research studies above, Chang and Mark (2009) looked at
medication errors and what factors influenced the occurrence of medication errors. Chang
and Mark (2009) analyzed contributing factors to medication errors occurring in acute-
care hospitals and comprehend if different severities of errors had different antecedents.
Chang and Mark studied both severe errors that were harmful to the patient’s health
status which needed immediate interventions, and nonsevere errors which did not require
much intervention. Healthcare work environments, staffing for adequacy, healthcare
work conditions, and outcomes of both the patients and organization was also analyzed.
Data was collected from a random sample of 246 nursing units in 146 hospitals in the
United States, focusing on registered nurses employed on their unit for more than three
months.
A trained study coordinator was in charge of distributing questionnaires to staff
nurses and obtaining administrative data over six months. Each nursing unit had the staff
nurses complete three questionnaires. The researchers used a generalized estimating
equation with a negative binomial distribution to analyze the data. Both nursing expertise,
the way the registered nurses rated the expertise of their nursing workgroup in terms of
recognizing critical patient problems, and nursing experience, the average of each nurse’s
experience as a registered nurse in months, had an impact on the occurrence of
medication errors. The results showed the greater the level of nursing expertise, the fewer
the nonsevere errors. In contrast, as nursing units had more experienced nurses on the
unit, more nonsevere medication errors were made (Chang and Mark, 2009).

17. 12
Chang and Mark identified barriers to safe medication administration and showed
the association between those barriers and the severity of medication errors (2009). The
researchers found nursing units with more experienced nurses had reported more
nonsevere medication errors, therefore supporting the current research hypothesis of the
students. The student’s current study further expands on the research already conducted
by examining the amount of barriers to medication administration between novice nurses
and experienced nurses.
Barriers to Safe Medication Administration
While Chang and Mark’s study presented barriers to medication administration
and determined whether or not the barriers were truly impeding, the nursing study
conducted by Maiden, Georges, and Connelly focused on the effects that moral distress
and compassion fatigue have on medication errors in a critical care setting. The study had
three specific focuses: to describe, to observe, and to comprehend the levels of moral
distress, compassion fatigue, perceptions about medication errors, and nursing
characteristics. The population included a national sample of 205 certified critical care
nurses. These nurses were members of the American Association of Critical-Care Nurses
and were required to have been involved with patient care delivery in the preceding year
(Maiden, Georges, & Connelly, 2011).
Researchers used quantitative surveys which were mailed to the certified critical
care nurses, as well as a qualitative survey which was sent to a subgroup of the critical
care nurses. All 205 subjects provided written, informed consents to participate in the
study. There were several quantitative surveys sent to the subjects. One was a
demographic questionnaire which asked for age, sex, employment status, marital status,

18. 13
religious affiliation, unit tenure, nursing tenure, and intent to leave current position. A
moral distress scale, which contained a 38-item, seven-response Likert-type scale, was
distributed. A professional quality of life scale containing a 30-item, five-response
Likert-type scale was also sent out. Furthermore, there was a medication administration
error survey which asked questions about reasons medication errors occurred, reasons
errors are not reported, and an estimated percentage of errors that are reported (Maiden et
al., 2011).
Maiden et al. (2011) found that the demographics of the subjects were mostly
married female, who worked full time and practiced nursing an average of 13.61 years.
The average age of the individuals was 47.49 years old. There was an elevated level of
moral distress and a low level of compassion fatigue reported. Researchers also found
medication packaging was the highest reported reason for medication errors occurring,
and fear was the most reported reason for not reporting medication errors (Maiden et al.,
2011).
Poor communication between the physician and the nurse, nurse staffing levels,
medication packaging, moral distress, and compassion fatigue were the barriers to safe
medication administration identified. The research identified several barriers that can be
included in a questionnaire to expand the knowledge. Since fear was the most common
reason for not reporting medication errors, there was a possibility subjects in the current
study will be nervous about answering the questionnaire related to barriers of safe
medication administration (Maiden et al., 2011).
Dilles, Elseviers, Van Rompaey, and Vander (2011) focused on nurses in nursing
homes to identify different barriers to safe medication administration and compare the

