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Medication errors 1
Critical care nurse perception of medication errors
Critical care nurse perception of medication error...
Medication errors 2
Aim: This study describes Jordanian critical care nurse perceptions about medication
errors, this stud...
Medication errors 3
Findings: Findings reveal that there are differences in the perceptions of nurses about
the causes and...
Medication errors 4
• There is no strong relationships between nurse characteristics and number of
medication errors. This...
Medication errors 5
include harm to nurses in terms of professional and personal status, confidence, and
practice (Mayo et...
Medication errors 6
1991). This places the nurse at the front line when it comes to drug administration
accountability (Be...
Medication errors 7
what situation constituted a medication error, and 14% were not sure when to report
the error.
Most of...
Medication errors 8
Descriptive studies are appropriate in health care systems that have few
resources, such as the Jordan...
Medication errors 9
Data Analysis: the statistical package for social sciences (SPSS) version 12
used for coding, data ent...
Medication errors 10
2.Drug errors occur when the physician prescribes the wrong dose.
3. Drug errors occur when the physi...
Medication errors 11
because he was in x-ray for 3 h.
- Drug error
- Notify physician
- Incident report necessary
2. Four ...
Medication errors 12
5. A physician orders oxycodone hydrochloride and
acetaminophen (Percocet) 1–2 tabs for post-operatio...
Medication errors 13
For other scenarios, nurses had quite disparate responses. For example, nurses
were split (48.2% vers...
Medication errors 14
- I am usually sure when a medication error should be
reported using an incident report.
- Some medic...
Medication errors 15
identified on this study’s survey. However, the top ranked causes from this study
could be a starting...
Medication errors 16
This study identified differences in reporting medication errors as well as
perceived barriers to rep...
Medication errors 17
REFERANCES:
Benner, P., Sheets, V., Uris, P., Malloch, K., Schwed, K., &Jamison, D. (2002).
Individua...
Medication errors 18
Kapborg, I., & Svennson, H. (1999). The nurse’s role in drug handling within
municipal health and med...
Medication errors 19
Appendix 1
Nurse Perception of Medication Errors
Modified Gladstone 2001
Why Do You Think Medication ...
Medication errors 20
e. Drug errors occur when the physician prescribes the
________
wrong dose.
f. Drug errors occur when...
Medication errors 21
NURSES’ PERCEPTIONS ABOUT MEDICATION ERRORS:
It is not always clear to nurses whether what they view ...
Medication errors 22
c. Incident Report Necessary Yes No
8. A patient is receiving a routine 9 am dose of digoxin everyday...
Medication errors 23
0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, more than ten, please specify _______.
20. What is your primary hos...
Medication errors 24
Appendix 2
Informed consent
Dear registered nurse,
We are master student in the faculty of nursing "J...
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Nursing thesis download by Willie Evangelista

  1. 1. Medication errors 1 Critical care nurse perception of medication errors Critical care nurse perception of medication errors May, 2006
  2. 2. Medication errors 2 Aim: This study describes Jordanian critical care nurse perceptions about medication errors, this study was undertaken to ask nurses about what they believe constitutes a medication error, what is reportable, and what barriers to reporting exist. Background: Any practicing nurse knows that the causes of medication errors are both varied and complex. Medication errors have serious direct and indirect results, and are usually the consequence of breakdowns in a system of care. Method: A self-report survey method with convenience sampling used to collect data form 83 critical care nurses from two private hospitals in Amman for this descriptive study.
  3. 3. Medication errors 3 Findings: Findings reveal that there are differences in the perceptions of nurses about the causes and reporting of medication errors. Causes include nurse miscalculates the dose, physician prescribes the wrong dose, and illegible physician handwriting. Only 41.8% of the 83 nurses believed that all drug errors are reported, and reasons for not reporting include fear of manager and peer reactions. Conclusion: The study findings can be used in programs designed to promote medication error recognition and reduce or eliminate barriers to reporting. Key words: medication errors, nursing, , reporting. SUMMARY What is already known about this topic: • Medication errors have serious direct results such as patient harm as well as increased healthcare costs and indirect results include harm to nurses in terms of professional and personal status, confidence, and practice. • Medication errors represent the largest single cause of errors in the hospital setting.
