Nurses' perceptions of medication errors in malta,home remedies for diabetic leg ulcers,diabetes medicine list in pakistan 92,type 2 diabetic food list vegetarian - Try Out


Medication administration errors (MAE) is one of the factors causing death and harm to patients and the most common important challenges threatening healthcare system in all countries worldwide [2]. American Society of Health System Pharmacists (ASHP), (2003) recognises that medication errors can be minimised by assessing the medication use process, identifying inadequacies within systems, and developing interventions to correct the recognised deficiencies. A possible contributing factor to MAEs in the ED is the unique medication distribution system used. Although the results are mixed, several studies suggest that links exist between medication error and systemic organisational factors. Previous studies have examined important factors in refusal or act as barriers to report medication errors [10-13] or the analysis and improvement medication error reporting practices by emergency department physicians, nurses, and pharmacists [14].
Understanding factors that contribute to medication error is the first step toward preventing it to ensure safety and quality of patient care. This study was carried out in emergency department at teaching Main University Hospital in Alexandria governorate, Egypt which contains 42-bed during the period from June 2013 to the end of august 2013.
All nursing staff (n=84) who were working in the previously mentioned setting and willing to participate in such study were included. Medication Administration Error Survey: It was developed by Wakefield in 1998 [1] included 16 items regarding reasons why medication errors occur. The Ethics Committee of Faculty of Nursing, Alexandria University has approved the study protocol. Before embarking to data collection, an informed consent was obtained from each participant to share in the study. After data were collected it was revised, coded and fed to statistical software SPSS IBM version 20. Table 1 illustrated the demographic characteristics of nursing staff at emergency department in Main University Hospital. Figure 1 represents the perception of participants for why medication administration errors occur. Table 2 describes the relationship of socio-demographic data with the four reasons of why medication administration errors occur. In this study, results of the factor analysis ranked four categories of factors influencing the occurrence of MAEs in emergency department. The present study factor analysis for MAEs causes ranked pharmacy processing as the third factor influencing the occurrence of MAEs in ED .Ideally, the pharmacist should collaborate with the prescriber in developing, implementing, and monitoring a therapeutic plan to produce defined therapeutic outcomes for the patient. Based on the nurse perception, the results of the current study showed that regarding demographic characteristics, there was no relation between participants’ age, marital status and their experience in units with nurse staffing and pharmacy processing factors that influencing the occurrence of MAEs.
An interesting finding in this section of the study, in relation to nurses’ experience in nursing and hospital, there were statistically significant relationship between nurses experience and medication packing reasons of why MAEs occur, in which nurses who have more working experience highly perceived that medication packaging is factor causing the occurrence of MAEs compared to nurses who have worked less years of experience.
This study showed statistically significant correlation between participants’ most frequent shift with medication packaging reasons of why MAEs occur where nurses who are working night shift has highest mean for perception that medication packaging is the most factor causing MAEs. In conclusion, this study determined the factors influencing the occurrence of medication administration errors, as perceived by nurses in emergency department. In summary, the findings from this study highlight the need to further examination on how hospital management is addressing the problem of MAEs occurrence in ED and the role of the nurse managers in preventing medication errors through participation in quality management processes. This case-control study examined the perceived impact of bar-coded medication administration system (BCMA) on nurses’ ability to give medications, perceptions of medication errors, and nurses’ satisfaction with the medication administration process. In 1999, The Institute of Medicine (IOM) reported that nearly a million patients each year are injured in hospitals in the United States due to error. One reason for the variations is the fact that implementation of BCMA systems has an impact on the current work processes of nurses, who give the majority of medications in healthcare facilities. Bar-coded medication administration systems are implemented to reduce medication administration errors, but it is unclear if the bedside nurses view the systems as effective in error prevention.
A BCMA system utilizes bar-coded medication doses, patient identification bracelets, and nurse staff badges to facilitate the five rights (right patient, right medication, right dose, right time and right route) of medication administration.