19. 14
importance of those barriers. Expert meetings were conducted, and nurses from 25
institutions met to discuss the different barriers they experienced during medication
administration. A cross-sectional survey was created based on the information collected
from the expert meeting. Not all barriers stated during the meeting were used. Instead, the
survey focused on barriers related to preparing medications, medication administration,
and monitoring medication effects. A total of 246 nurses and 270 nursing assistants from
nursing homes with more than 60 beds participated in the survey.
Several barriers to safe medication administration were identified when the data
was analyzed. The main barriers identified included being interrupted during preparation,
inadequate knowledge of drug and food interactions, lack of time for double-checking,
insufficient information from the physician, and inadequate knowledge of side effects of
medications. Other barriers that the nurses identified were insufficient knowledge on
crushing pills, inability to correctly calculate dosage, inadequate knowledge of correct
administration time, insufficient resources for information on the topic, and limited
accessibility to pharmacists (Dilles et al., 2011).
Nurses must know which barriers are the most prominent in safe medication
administration. These barriers were considered in development of the current studies
questionnaire to expand the Dilles et al. (2011) research. Dilles et al. (2011) identified
three main barriers which included: interruption, inefficient knowledge, and lacking of
interdisciplinary cooperation (Dilles et al., 2011).
Mark and Belyea (2009) studied acute care facility staffing and changes in
medication errors. The purpose of the study was to observe the connection between
alteration in acute care unit staffing and changes in medication errors. Additionally, Mark

20. 15
and Belyea (2009) focused on the implications of the study, such as quality and patient
safety which would be affected by the changes in staffing and the changes in medication
errors.
The longitudinal study utilized data that was acquired from the Outcomes
Research in Nursing Administration Project (ORNA-II). The ORNA-II was a multisite
organization study which was conducted to examine staffing, working environment,
outcomes, as well as internal and external environments. The design for the ORNA-II
was a prospective, non-experimental, longitudinal, causal modeling design. Therefore,
the research study conducted a secondary analysis and review of the data already
obtained through the ORNA-II. A sample of 284 nursing units consisting of medical
surgical units or medical surgical specialty units in 145 JCAHO accredited hospitals
consisting of 99 licensed beds were selected. Federal, for- profit, and psychiatric facilities
were excluded from the study. Additionally, sources for the data were the American
Heart Association (AHA) Annual Survey of Hospitals and registered nurses that had been
employed for three months and working 20 hours per week. After the data was gathered,
a statistical analysis was conducted by utilizing the Mplus statistical program and an
autoregressive latent trajectory (Mark & Belyea, 2009).
Mark and Belyea (2009) reported the units evaluated averaged 13-80 beds per
unit. Additionally, slightly over half the nursing staff studied was registered nurses. Also,
half of the total hours worked during the study were performed by registered nurses. Per
1,000 inpatient days, medication errors differed from 5.36 to 6.22 over from the identical
period of time. The study produced a limited support for the relationship between
external and internal environment and nurse staffing affecting the initial level of

21. 16
medication errors. Also, Mark and Belyea (2009) found limited support for the rate of
change in staffing over a six-month period of time being affective in the change in
medication errors. The study found hospitals with a higher case mix had minor increases
in errors. Hospitals involved in teaching had an increase in errors seen over time. Larger
nursing units reported more medication errors per 1,000 patients. Overall, the study
supplied little support for a correlation between the number of nurse staffed and
medication errors (Mark & Belyea, 2009).
Mark and Belyea (2009) displayed a limited correlation between staffing and
medication errors. Thus, the study encouraged further research to look at this problem
more in-depth and reevaluate. The study did help develop a means to guarantee
theoretical models can be used to reflect organizational reality and be tested statistically.
Therefore, the study provided information on how to improve the patient safety and
optimal care in acute facilities, and it showed the significance in the size of a facility in
relation to the number of medication errors committed. Additionally, the study exhibited
the significance of the size of the unit in relation to the number of medication errors made
in correlation with the current research study (Mark & Belyea, 2009).
Prevention of Medication Errors
Barriers to medication administration are daunting, but can be reduced by several
prevention methods. Aspden, Wolcott, Bootman, and Cronenwett (2006) aimed to
decrease medication errors by providing prevention strategies and creating a standard to
uphold. The focus was on “safe, effective, and appropriate” (Aspden et al., 2006, p 1),
medication administration in several healthcare environments. The report had multiple
purposes, such as evaluating approaches created to reduce medication errors, providing