  4. 4. Medication errors 4 • There is no strong relationships between nurse characteristics and number of medication errors. This would seem to indicate that any nurse is potentially at risk for making a medication error. • Prevention of medication errors is linked to accurate reporting of medication errors. What this paper adds: • There is a gap between the nurse’s perceived knowledge and his or her actual knowledge about medication errors. • There is differences in reporting medication errors as well as perceived barriers to reporting. • Strong barriers to reporting did not include fear of disciplinary action but were more in line with interpersonal reactions from managers and staff. • Nurses tend to inform physicians rather than complete incident report regarding medication errors. INTRODUCTION AND PEARPOSE: 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 et al. 1985). Medication errors have serious direct and indirect results, and are usually the consequence of breakdowns in a system of care. Direct results include patient harm as well as increased healthcare costs. Indirect results
  5. 5. Medication errors 5 include harm to nurses in terms of professional and personal status, confidence, and practice (Mayo et al. 2004). Ten to 18% of all reported hospital injuries have been attributed to medication errors (Hume 1999). Five percent of all medication errors reported to the US Food and Drug Administration (FDA) in 2001 were fatal (Thomas et al. 2001). United States data from 1993 indicate that 7391 patients died from medication errors, and patient stays associated with medication errors increased by 4.6 days, with a resulting cost increase of $4685 per patient (Hume 1999). Medication errors represent the largest single cause of errors in the hospital setting, accounting for more than 7000 deaths annually (Kohn et al. 1999). There is a large number of studies examine medication errors from several aspects, but none of them examine the critical care nurse perceptions of medication errors. So, this study examined the perceptions of medication errors among critical care nurses in multiple settings. More specifically, it was designed to investigate what nurses believe constitutes a medication error, what is reportable, and what barriers to reporting exist. REVIEW OF LITREATURE: Medication errors are typically defined as deviations from a physician’s order. Hospital medication error rates can be as high as 1.9 per patient per day (Fontan, et al. 2003). A single patient can receive up to 18 doses of medication per day (Marino et al. 2000), and a nurse can administer as many as 50 medications per shift (Morris
  6. 6. Medication errors 6 1991). This places the nurse at the front line when it comes to drug administration accountability (Benner et al. 2002). Sources of errors include illegibly written orders, dispensing errors, calculation errors, monitoring errors, and administration errors (i.e., giving the wrong medication to the patient). Physicians, pharmacists, unit clerks, and nurses can be involved in the occurrence of medication errors (Mayo et al. 2004). No studies have demonstrated strong relationships between nurse characteristics (i.e., age, years of practice, and education) and number of medication errors (Osborne et al. 1999). This would seem to indicate that any nurse is potentially at risk for making a medication error (Mayo et al. 2004). Prevention of medication errors is linked to accurate reporting of medication errors. Reporting medication errors is dependent on individual nurse’s decision making. Medication errors are typically reported through institutional reporting systems such as incident reports (Wakefield et al.1996). Moore (1998), however, estimated that organizations relying on incident reports to provide data miss up to 95% of the medication errors. Several studies have demonstrated underreporting among nurses (Gladstone 1995; Osborne et al. 1999; Kapborg et al. 1999). Nurses themselves believe only 25% of all medication errors are reported using incident reports (Osborne et al. 1999). Nurse managers and physicians also believe that medication errors are underreported by nurses (Kapborg et al. 1999). It is estimated that 95% of medication errors are not reported because staff fear punishment (Gladstone 1995; Osborne et al. 1999; Kapborg et al. 1999). Disciplinary actions including job loss also affect reporting rates. Interestingly, Osborne et al, (1999) found that 15.8% of the nurses in their study were unsure as to