Research has been conducted on the satisfaction of nurses with BCMA technology, but the results have been inconclusive. The  Medication Administration System-Nurses Assessment of Satisfaction (MAS-NAS) Scale, developed by Hurley, et al. A positive correlation between nursing job satisfaction and job performance motivates nurse managers to investigate causes of low satisfaction among nurses. Although BCMA systems provide robust technology designed to reduce medication administration errors, there is concern that the benefits of these systems are not fully realized due to a failure to adequately integrate the systems into the current nursing work processes. Measuring satisfaction with BCMA technology requires an understanding of how technology is introduced into the healthcare work process. This study investigated nurse satisfaction with the use of a BCMA system as compared to a previous non-barcoded medication administration system. A case-control pilot study was designed to test the nursing satisfaction with a medication administration process prior to and after implementation of a BCMA system.
The nurses on the 28-bed medical unit piloted the BCMA system and were recruited as the experimental group. The BCMA system implemented on the experimental unit was the AdminRX® system (McKesson Automation, Inc. After thorough testing of the BCMA-hospital information system interface by staff nurses from the experimental unit, pharmacists, vendor support, and the nurses on the BCMA unit were educated on the use of the BCMA systems using a train-the-trainer approach. The first seven questions used a Likert-type scale from 1 (Strongly Disagree) to 5 (Strongly Agree) with a choice of 3 (Don’t Know) at the center of the scale. The Statistical Package for Social Sciences (SPSS) (Version 16.0 for Windows, SPSS, Chicago, IL) was used to conduct statistical data analysis. Completion of the questionnaires was voluntary and the return rate of the questionnaires was approximately 42%. There were significant differences in the age and years of experience between the experimental and control groups (Table 1).
A comparison of satisfaction between the control and experimental units before BCMA implementation demonstrates differences in two areas.
Following the implementation, the experimental group had decreases in satisfaction with the medication administration process in three areas (Table 2). A comparison of the control group surveys, pre- and post-implementation of the BCMA system on the experimental unit did not yield any statistically significant differences for any of the satisfaction indices. This pilot study indicated that the nurses on the experimental unit perceived that there was a decreased ability to visually see the medications due, as well as medications previously given, on the handheld device following implementation of the BCMA system. The use of BCMA systems is viewed as a promising technology to reduce medication errors in hospital settings, but  implementation of these systems may be less than optimal if they have unintended outcomes on the medication administration process.
This study also demonstrated an overall reduction in nurses’ satisfaction with the medication administration process when the BCMA system was implemented. The implementation of new technologies into healthcare systems can be a complicated endeavor. Theories of diffusion of innovation set forth by Rogers (2003) indicate that technology is accepted and integrated into work processes in stages and there would therefore be differences in satisfaction depending upon when measurement took place. Bar-coding medication administration may be a technology that will significantly reduce medication errors in hospitals and therefore greatly improve patient safety. Valerie Gooder, PhD RN began her nursing career in Adult Critical Care Nursing after earning a BSN at the University of Wyoming.
The definition typically cited in literature that is authored by nurses defines MAE as mistakes associated with drugs and intravenous solutions that are made during the prescription, transcription, dispensing, and administration phases of drug preparation and distribution [1,3]. For example, on-pharmacy profiled automated dispensing cabinet (ADC), unit stock, or refrigerator, as the prescriber’s order may not be reviewed by a pharmacist before the drugs are given (Flynn et al. These include nurse staffing adequacy, hours worked per week, overtime, staffing mix (professional versus unregulated), and other factors reflecting how the work system is designed [5-7]. However, few studies have focused only on the assessment of the occurrence and reasons of nursing medication errors, these studies recommended further studies to determine and investigate the causes of medication errors [15-18].
Therefore we have conducted this study to explore the most important factors influencing the occurrence of MAEs in ED from nurses’ perspective which can lead to improve medication administration process, diminish the risks of adverse events that impact patient morbidity and mortality, improve patient safety, and lower cost of patient care.
Respondents were asked to how much they believe they affect the occurrence of medication errors in the emergency department using a six points Likert type scale with fix values ranging from 6= strongly agree to 1= strongly disagree. They have determined that this survey does not fall under the committee’s jurisdiction. This study revealed no statistically significant relation between participants’ sex, residence, and educational level and their experience in units with reasons of why MAEs occur. In descending order of magnitude, these categories included physician communication, followed by medication package, then pharmacy processing and finally nurse staffing.