22. 17
guidance to individuals involved with medication, and establishing a method to evaluate
healthcare costs in relation to medication errors.
The report was an evidence-based review of literature, government reports and
data, case studies, empirical evidence, and additional materials provided by government
officials and others. The reviewed population consisted of patients, physicians, nurses,
and pharmacists in healthcare settings, who participated in the medication process. The
review considered “the nature and causes of medication errors; their impact on patients;
and the differences in causation, impact and prevention across multiple dimensions of
healthcare delivery” (Aspden et al., 2006, p 3). The settings included were populations of
patients, healthcare settings, clinics, and institutional cultures. Data was compiled by
three committees who then turned the information over the final 17-member committee.
The 17-member committee, composed of individuals with expertise related to the report,
conducted the review. The committee’s knowledge and expertise were enhanced on the
issue by providing a workshop (Aspden et al., 2006).
The report provided information on the steps needed to enhance patient safety.
Also, action agendas were offered to improve safety of medication administration. The
report focused on the collection of accurate medication errors which occur in order to
improve patient safety. The discussion of electronic sources to prevent errors was
supported by the Aspden et al. (2006) report. Support was also offered to adequate
division of labor, proper training, and effective communication.
In review of the literature and research, the Aspden et al. (2006) report compiled
data on the amount of errors occurring in a year and the amount of hospital expenses to
cover the errors. Futhermore, the report explained errors of such caliber are preventable.

23. 18
While doing so, the review explained that improving provider-patient communication,
effectively using technology, removing barriers to safe medication administration, and
establishing a safe environment to deliver care were essential steps to reducing
medication errors.
Aspden et al. (2006) conducted a literature review in order to set guidelines to
prevent future medication errors. The report provided information on the occurrence and
prevention of medication errors. The report highlighted methods to prevent medication
errors, which could be beneficial when a barrier to medication administration is
presented. The methods to prevent barriers include: implementing BCMA technology at
the bedside, using automated dispensing devices, including a pharmacist during rounds of
care, eliminating abbreviations, limiting the number of different types of common
equipment, improving communication practices, implementing methods to reduce
workplace fatigue, creating a culture of safety, improving the workspace for preparing
medications, and improving patient’s knowledge of treatment. The report encouraged
further study to be conducted on the incidence, costs, and prevention of medication
errors, therefore indicating necessity of the current study (Aspden et al., 2006).
Crimlisk, Johnstone, and Sanchez (2009) also evaluated methods to move toward
safer practice. The purpose of the research study was to “develop a clinical program that
offered evidence-based practice, simulations, and best practice for intravenous
continuous infusion (IVCI) medications, and evaluate the participant responses and the
clinical outcomes” (Crimlisk et al., 2009, p 155). Educational workshops were provided
to medical/surgical nurses in a 626 bed, level one trauma center. The research method
was descriptive, quantitative, and longitudinal. Researchers collected demographics,

24. 19
evaluations of the educational workshops, nurse comments, and clinical data on
medication errors for three years.
The Crimlisk et al. (2009) study found that nurses requested more educational
workshops to enhance knowledge of IVCI medication administration. In 2005, five
medication errors were reported, and in 2006 and 2007, only three were reported.
Medication errors that did not cause patient harm were reduced from one error per 280
orders in 2005 to one error per 660 orders in 2007. The research was limited to
medication errors during IVCI. The research explained that staffing representation was
skewed because 72% of staff from campus number one was full time, whereas campus
number two only had 3% full time staff (Crimlisk, Johnstone, & Sanchez, 2009).
Crimlisk et al. (2009) found that nurses believed that they needed more education
to prevent medication errors, and the researchers provided statistics to support the nurses’
belief as correct. The study focused on IVCI medication administration because of the
seriousness in which IVCI adverse events can harm patients. The study suggested proper
education on medication administration would reduce medication errors. The study
highlighted using the five rights of medication administration, including two extra rights:
the right documentation and the right fluid, to reduce barriers to medication
administration, thereby reducing medication errors.
Lucero, Lake, and Aiken (2010) provided a different aspect to prevention
methods. The research study examined the relationship between unmet nursing care
needs and the reporting of adverse events. A medication administration error was
considered an adverse event in the study. The data was collected from a sample of 10,184
registered nurses in 168 acute care hospitals in Pennsylvania. The design of the study was