  7. 7. Medication errors 7 what situation constituted a medication error, and 14% were not sure when to report the error. Most of these studies have limitations that include an inadequate number of sites (e.g., one hospital) and units (e.g., one medical and surgical unit). It is difficult to know to what degree the local culture influences nurse perceptions about medication errors in these limited site studies. Nonrandom sampling and small sample sizes raise additional methodological issues (Mayo et al. 2004). Reporting systems are dependent on the nurse’s (1) ability to recognize an error has occurred, (2) belief that the error warrants reporting, (3) belief that she/he has committed the error, and (4) willingness to overcome the embarrassment and fear of retaliation for having committed a medication administration error (Kapborg et al. 1999). METHODS: Sample and setting: The target population is all registered nurses working in critical care units (intensive care unit ICU, coronary care unit CCU) in Jordan. The accessible population was 83 registered nurses works in critical care units (ICU and CCU) at two privet hospitals in Amman, data collected in April and May, 2006. A convenience sample used through many visits to selected hospitals (two privet hospitals in Amman). Although “the convenient sample provides little opportunity to control bias” (Burns et al. 2001, p.374), “The convenience sample is the most commonly used sampling in nursing” (Polit et al. 1995, p.233), And it save time and money (Marie 1992). Design: quantitative cross sectional descriptive design was used, in order to identify what nurses believe constitutes a medication error, what is reportable, and what barriers to reporting exist.
  8. 8. Medication errors 8 Descriptive studies are appropriate in health care systems that have few resources, such as the Jordanian in which satisfying basic human needs come first (Mrayyan 2003). Instrument: The Modified Gladstone survey used to collect data for this study. This instrument measured (1) nurse perceived causes of medication errors (10 items), (2) 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) nurse views about reporting medication errors (6 items), and (5) nurses biographical data. (See Appendix 1). Instrument content validity was determined acceptable by Osborne et al. (1999) and Goldstone (1995). In addition, Osborne et al, (1999) established reliability using the test-retest method (0.78) in their sample. An official permission from author obtained by sending an email to him asking him to use his instrument, she gratefully replied by the approval. Procedure: A self-report survey method used to collect data for this descriptive study. Institutional Review Board approval from the University of Jordan obtained and permission to conduct the study obtained from the hospitals directors. Verbal consent obtained from each participant. The researcher offered adequate information about the study purposes and its significance. Participation was voluntary. Participants were assured that their responses would be confidential and information that might reveal their identity would not be recorded, and only aggregated data would be communicated (see appendix 2). The time frame of this study was 3 months, between March 2006 and May 2006.
  9. 9. Medication errors 9 Data Analysis: the statistical package for social sciences (SPSS) version 12 used for coding, data entry, and to compute the descriptive statistics. Descriptive statistic (means, stander deviations (SD), range, median, and frequencies) used to describe the sample. The mean and SD for each item in the survey calculated. FINDINGS: Eighty-three critical care nurses responded to the survey, representing a 92% return rate. RN mean age was 25.8 years (range = 21– 52 years; SD = 5). Male nurses participant were 67.5% (n= 56), while female nurses participant were 32.5% (n = 27). Participants had been practicing for an average of 3.63 years (range = 1 month – 32 years; SD = 5.1). Nurses were primarily had Baccalaureate degree 98.8%. Regarding work setting the sample distribute as following: ICU nurses 38.6% (n = 32), CCU nurses 26.5% (n = 22), and ICCU nurses 34.9% (n = 29). As part of the demographic survey, RNs were also asked the number of medication errors they could remember making over the course of their career. The mean number of errors recalled was 4.07 per nurse (range = 0–25; SD = 3.9). However, most nurses (65%) recalled making 2 to 5 