The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings

Factors contributing to medication errors: A descriptive qualitative study of Italian nursing students

BACKGROUND

It is estimated that 20-40 % of medication errors (MEs) made by nursing students are not reported, thus creating a gap in learning from mistakes. There is scarce literature on the reasons for the underreporting of MEs made by nursing students.

OBJECTIVES

The aim was to analyse the opinions of nursing students about MEs, types and causes and factors that facilitate or discourage ME reporting during clinical training.

DESIGN

Qualitative descriptive design.

SETTINGS

Nursing School affiliated with Milan University, Italy.

PARTICIPANTS

A purposeful sample of third-year or near-graduation nursing students.

METHODS

Data were collected between October and November 2019 through focus groups until data saturation. A semi-structured interview was used for conducting the focus groups and categories were identified by content analysis. Triangulation of researchers and member checking were performed to ensure result trustworthiness.

RESULTS

The study sample was 37 students assigned to four focus groups. Four ME categories were identified: type; cause(s); barriers; and facilitators of reporting. The most common errors were wrong drug, incorrect drug dosage and dilution, which were attributed to individual and/or organizational factors. The main barrier to ME reporting was fear of receiving a negative evaluation by the head nurse. Nonetheless, constructive reflexive evaluation was perceived as a facilitator of ME reporting.

CONCLUSIONS

Our findings show that MEs made by nursing students during their placement oftentimes go unreported to avert negative evaluation. Barriers to ME reporting may be reduced by enhancing risk awareness and error analysis with the support of clinical nurses and nursing mentors.

Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review

BACKGROUND

Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs.

METHODS

Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors.

RESULTS

The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors.

CONCLUSION

Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.

Stakeholders views of medicines administration by pharmacy technicians on mental health inpatient wards

Background The involvement of pharmacy technicians in medicines administration has been highlighted as an opportunity to enhance medicines management support for nurses and service users. Currently, there is no published evidence around this development within psychiatry. Objective To explore the perceptions of key stakeholders toward the feasibility and acceptability of pharmacy technician-led medicines administration within a mental health inpatient setting. Setting Ten acute adult and older-adult wards across five inpatient units within one UK mental health provider. Method Stratified purposeful sampling was used to recruit participants from primary (pharmacy technician, nurse and service user) and secondary (pharmacist, doctor and senior manager) stakeholder groups. One-to-one, semi-structured interviews were audio recorded, transcribed and analysed thematically using Framework analysis. Main Outcome Measure Themes arising from perspectives of stakeholders concerning the feasibility and acceptability of pharmacy technician-led medicines administration. Results Twenty participants were recruited, including twelve primary stakeholders. Attitudes towards implementation were favourable overall. Anticipated risks included de-skilling of nurses around medicines and a potentially detrimental impact on the nurse-patient therapeutic relationship; these were contrasted by potential benefits including the release of nurse time and medicines education opportunities with staff and service users. Conclusion Technician-led medicines administration was perceived as a feasible service, potentially bringing opportunities for medicines optimisation and released nursing time to care. These findings may be a source of guidance for policymakers and researchers who wish to explore the development of such services. Further exploration of safety and effectiveness is required, particularly within mental health settings.

Pharmacology training in mental health nurse education: Justification for an increase in frequency and depth in the UK

This article explores the role and importance of Pharmacology within mental health nurse education. The article proposes that a lack of pharmacology content within undergraduate mental health nurse education may not fully prepare nurses for their role once qualified and as a result influence negatively upon service user care.

Adverse events occurring on mental health units

OBJECTIVE

While the study of suicide on mental health units has a long history, the study of patient safety more generally is relatively new. Our objective was to determine the type and relative frequency of adverse events occurring on Veterans Health Administration (VHA) mental health units; the primary root causes for these events; and make recommendations for abating or mitigating these events.

METHODS

We searched our national database for any reported adverse event that occurred on an inpatient mental health unit between January 1, 2015 and December 31, 2016. We found 87 Root Cause Analysis (RCA) reports and 9780 safety reports. The safety reports were coded for type of event and the RCAs were further coded for underlying causes and severity.

RESULTS

Of the 87 RCA reports, there were 31suicide attempts, 16 elopements, 10 assaults, 8 events involving hazardous items on the unit, 7 falls, 6 unexpected deaths, 3 overdoses and 6 cases coded as "other". For the 9780 safety reports falls were the most common event, followed by medication events, verbal assaults, physical assaults, medical problems and hazardous items on the unit.

CONCLUSIONS

As with medical units, patients on mental health units are at risk for many types of adverse events. The same focus on patient safety is just as important for our mental health patients as for our medical patients. Mental health unit staff should undertake a structured assessment of all risk on their units. This broad approach may be more successful than focusing on a particular event type.