25. 20
a secondary analysis of data collected in a 1999 study. The method used was a
multivariate linear regression model which related the effect of inadequate nursing care to
the occurrence of adverse events, such as medication administration errors (Lucero et al.,
2010).
Surveys were collected from registered nurses from a variety of units. The data
was analyzed to determine the relationship between the quality of nursing care and the
occurrence of adverse events, including medication administration errors. The results of
the study suggested inadequate nursing care was significantly related to the reporting of
adverse events. The study concluded that the time a nurse spends with a patient directly
correlates with the outcome in prevention of adverse events—the more time spent, the
better the outcome (Lucero et al., 2010).
The study was pertinent to prevention of medication errors by allowing nurses to
be aware of the correlation between inadequate care and the occurrence of adverse
events, such as medication administration errors. We as nurses should spend enough time
with patients to effectively provide adequate care. The extra time spent could potentially
prevent medication administration errors (Lucero et al., 2010).
Conclusion
The Sakowski et al. (2008) and DeYoung et al. (2009) studies both researched the
use of BCMA. DeYoung et al. (2009) looked at the occurrence of medication errors,
while Sakowski et al. (2008) focused on the severity of the medication errors that
occurred. The DeYoung et al. (2009) study showed the use of the BCMA system reduced
the rate of errors, and Sakowski et al. (2008) research further showed the use of the
BCMA system reduced the severity of the medication errors made. Like DeYoung et al.

26. 21
(2009) and Sakowski et al. (2008), Chang and Mark (2009) also researched the
occurrence of medication errors and their severity. Chang and Mark (2009) focused on
identifying antecedents to medication errors, and the ways antecedents affected the
occurrence and the severity of the errors made. All three of these research studies
analyzed different aspects of medication errors, but each had a different focus and found
results that could be tied together for further research.
According to Maiden et al. (2011), medication packaging, moral distress, and
compassion fatigue were three of the main barriers identified in safe medication
administration. However, Dilles et al. (2011) found that interruption during preparing
medications, lack of drug knowledge, and lack of time while double-checking medication
orders were significant barriers found. Both research studies identified poor
communication between nurses and physicians as a barrier. In accordance with Dilles et
al. (2011), Crimlisk et al. (2009) identified interruption barriers to safe medication
administration as telephone calls and environmental noise. Also, Mark and Balyea (2009)
found that increased unit size was a barrier to safe medication administration.
The Aspden et al. (2006), Crimlisk et al. (2009), Lucero et al. (2010), and
DeYoung et al. (2009) research studies all incorporated prevention methods of
medication administration. Each of the research studies touched on the five rights of
medication administration. The articles recommended nurses check the medication, route,
dose, patient, and administer the medication in a timely manner in order to prevent errors.
All four of the research studies also supported the prevention method of documentation
before and after medication administration in order to prevent errors such as omission,
over dosing, and toxicity.

27. 22
Aspden et al. (2006) and Lucero et al. (2010) suggested medication errors are
more prone to occur when there are inadequacies in staffing. In contrast, Mark and
Belyea (2009) presented conflicting information by reporting no significant correlation
between staffing and medication errors. Aspden et al. (2006) and Lucerno et al. (2010)
also discussed the prevention method of proper communication between nurses and
patients. Both studies encouraged nurses to spend more time communicating and
educating the patients in order to provide acceptable patient care. Lucerno et al. (2010)
specifically stated that the more unmet care of patients leads to an overall decline of
patient care. Finally, Aspden et al. (2006), Crimlisk et al. (2009), and DeYoung et al.
(2009) advocated for the use of electronic devices in order to prevent medication errors.
Use of IV pumps, computerized order entry, and BCMA systems were electronic sources
to aid in safe medication administration.

28. 23
Chapter III
ResearchDesign
A non- experimental comparative research design was utilized in this study. The
non- experimental design used variables that already existed in the target population. The
non- experimental comparative design was appropriate for the study due to the
accumulation of quantitative data which compared novice nurses to experienced nurses
and the prevalence of barriers to medication administration.
Variables
The independent variable under investigation was years of experience. The years
of experience were further divided into two groups, novice nurses and experienced
nurses. The dependent variable, which was predicted to fluctuate contingent upon the
amount of experience that a nurse had, was the amount of medication administration
barriers identified by each nurse. The variables controlled in the study were a
questionnaire with a specified number of questions provided through a course
management system, a set time frame in which the subjects had to take the survey, and
the previous experience of registered nursing with all subjects. Some extraneous
variables were identified by the student researchers, which included the environment in
which the questionnaire was completed, the mood or affect of the subjects during
completion of the questionnaire, and interpretation of the questionnaire by the subjects.
Subjects and Setting
The student researchers gathered data from the RN to BSN students, Master of
Science in Nursing (MSN) students, and Doctor of Nursing Practice (DNP) students at a
small, rural university in the southeast United States of America. The target population