errors over their career. Table 1 portrays the ranked causes of medication errors as perceived by the participating RNs. Nurses ranked the listed causes from 1 to 10, with 1 indicating most frequent cause and 10 indicating least frequent cause. Mean scores were calculated for each item and are listed in the table. The top 3 ranked (out of 10) perceived causes of drug errors were the following: (1) nurse miscalculates the dose, (2) physician prescribes the wrong dose, and (3) physician’s writing on the doctor’s order form is difficult to read or illegible. Table 1. Ranked causes of medication errors*. Item Mean SD 1. Drug errors occur when the nurse miscalculates the dose. 4.47 2.50
  10. 10. Medication errors 10 2.Drug errors occur when the physician prescribes the wrong dose. 3. Drug errors occur when the physician’s writing on the doctor’s order form is difficult to read or illegible. 4. Drug errors occur when there is confusion between 2 drugs with similar names. 5. Drug errors occur when the nurse fails to check the patient’s name band with the Medication Administration Record (MAR). 6. Drug errors occur when nurses are tired and exhausted. 7. Drug errors occur when nurses are distracted by other patients, coworkers, or events on the unit. 8. Drug errors occur when the nurse sets up or adjusts an infusion device incorrectly. 9. Drug errors occur when nurses are confused by the different types and functions of infusion devices. 10. Drug errors occur when the medication labels/packaging are of poor quality or damaged. 4.98 4.99 5.11 5.29 5.48 5.90 6.10 6.30 6.31 2.89 2.48 2.24 3.42 3.16 2.92 2.70 2.95 2.73 * Ranking: 10 indicates least frequent cause; 1, indicates most frequent cause. Based on 6 quite different scenarios presented to the nurses, Table 2 represents how nurses classified each scenario as a medication error (yes or no responses) and if they would or would not report the situation to a physician or complete an incident report. Table 2. Classifying and reporting of medication errors Items Yes % (n) No % (n) 1. A patient misses his midday dose of oral ampicillin
  11. 11. Medication errors 11 because he was in x-ray for 3 h. - Drug error - Notify physician - Incident report necessary 2. Four patients on a busy surgical unit receive their 6 PM done of IV antibiotics 4 h late. - Drug error - Notify physician - Incident report necessary 3. A patient receiving TPN feeding via an infusion pump is given 200 ml/h instead of the correct rate of 125 mL/h for the first 3 h of the 24-h infusion. The pump was reset to the correct rate after the change of shift at 7 AM when the oncoming nurse realized that the pump was set at the incorrect rate. - Drug error - Notify physician - Incident report necessary 4. A patient admitted with status asthmaticus on 08/13 at 2 AM is prescribed albuterol (ventolin) nebulizers every 4 h. The nurse omits the 6 AM dose on 08/13 as the patient is asleep. - Drug error - Notify physician - Incident report necessary 28.9 (24) 73.5 (61) 21.7 (18) 80.7 (67) 68.7 (57) 32.5 (27) 84.3 (70) 75.9 (63) 66.3 (55) 59 (49) 72.3 (60) 30.1 (25) 71.1 (59) 26.5 (22) 78.3 (65) 19.3 (16) 31.3 (26) 67.5 (56) 15.7 (13) 24.1 (20) 33.7 (28) 41 (34) 27.3 (23) 69.9 (58)
  12. 12. Medication errors 12 5. A physician orders oxycodone hydrochloride and acetaminophen (Percocet) 1–2 tabs for post-operation pain every 4 h. At 4 PM the patient complains of pain, requests 1 pill and is medicated. At 6:30 PM the patient requests a second pain pill. The nurse administers the pill. - Drug error - Notify physician - Incident report necessary 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. - Drug error - Notify physician - Incident report necessary 48.2 (40) 69.9 (58) 55.4 (46) 26.5 (22) 85.5 (71) 16.9 (14) 51.8 (43) 30.1 (25) 44.6 (37) 73.5 (61) 14.5 (12) 83.1 (69) TPN, total parental nutrition. Some scenarios elicited common responses in terms of classifying medication scenarios. For example, most nurses (84.3%) responded that they would classify a fast running TPN (total parental nutrition) rate (200 mL/h for 3 hours instead of the correct 125 mL/h) as a drug error; 75.9% would notify the physician; and 66.3% would complete an incident report. On the other hand, most nurses (73.5%) would not classify as a medication error the withholding of a routine morning dose of digoxin because the digoxin blood level report was late. However, in this case 85.5% would notify the physician, but only 16.9% would complete an incident report.
