Facilitators and Barriers to Safe Medication, Administration to Hospital Inpatients | Nursing Research Paper

March 15, 2023March 18, 2023 Stafi_Massy

Introduction to the issue

The topic for the report is to examine the facilitators and barriers to safe medication, administration to hospital inpatients. Medication administration errors occur in 8.0% to 19.6% of doses in the hospitals across the world. These figures must be interpreted with some caution due to various differences among certain studies (Chowdhry et al. 2016). However, the medication administration errors are common. Even in the countries like the United Kingdom where MAE rates are extremely low, MAEs can result in harm to the hospital inpatients. The actual number of patients that suffer harm is substantial considering the huge number of medication administrations that take place (Chen and Tsai, 2017). Hence, nurses should know about the facilitators and barriers for safe medication, administration to hospital inpatients so that they can provide necessary support to them. The nurses must follow an efficient mechanism within hospital systems to administer medications safely and successfully (Härkänen et al. 2015). There are various barriers to safe medication, administration to Hospital inpatients and also many factors that increase the issues. For instance, there can be issues including medicines not being available, less equipment, inefficient workflow and frequent interruptions that contribute to the Medication administration errors (Elliott & Liu, 2010). The inefficiency in medication ordering, storage and transport systems also lead to unsafe medication and problems for the patients (Peris-Lopez et al. 2011).

In this, nurses are expected to play a very vital role (Jheeta, S. and Franklin, 2017). There have been several researches suggested that some nurses indicate the problems by developing routine alternative practices. Therefore, it is vital that healthcare organisations engage with nurses to use their tacit knowledge of the errors (McLeod, Barber & Franklin, 2013). For instance, direct observation can be an important research technique to enable the tacit knowledge to be known. Although this way can be time-consuming but it is extremely useful if managed effectively. Nurses are considered to be adaptable healthcare professionals who need to balance their priorities well and also cope with the demands (Rostami et al. 2019). Medication administration is a critical nursing task due to which nursing staff may become over task-focussed and not care too much on providing proper patient-care (Magalhães, Dall’Agnol & Marck, 2013). Hence, it can be inferred that nurses can play tremendously in determining the facilitators and barriers to safe medication (Westbrook, 2020).

The question and the question framework

There are different frameworks available including PICO(T), PICo and PEO etc. In this study, the research will use the PICO(T) framework which includes Problem/Patient/Population, Intervention, Comparison, Outcome and Time/Type of Study.

The first step in framing the research question is to write the information in a correct manner. For instance, the following information needs to be in the form of a question.

What are the facilitators and Barriers to Safe Medication, Administration to Hospital Inpatients?

The question above includes the PICO elements:

P (Problem or Patient or Population): Barriers to Safe Medication
I (intervention/indicator): Efficient Medication Administration
C (comparison): facilitators and barriers of safe medication, administration to hospital Inpatients.
O (outcome of interest): Safe medication

The search

Search terms

The different search terms that have been used for researching data for the study are as follows.

Medication Administration Errors or MAEs
Safe medication and administration
MAEs for hospital inpatients
Role of nurses in reporting MAEs
Training and policies for coping with MAEs

Database choice

In this study, the researcher will focus on considering various databases for sourcing scholarly articles relevant to the study. In this study, the researcher focuses on two key databases; MEDLINE and CINAHL. The first is MEDLINE, which is the National Library of Medicine’s premier bibliographic database. It covers various different fields such as medicine, nursing, dentistry, veterinary medicine, the healthcare system and many clinical services. This database consists of bibliography citations and author abstracts from as many as 4600 biomedical journals that were published in the United States and many other countries. This database has information of over 12 million citations that date back to the earlier times like the mid-1950s. The coverage of the database is across the globe. The researchers get access to global resources through this database due to which the information available is plenty. The majority of the records in this source are from the English-language sources and even have English abstracts.