29. 24
was identified as registered nurses. The accessible population consisted of the RN to
BSN, MSN, and DNP students at the small university. The student researchers utilized a
non-random convenience sampling. Data was gathered from about 30 novice nurses and
30 experienced nurses. The target population was not representative of the accessible
population due to the use of convenience sampling and the time constraints.
Data Collection Instruments
“The Barriers to Safe Medication Administration,” an online questionnaire which
was given through a course management system was used for the purpose of this study.
By non-random convenience sampling, a semantic differential scale was used within the
questionnaire. The questionnaire contained nineteen questions. Demographic questions
were asked on the questionnaire to determine if the registered nurses were experienced or
novice nurses and in what healthcare setting they practiced. Other questions that were
asked throughout the questionnaire determined the prevalence of barriers that were
present during the medication administration process. The student researchers found the
use of an online questionnaire with a semantic differential scale most appropriate to
gather the data.
The level of reliability of the research study was questionable because of the short
time span to gather the data. The limited amount of subjects used in the study also
contributed to the questionable level of reliability. The type of subjects the student
researchers questioned were not representative of the target population because the study
only used a limited amount of registered nurses within the field, and the subjects were
only from one school. The questionnaire was reviewed by a panel of experts resulting in
face validity.

30. 25
Data Collection Procedures
The student researchers obtained advisor, International Review Board (IRB),
dean, and department chair approval. After approval, the questionnaire was entered into
the course management system (CMS). Then the researchers sent out an e-mail
containing directions for taking the online questionnaire. The questionnaire was available
through a course management system which protected confidentiality of the participants.
No identifiable data was collected. The students were not coerced into participating and
academic standing was not affected. Also, the participants were informed that the
questionnaire did not have a time limit, but it could take up to twenty minutes to
complete. The questionnaire remained open for two weeks. All participants were given
the same questionnaire to complete. Consent was given upon submission of the
questionnaire by the nurses. Participants could withdraw from the study until the
submission of the questionnaire. Before the survey closed, the researchers sent an email
to remind the participants to take the questionnaire.
Analysis Method
The Spearman rho correlational test and descriptive statistics were used to analyze
the data collected. The test was chosen because it allowed appropriate measurement of
the variables in the study. The correlational test was also reliable for rejecting the null
hypothesis. A correlational statistical test is a data analysis method that tells if two
variables are related. The variables being measured in this particular study are nursing
experience and barriers to safe medication administration. Therefore, the correlational
statistical test was used to analyze the relationship between the variables given. The
study was performed with a confidence level of 0.05.

31. 26
Limitations
The research study has several limitations to address. Due to time constraints, the
small sample size of students, who have previously been nurses, at a small university in
the Southeast region of the United States limited the study. Also, the use of non-random
convenience sampling affected the study. The small sample and use of the non-random
method of sampling may not have represented the target population of the study. Having
a larger sample and a random sample may have decreased the probability of statistical
error. Finally, the tool, which had face validity only, was created by the student
researchers and therefore could have been biased. Use of a previously created tool may
have made the study more reliable. The participants were not in a controlled
environment; therefore, the use of outside resources to answer the questionnaire could
have influenced the results.

32. 27
Chapter IV
Summary of the Study
The purpose of the study was to determine whether there was a difference in the
number of barriers to safe medication administration between novice nurses and
experienced nurses in the healthcare setting. The stated research hypothesis was that
experienced nurses have more barriers to safe medication administration than novice
nurses in the healthcare setting. The null hypothesis was there is no significant difference
in the number of barriers to safe medication administration between novice nurses and
experienced nurses in the healthcare setting. The student researchers used the Barriers to
Safe Medication Administration questionnaire which was compiled by a panel of experts.
The questionnaire (Appendix B) consisted of 19 questions, four of which were
demographic questions and 15 of which were semantic differential scale questions based
on barriers in the healthcare setting.
The student researchers collected data from 44 participants total; 34 participants
had greater than two years’ experience as a nurse and 10 participants had less than two
years’ experience (Figure 1). There were a total of three males and 41 females. Of the
participants, 25 had the majority of their experience in the hospital, five in the clinic, six
in long term care, four in home health, four in other areas of healthcare. Of the
participants, 26 were medical-surgical nurses, seven were intensive care nurses, four were
emergency room nurses, three were post critical care nurses, one was a pediatric nurse,
and three were labor and delivery nurses (Figure 2).