  13. 13. Medication errors 13 For other scenarios, nurses had quite disparate responses. For example, nurses were split (48.2% versus 51.8%) in their classification of a scenario involving pain control medication. However, once again more nurses would notify the physician (69.9% versus 30.1%), yet were split (55.4% versus 44.6%) when it came to completing an incident report. In the all 6 scenarios, more nurses would notify physicians than not notify them no matter how they first classified the scenarios. In 4 out of the 6 scenarios, more nurses would not complete an incident report; this decision mirrored their original classification of the scenario as either being a medication error or not being a medication error. In addition to evaluating scenarios, nurses were also asked, “In your estimation, what percent of all drug errors are reported to the nurse manager by the completion of an incident report?" The mean percentage was 41.83, indicating that less than half of the nurses believed that all drug errors are reported to a nurse manager using an incident report. Table 3 presents additional nurse responses to statements about reporting medication errors. Most nurses indicated that they knew what constituted a medication error (85.5%) and when to report an error using an incident report (77.1%). Reasons for not reporting errors included “afraid of manager reaction” (73.5%), “afraid of coworkers’ reactions” (67.5%), and “not thinking an error was serious enough” (56.6%). However, the majority of nurses (73.5%) do not seem to fear disciplinary action (losing one’s job) because of committing an error. Table 3. Reporting medication errors Items Yes % (n) No % (n) - I am usually sure what constitutes a medication error. 85.5 (71) 14.5 (12)
  14. 14. Medication errors 14 - I am usually sure when a medication error should be reported using an incident report. - Some medication errors are not reported because nurses are afraid of the reaction they will receive from the Nurse Manager. - Some medication errors are not reported because nurses are afraid of the reaction they will receive from their peers. - Have you ever failed to report a drug error because you did not think the error was serious to warrant reporting? - Have you ever failed to report a medication error because you were afraid you might be subject to disciplinary action or even lose your job? 77.1 (64) 73.5 (61) 67.5 (56) 56.6 (47) 26.5 (22) 22.9 (19) 26.5 (22) 32.5 (27) 43.4 (36) 73.5 (61) Most nurses indicated that they knew what constituted a medication error (85.5%), but when they asked in the first scenario about patient misses his midday dose of oral ampicillin because he was in x-ray for 3 hours, most nurses (71.1%) responded that they would not classify it as medication error, 73.5% would notify the physician; and only 21.7% would complete an incident report. This raise a question, are nurses really know what constituted a medication error or not? LIMITATIONS: The sample size of this study was small, and therefore, the findings may not be generalizable to nonrepresented critical care nurses. The use of convenience sample method, which may increased the probability of bias, and this might not be representative for the population, and this may have affected the results. Regarding the ranking of medication errors, there may be additional causes that were not
  15. 15. Medication errors 15 identified on this study’s survey. However, the top ranked causes from this study could be a starting point for organizations to address system issues. In addition, the scenarios were brief and did not provide situational details. CONCLUSION: Any practicing nurse knows that the causes of medication errors are both varied and complex. Because medication errors are such a concern to the public, healthcare organizations, and nurses themselves, this study was undertaken to ask nurses about what they believe constitutes a medication error, what is reportable, and what barriers to reporting exist. All nurses in an organization may need help in identifying what is a medication error, when to report it, and to whom. This study calls attention to the need to clarify with nursing staff what constitutes a medication error. Interestingly, nurses were “usually sure what constitutes an error”(85.5% yes, 14.5% no) yet were not in high agreement with one another when given actual medication scenarios (i.e., 48.2% yes, 51.8% no). This study has identified a gap between the nurse’s perceived knowledge and his or her actual knowledge. It is clear that nurses need specific information about what constitutes medication errors. The information gained from this study can be used in educational programs designed to promote the recognition of these errors. Now that we know nurses differ in their perceptions as to what constitutes a medication error, do organizations have clear guidelines available as to what situations represent medication errors? Regardless of our personal opinions, traditions related to nursing’s 5 rights of medication administration, or our unstated expectations, this study demonstrates that nurses are not “on the same page” as to what is a medication error and when to report to it.