Another database which the researcher uses is Cumulative Index to Nursing and Allied Health, also known as CINAHL. This provides authoritative coverage of the literature concerned with the nursing and allied services. For this particular research question, there can be plenty of information available. Also the purpose of using two databases is to access plenty of resources for the research questions and getting the best information.

Search Strategy

The table below provides a view of the search strategy which will be taken in this study.

Database	Search terms	Results
CINAHL	Safe medication and administration, role of nurse in safe medication, MAEs for hospital inpatients	116 articles
MEDLINE	MAEs and nurses, importance of nurses to report MAEs	100 articles

Inclusion and exclusion criteria

There were several articles found out on the database. However, there is a need to exclude and include these articles based on the genuinity of the data. My agenda is to ensure that I use only relevant articles that help me address my research questions. There were plenty of results shown in both the databases including MEDLINE and CINAHL. However, I have used different criteria for including the results such as focussing on the credential of the authors. I ensured that I only use articles from these databases and go through credentials of the authors once before selecting the article for the final review. Besides this, I excluded all the irrelevant articles that did not use the search terms that I had used for conducting the research.

The articles

The four articles related to the research question are as follows.

McLeod, M., Barber, N., & Franklin, B. (2015). Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study). PLoS ONE, 10.

In this article, the authors have focussed on explaining the need of the nurses to consider Medical administration errors and also the common reasons due to which these errors take place. In this article, the focus of the authors is on potential benefits of the observational approach. The focus is on nurses determining different problems in the natural setting to determine safe practices. The authors have used observational methods in this article for carrying out the study (McLeod, Barber & Franklin, 2015). The observational methods have helped in providing a view of the findings across different healthcare organisations. This helps in maximising the utility and also enhances the safety of the patients. In this article, three key things about safe medication and administration have been found out. The first is to get optimisation of ward-based medication systems. The second is to support the nurses in an efficient way so that they can manage their interruptions and distractions so that MAEs can be reduced. The third is to encourage the inpatient to involve with the medications whenever needed.

Garfield, S., Jheeta, S., Husson, F., Lloyd, J., Taylor, A., Boucher, C., Jacklin, A., Bischler, A., Norton, C., Hayles, R. and Dean Franklin, B., 2016. The role of hospital inpatients in supporting medication safety: a qualitative study. PLoS One, 11(4), p.e0153721.

This article explains about the role of hospital inpatients in providing support for medication safety. The authors have conducted a peer-reviewed study to highlight the problem of inpatient medication errors. The authors have indicated that this field is not yet explored widely by the researchers (Garfield et al. 2016). The authors have assumed that electronic prescribing is becoming very popular in hospitals for the inpatients. However, there is a need to explore hospital inpatients involvement with medication safety-related behaviours, facilitators and barriers. Patients have wider access to the paper-based records than electronic. The authors have recommended that there is a need to develop interventions for increasing the involvement of patients with medication safety behaviours (Garfield et al. 2016).

Keers, R.N., Plácido, M., Bennett, K., Clayton, K., Brown, P. and Ashcroft, D.M., 2018. What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff. PloS one, 13(10), p.e0206233.

This article is about medication administration errors in mental health. The authors have indicated that Medication Administration errors are a common problem for the safety of the patients in the mental health hospitals. But there have not been many studies undertaken to determine the causes of the errors in medication administration (Keers et al. 2018). So this study specifically deals with determining the causes of these errors that influence inpatients in a mental health hospital in England. This is the first qualitative study to determine the causes of certain types of errors in mental hospitals. The study helps in findings that there can be many interacting errors and also breach conditions and system failures due to which errors in the medication administration can take place. As a result of this, the hospitals have to work with all the stakeholders including nurses and government to find perfect strategies to deal with the problems (Keers et al. 2018).

Haw, C., Stubbs, J. and Dickens, G.L., 2014. Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital. Journal of Psychiatric and Mental Health Nursing, 21(9), pp.797-805.