33. 28
Figure 1. Breakdown of participants by experience. This figure shows the number of participants who
worked either *two years or longer, or **less than two years.
Figure 2. Breakdown of participants by unit. This figure shows a breakdown of total participants by unit of
experience. Med/Surg = medical-surgical unit. ICU = intensive care unit. ER = emergency room. PCU =
post critical care unit. Peds = pediatric unit. L&D = labor & deliver unit.
Statistical Analysis
Data was coded and entered into SPSS for Spearman Rank Order Correlation
analysis. The Spearman Rho is designed to statistically rank information gathered about
two variables of interest. Then the correlation between those two variables is calculated.
The significance level or probability value (p value) used for this research study was
95%, or p = 0.05. The p value designates that the researcher was willing to accept that 5%
34
10
0
10
20
30
40
Experienced* Novice**
26
7
4
3
1
3
0
5
10
15
20
25
30
Med/Surg ICU ER PCU Peds L&D

34. 29
of the results were based on chance. If the calculated p value is greater than 0.05, the
correlation between the variables is insignificant. If the p value is less than 0.05, the
correlation between the variables is significant.
After data analysis, the student researchers found that there was no statistical
significant difference between novice nurses and experienced nurses in regards to the
occurrence of barriers to safe medication administration. The correlation coefficient of
0.131 with a p-value of p = 0.198 showed a very low correlation between the amount of
experience versus barrier occurrence (Table 1). The p-value being above 0.05 indicated
that the correlation was not statistically significant.
Table 1
Experience versus Barriers
Categories compared rs p
Years of experience &
Number of barriers 0.131 0.198
Note. p<0.05, one-tailed.
Other findings included which barriers were most often and least often perceived.
Of the 15 barriers to safe medication administration listed on the questionnaire, the four
barriers reported most frequently were understaffing, interruptions, lack of time, and
errors in communication. In contrast, lack of motivation, lack of access to a pharmacist,
and compassion fatigue were determined to be non-barriers.
Overall, the analysis shows that there is no statistical difference between the
amount of nursing experience and the occurrence of barriers during medication
administration. Therefore, the student researchers failed to reject the null hypothesis. The
null hypothesis stated that there is no significant difference between the number of

35. 30
barriers to safe medication administration between novice nurses and experienced nurses
in the healthcare setting.
Serendipitous Findings
Based on the Spearman Rank Order correlation, there were two serendipitous
findings. An increase in compassion fatigue was reported with an increase in years of
experience. The correlation coefficient was 0.286 and the p-value was 0.03, although
there was a low correlation, it was statistically significant (Table 2). There was also a
correlation between the number of perceived barriers reported and unit of employment.
The correlation coefficient was 0.355 with a p-value of p = 0.009 (Table 2). The
moderate correlation was statistically significant. Medical-surgical nurses reported the
most perceived barriers, while the pediatric nurse reported the least perceived barriers
(Table 3).
Table 2
Significant serendipitous findings
Categories compared rs p
Years of experience &
Compassion fatigue 0.286 0.355
Unit &
Number of perceived barriers 0.03 0.009
Note. p<0.05, one-tailed.
Table 3
Perceived Number of Barriers by Unit
Unit
Avg # of
Barriers* %
Medical Surgical 13.6 of 15 90.6
Intensive Care 13.3 of 15 88.7
Emergency Room 12.5 of 15 83.3
Labor & Delivery 12.3 of 15 82.0

36. 31
Post Critical Care 11.7 of 15 78.0
Pediatric 6 of 15 40.0
*Note. Average number of barriers was determined by using survey answers reporting that a barrier was
perceived rarely, sometimes, often, or always.
Alterations from Proposal
There were no alterations to the research proposal.
Limitations of the Study
Limitations in this research study involved sample size, convenience sampling,
location of the study, time, and validity. Conducting the study at a small university in the
Southeast region of the United States limited the accessibility to the target population.
The small sample size of 43 nurses at the small university, limited the study. The student
researchers estimated gathering results from 30 novice nurses and 30 experienced nurses.
Unfortunately, data was collected from 10 novice nurses instead of 30. Conversely, 34
experienced nurses participated in the questionnaire. Also, the use of non-random
convenience sampling affected the study. The utilization of the small sample size and use
of the non-random sampling may not exemplify the target population. Increasing the
sample size while using a larger university may have reduced the possibility of error.
Additionally, a random sample may have decreased the probability of statistical error. In
attempt to acquire more participants, the student researchers left the questionnaire up for
three weeks rather than the original two week deadline. The Barriers to Safe Medication
Administration questionnaire had face validity only. Furthermore, the questionnaire was
made by the student researchers, which could have allowed for bias. Employment of a
tool already available may have made the study more dependable. The uncontrolled