  16. 16. Medication errors 16 This study identified differences in reporting medication errors as well as perceived barriers to reporting. However, strong barriers to reporting did not include fear of disciplinary action but were more in line with interpersonal reactions from managers and staff. Discussions among staff and nurse managers medication errors is desperately needed. From this study, there is several questions to raise with nurses include the following: (1) How do nurses define medication errors? (2) Is there a unique and different definition for reportable medication errors versus non-reportable errors? (3) Why is there a difference in nursing judgment between reporting medication errors to physicians and reporting medication errors using incident reports? (4) What can organizations do to promote the reporting of medication errors and near misses? While this study has generated some important questions, it also has provided some insights into medication errors and reporting. The knowledge gained from this study can contribute to educational programs that promote the recognition of medication errors. The knowledge also can assist with system redesigns to reduce or eliminate barriers to reporting medication errors. Patient safety programs can be strengthened through accurate, and comprehensive reporting, ultimately ensuring the highest quality patient care.
  17. 17. Medication errors 17 REFERANCES: Benner, P., Sheets, V., Uris, P., Malloch, K., Schwed, K., &Jamison, D. (2002). Individual, practice, and systems causes of errors in nursing. Journal of Nursing Administration 32(10),509– 523. Betz, R., & Levy, B. (1985). An interdisciplinary method of classifying and monitoring medication errors. American Journal of Hospital Pharmacy. 42(8): 1724-1732. Burns, N., & Grove, S. (2001).The practice on Nursing Research :conduct, Critique and Utilization (4th ed) . Philadelphia: W.B Saunders. Fontan, J., Maneglier, V., Nguyen, V.X., Loirat, C., & Brion, F. (2003). Medication errors in hospitals: computerized unit drug dispensing systems versus ward stock distribution system. Pharmacy World Science 25(3),112–117. Gladstone, J. (1995). Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. Journal of Advanced Nursing 22, 628–637. Hume, M. (1999) Changing hospital culture, systems reduce drug errors. Excellent Solution Healthcare Management 2(4) 4–9.
  18. 18. Medication errors 18 Kapborg, I., & Svennson, H. (1999). The nurse’s role in drug handling within municipal health and medical care. Journal of Advanced Nursing 30(4), 950– 957. Kohn, L.T., Corrigan, J. M., & Donaldson, M. S. (1999) To error is human: building a safety health system. Washington, DC: National Academy Press. Marie, R. (1992). Foundation of nursing research. (2nd ed). Appleton & lange. East Norwalk. Marino, B.L., Reinhardt, K., Eichelberger, E.J., & Steingard, R. (2000). Prevalence of errors in a pediatric hospital medication system: implications for error proofing. Outcomes Manage Nursing Practice 4(3),129–135. Mayo, A., & Duncan, D. (2004). Nurse perceptions of medication errors. Journal of Nursing Care Quality 19(3), 209- 217. Moore, J.D. (1998). Getting the whole story: the way medication errors are reported affects the results. Mod Health. December 21–28, 1998:46. Morris, S. (1999). Who’s to blame? Nursing 4(33),8. Mrayyan, M.T. (2003). Nurse autonomy, nurse job satisfaction and patient satisfaction with nursing care: their place in nursing data sets. Canadian Journal of Nursing Leadership 16 (2), 74 83. Osborne, J., Blais, K., & Hayes, J.,S.(1999) Nurses’ perceptions: when is it a medication error? Journal of Nursing Administration 29(4), 33–38. Polit, D., & Hungler, B. (1995). Nursing Research: Principles and Methods (5th ed). Philadelphia. Lappincott Company. Thomas, M.R., Holquist, C., & Phillips, J. (2001). Medication error reports to FDA show a mixed bag. FDA Safety Page. 145(19), 23. Wakefield, D.S., Wakefield, B.J., Uden-Holman, T., & Blegen, M.A. (1996). Perceived barriers in reporting medication administration errors. Best Practice Benchmarking Healthcare1(4),191–197.