This study is about the medication administration errors and problems in mental health settings. The authors in this study indicates that nurses should play a crucial role in reporting all the errors in medication administration so that any harm to patients can be avoided. The authors conducted a qualitative study and conducted a survey among 50 nurses to determine their opinion about whether they would report an error to the concerned person or not. The results of the survey were amazing as half of the nurses indicated that they would definitely report any error to the concerned person such that any harm to patients can be avoided (Haw, Stubbs & Dickens, 2014). The authors indicated in the study that it is vital for the nurses to be vigilant and report any errors since this can cause a big loss for patient safety later. Although reporting can add extra workload for the nurses and can be time-consuming but this is important for safe medication and administration of hospital inpatients. The authors recommended at the end of the study that hospitals must provide training and develop policies for the nurses so that they can prevent any MAEs. medication errors can lead to huge patient harm. As a result of this, nurses have to face many worse consequences. Hence, nurses must immediately report the errors to the concerned person. There should be proper guidance for nurses such that any errors can be immediately resolved without any further escalation. This study effectively determined the reasons for the nurses about why they do not report the errors and barriers they face during the reporting. The authors conducted thematic analysis to reveal common themes for not reporting an error and reporting an error. The authors indicated that the nurses are often not convinced about why they should report the errors to concerned people. This indicates lack of knowledge among nurses and their role is safe medication and administration. Therefore, this study has tried to highlight all those issues and put forward different ways about why it should be done.

References

Chowdhry, U., Jacques, A., Karovitch, A., Giguère, P. and Nguyen, M.L., 2016. Appropriateness of dabigatran and rivaroxaban prescribing for hospital inpatients. The Canadian journal of hospital pharmacy, 69(3), p.194.

Chen, Y.Y. and Tsai, M.L., 2014. An RFID solution for enhancing inpatient medication safety with real-time verifiable grouping-proof. International Journal of Medical Informatics, 83(1), pp.70-81.

Härkänen, M., Ahonen, J., Kervinen, M., Turunen, H. and Vehviläinen‐Julkunen, K., 2015. The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews. Scandinavian Journal of Caring Sciences, 29(2), pp.297-306.

Elliott, M., & Liu, Y. 2010. The nine rights of medication administration: an overview. British Journal of Nursing, 19(5), 300-305.

McLeod, M.C., Barber, N. and Franklin, B.D., 2013. Methodological variations and their effects on reported medication administration error rates. BMJ quality & safety, 22(4), pp.278-289.

McLeod, M., Ahmed, Z., Barber, N. and Franklin, B.D., 2014. A national survey of inpatient medication systems in English NHS hospitals. BMC health services research, 14(1), p.93.

McLeod, M., Barber, N. and Franklin, B.D., 2015. Facilitators and barriers to safe medication administration to hospital inpatients: a mixed methods study of nurses’ medication administration processes and systems (the MAPS study). PLoS One, 10(6), p.e0128958.

Magalhães, A.M.M.D., Dall’Agnol, C.M. and Marck, P.B., 2013. Nursing workload and patient safety-a mixed method study with an ecological restorative approach. Revista latino-americana de enfermagem, 21(SPE), pp.146-154.

Jheeta, S. and Franklin, B.D., 2017. The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study. BMC health services research, 17(1), p.547.

Rostami, P., Heal, C., Harrison, A., Parry, G., Ashcroft, D.M. and Tully, M.P., 2019. Prevalence, nature and risk factors for medication administration omissions in English NHS hospital inpatients: a retrospective multicentre study using Medication Safety Thermometer data. BMJ open, 9(6), p.e028170.

Peris-Lopez, P., Orfila, A., Mitrokotsa, A. and Van der Lubbe, J.C., 2011. A comprehensive RFID solution to enhance inpatient medication safety. international journal of medical informatics, 80(1), pp.13-24.

Westbrook, J.I., Li, L., Raban, M.Z., Woods, A., Koyama, A.K., Baysari, M.T., Day, R.O., McCullagh, C., Prgomet, M., Mumford, V. and Dalla-Pozza, L., 2020. Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients. BMJ Quality & Safety.