37. 32
environment the participants were in may have influenced their answers and allowed for
the use of outside resources to assist with the questionnaire.
Similar Findings
Based on the literature reviewed, two studies were identified that had similar
findings. Maiden et al. (2011) found that poor communication between the physician and
the nurse, nurse staffing levels, medication packaging, moral distress, and compassion
fatigue were barriers to safe medication administration. The student researchers also
found these to be barriers of safe medication administration of nurses from a small, rural
university in the southeastern United States of America. Dilles et al. (2011) found that
being interrupted during preparation, inadequate knowledge of drug and food
interactions, lack of time for double checking, insufficient information from the
physician, and inadequate knowledge of side effects of medication were barriers to safe
medication administration. Other barriers included: insufficient knowledge on crushing
pills, inability to correctly calculate doses, inadequate knowledge of correct
administration time, insufficient resources for information on the topic, unlimited access
ability to pharmacists. They identified that the three main barriers were interruption,
inefficient knowledge, and lack of interdisciplinary cooperation. The student researchers
also found that interruptions during the medication administration process, time and work
pressure, lack of knowledge or understanding of pharmacology, poor communication
between the physician and nurse, and limited accessibility to pharmacists were barriers to
safe medication administration of nurses from a small, rural university in the southeastern
United States of America.

38. 33
Contradictory Findings
Based on the analysis of the data gathered from the student researchers study, no
contradictory findings were found from the review of literature.
Conclusion
After analysis of the data, the student researchers found that there was no
statistically significant difference between novice nurses and experienced nurses in
regards to the occurrence of barriers to safe medication administration. Although the
student researchers failed to reject the null hypothesis, the study found that compassions
fatigue was more common in the experienced nurses. The study also found that there was
also a correlation between the number of perceived barriers reported and unit of
employment.

39. 34
Chapter V
Summary of the Study
The purpose of the research study was to determine whether novice nurses or
experienced nurses have more barriers to safe medication administration in the healthcare
setting. The research hypothesis stated that experienced nurses have more barriers to safe
medication administration than novice nurses in the healthcare setting. The student
researchers gathered data from the RN to BSN students, Master of Science in Nursing
(MSN) students, and Doctor of Nursing Practice (DNP) students at a small, rural
university in the southeast United States of America. A non-experimental comparative
research design was utilized to collect data from previously registered nurses. Participants
completed an online questionnaire. The data collected was coded and interpreted by the
Spearman Rank Order Correlation through the use of the SPSS system, with a preset
confidence level of 0.05. With a 0.131 correlation and p-value of 0.198, the student
researchers failed to reject the null hypothesis.
Conclusions of the Study
From the research study, the student researchers failed to reject the null
hypothesis. The null hypothesis stated there is no significant difference between the
number of barriers to safe medication administration between novice nurses and
experienced nurses in the healthcare setting. The student researchers predicted that nurses
with more years of nursing practice would experience more barriers to medication
administration than would new nurses. There was no statistical data available to support
that nurses with more years of practice, experience more barriers to medication
administration than did new nurses. The results of this research study included many

40. 35
uncontrolled variables, which could have affected the outcome including the limitations
of the location the sample was disclosed to, small sample size, and time.
Implications for Nursing
Current evidence based practice is very important for nurses because medicine
and technology are constantly changing and evolving to improve the treatments that
patients are provided and the outcome or prognosis of patients. Nurses must stay up to
date and practice the most recent evidenced based practice in order to provide the highest
quality of care to their patients. This study implicates nursing because nurses were able to
identify barriers to safe medication administration. Nurses administer numerous
medications to numerous patients on a daily basis. By identifying these barriers that could
potentially cause errors, this study will then allow for measures to be put in place to
minimize the occurrence of barriers that nurses face during the process of medication
administration. The health care profession can use these findings to further increase
patient safety by preventing future medication errors.
Recommendations
The student researchers believed the research study could have been enhanced in
various ways. One major change to improve the study would have been to survey a
larger sample size of both novice and experienced nurses. This would have given more
credibility to the results obtained by having a more representative sample of the target
population. Additionally, only one institution was utilized in the study. Therefore, if the
student researchers expanded the study to several healthcare facilities, the results may
have been more applicable to the nursing profession. Also, the time constraints of the
study possibly could have limited the amount of participation. Thus, allowing more time