  19. 19. Medication errors 19 Appendix 1 Nurse Perception of Medication Errors Modified Gladstone 2001 Why Do You Think Medication Errors Occur? 1. The following ten statements are all possible causes of medication errors. Please read them carefully and Rank #1 to #10. (#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.
  20. 20. Medication errors 20 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. ________ 2. In your estimation, what percentage of all drug errors are reported to the Nurse Manager by the completion of an incident report? (Please make an X on the line that corresponds most closely to your estimation.) 1% ________________________________________________________100 % (1.11)
  21. 21. Medication errors 21 NURSES’ PERCEPTIONS ABOUT MEDICATION ERRORS: 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 answer “YES” or “NO” for each of the following statements: 3. A patient misses his midday dose of oral ampicillin because he was in X-Ray for three hours. a. Drug Error Yes No b. Notify Physician Yes No c. Incident Report Necessary Yes No 4. Four patients on a busy surgical unit receive their 6:00pm doses of IV antibiotics 4 hours late. a. Drug Error Yes No b. Notify Physician Yes No c. Incident Report Necessary Yes No 5. A patient receiving TPN feeding via an infusion pump is 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 7:00am when the oncoming 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 6. A patient admitted with status asthmaticus on 08/13/97 at 2:am is prescribed ventolin nebulizers every four hours. The nurse omits the 6:00am dose on 08/13/97 as the patient is asleep. a. Drug Error Yes No b. Notify Physician Yes No c. Incident Report Necessary Yes No 7. A physician orders percocet 1-2 tabs for post-op pain every 4 hours. At 4:00pm the patient complains of pain, requests one pill and is medicated. At 6:30pm the patient requests the second pain pill. The nurse administers the pill. a. Drug Error Yes No b. Notify Physician Yes No
  22. 22. Medication errors 22 c. Incident Report Necessary Yes No 8. A patient is receiving a routine 9 am dose of digoxin everyday. 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 What are your views about reporting medication errors? Please check the most appropriate response: 9. I am usually sure what constitutes a medication error Yes No 10. I am usually sure when a medication error should be Yes No reported using an incident report 11. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from the Nurse Manager. 12. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from their coworkers. 13. Have you ever failed to report a drug error because Yes No you did not think the error was serious to warrant reporting? 14. Have you ever failed to report a medication error Yes No because you were afraid that you might be subject to disciplinary action or even lose your job? Your training and experience. Please fill in the answers below. 15. Age _______ 16. Gender _______ M _______ F 17. Check highest level of education _______ Bachelor of Science Degree in Nursing _______ Master of Science in Nursing _______ Other: (specify) 18. How long have you been a practicing nurse? _______ Years 19. How many medication errors do you remember making over the course of your career? (Circle the Correct answer.)
  23. 23. Medication errors 23 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, more than ten, please specify _______. 20. What is your primary hospital work setting? Thank you!
  24. 24. Medication errors 24 Appendix 2 Informed consent Dear registered nurse, We are master student in the faculty of nursing "Jordan University". we are going to conduct a study about Critical Care Nurse Perception of Medication Errors. As you know there is increasing attention to increasing medication errors, so our purpose to investigate your perception and understanding of medication error that might happened with you .better understanding will decrease rate and seriousness of medication error. As a result, our patient outcome might be improved. This survey will be conducted through distribution a questionnaire for registered nurses working in critical care settings (ICU and CCU). Taking part in this project is entirely up to you, and even if you begin the survey, you may stop at any time, even there is no risk of participation and all gathered data will be completely confidential, and will not be used to another purpose. Your involvement in this study may improve our nursing profession in the future , while you will not have any immediate benefits

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