41. 36
to complete the questionnaire possibly could have allowed for a greater number of
applicants. Finally, the student researchers felt that the questionnaire was too broad in
nature. As a result, a more specific questionnaire would have permitted more thorough
findings.
Further research should be conducted to determine the most significant barrier to
safe medication administration affecting both novice and experienced nurses. Each group
of participants cited several barriers impacting safe medication administration. Thus,
additional research concentrating on the single most influential barrier may lead to more
meaningful data. Furthermore, supplementary research could possibly lead to ways to
conduct safer medication administration. Also, extra research could lead to the
elimination of some barriers to safe medication administration.

42. 37
Appendix A
Consent Form to Dean of MUW College of Nursing & Speech-Language Pathology
Mrs. Shelia V. Adams
MUW College of Nursing & Speech-Language Pathology
1100 College Street
Columbus, MS 39701
January --, 2013
Dear Dr. Adams,
As baccalaureate senior nursing students, one of our requirements for graduation is to
complete a research project. We are requesting your permission to send a questionnaire to
the registered nurses enrolled in your graduate and RN to BSN nursing programs. We are
researching the comparison of the amount of barriers to safe medication administration
between novice and experienced nurses.
This process will take approximately 20 minutes of each participant’s time to complete
via blackboard online. Confidentiality will be maintained throughout the study. Consent
will also be obtained from each individual participant of the study. The consent form will
be at the beginning of the questionnaire. The participants’ names will not be included in
the study, therefore maintaining anonymity. We would appreciate your assistance in this
matter. We appreciate your cooperation.
Please sign and return to the consent form by January --, 2013 to:
Attn: Tammie McCoy
Fax: 662-___-____
____Yes, permission is granted to conduct the following research study on registered
nurses enrolled in these graduate programs.
____No, permission is not granted to conduct the following research study on registered
nurses enrolled in these graduate programs.
_____________________________ _________________
Signature of Dean Date
Thank you,
Jennifer Allred Rachel Hicks
Amanda Bufkin Kristen Pippin
Andrea Davis Mary Sears
Earika Evans Stephany Vance

43. 38
Appendix B
The Barriers to Safe Medication Administration
Participants in this study include registered nurses currently enrolled in RN to BSN,
MSN, DNP programs at a university in the southeast region of the United States of
America. No incentive or consequence is offered for participation in this study. By
submitting this questionnaire, you are consenting to the use of the information provided
by you for the purpose of this research study. All submissions will remain anonymous.
Directions: This questionnaire will be available for two weeks. It is estimated to take no
more than 20 minutes to complete; however, there will not be a time limit. This
questionnaire will maintain confidentiality. Participants can withdraw any time before
submission.
1. Gender.
o Male
o Female
2. How many years have you practiced as a Registered Nurse?
o Less than two years
o Greater than two years
3. Which type of clinical place do you practice as a Registered Nurse?
o Hospital
o Clinic
o Home Health
o Long-term Care Facility
o Other
4. Which area of practice do you have the most experience?
o Drop down box: Med-Surg, ICU, NICU, ER, PCU, L&D, Peds
Please rate how each of these barriers have impacted your experiences during safe
medication administration on a daily basis throughout your career as a Registered Nurse.
1. Time and work pressure (i.e., get in hurry):
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
2. Interruptions during the med process:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
3. Multiple medications due at the same time:
o Never a barrier

44. 39
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
4. Problems in readability, clarity, and completeness of prescriptions:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
5. Lack of knowledge or understanding of pharmacology:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
6. Poor communication between physician and nurse:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
7. Mental status of patient:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
8. Compassion fatigue:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
9. Lack of motivation/attitude:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
10. Nurse staffing shortage:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier

45. 40
11. Medication packaging
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
12. Limited accessibility to pharmacists:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
13. RN work hours:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
14. Work dynamics (i.e., frequent order changes):
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier
15. Medication not being readily available on the floor:
o Never a barrier
o Rarely a barrier
o Sometimes a barrier
o Often a barrier
o Always a barrier

46. 41
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