In addition, Peth in 2003 [22] in USA reported that the explosion of new drugs appearing in the marketplace has made it virtually impossible for physicians, nurses, and pharmacists to keep abreast of all of the latest data concerning the indications, contraindications, drug interactions, and adverse effects associated with each new drug. This finding is consistent with Wakefield in 2000 [23], who showed that workload and type of care delivery system, and other factors such as number of consecutive hours worked, rotating shifts, staffing mix and numbers, nurse-to-patient ratios, assignment of floating nurses to unfamiliar units .
This means that all nurses are almost ranking these factors influencing the occurrence of MAEs regardless of their age, marital status or years of experience. Anderson and Townsend in 2010 [20] mentioned that fatigue and sleep deprivation are linked to decreases in vigilance, memory, information processing, reaction time, and decision making. Top management should provide adequate staffing and fair scheduling for all urgent care to provide fair workload between nursing staff that reduce the occurrence of MAEs. Alternate methods may need to be created for a supportive unit culture that encourages multidisciplinary team from nurse, physician, and pharmacist to prevent medication errors and improve patient safety in the ER hospital setting. Wakefield BJ, Wakefield DS, Uden-Holman T, Blegen MA (1998) Nurses’ perceptions of why medication administration errors occur. Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Peris-Lopez P, Orfila A, Mitrokotsa A, van der Lubbe JC (2011) A comprehensive RFID solution to enhance inpatient medication safety. Flynn EA, Barker K, Barker B (2010) Medication-administration errors in an emergency department. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety. McGillis Hall L, Doran D, Pink GH (2004) Nurse staffing models, nursing hours, and patient safety outcomes.
Whitman GR, Kim Y, Davidson LJ, Wolf GA, Wang SL (2002) The impact of staffing on patient outcomes across specialty units.
Fairbanks RJ, Hays DP, Webster DF, Spillane LL (2004) Clinical pharmacy services in an emergency department. Al-Youssif S, Mohamed L, Mohamed N (2013) Nurses’ Experiences toward Perception of Medication Administration Errors Reporting.
Abou Hashish E, El-Bialy G (2013) Nurses’ Perceptions of Safety Climate and Barriers to Report Medication Errors.
Baker M, Attala H (2012) Medications errors, causes, and reporting behaviors as perceived by nurses. Lisa D (2009) Medication error reporting by physicians, nurses, and pharmacists in a Level 1 Trauma Center Emergency Department. Kamel S (2008) Studying medication administration errors in Ain –Shams University Hospital. Abo El-Maged N, Gaber E, El-Maghraby M (2002) Relationship between work setting and the occurrence of medication errors among nurses of Assiut University Hospital, Egypt.


Mousa S (2000) Assessment of nursing medication errors factors causing them in the critical care unit At El Manial University Hospital, Egypt. Dumo MA (2012) Factors Affecting Medication Errors among Staff Nurses: Basis in the Formulation of Medication Information Guide.
Peth HA (2003) Medication errors in the emergency department: a systems approach to minimizing risk.
Wakefield J B, Uden-Holman T, and Wakefield S D (2000) Development and Validation of the Medication Administration Error Reporting Survey, Journal of Advances in Patient Safety 4: 475-89. Al-Shara M (2011) Factors contributing to medication errors in Jordan: a nursing perspective. Hartel MJ, Staub LP, Röder C, Eggli S (2011) High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process.
The author developed a questionnaire based on Rogers’ diffusion of innovation theory and established content validity. Medication errors occur more often than other categories of preventable errors (19%), and most medication errors occurred during medication administration (34%) where they were more likely to directly impact the patient and cause harm (Bates, et al., 1995). Success of the BCMA system used in Veteran’s Administration hospitals in the 1990s prompted a Federal Drug Administration (FDA) mandate to barcode all prescription and most over-the-counter medications by mid 2006 (Traynor, 2004). Using the BCMA system requires more time than other traditional methods of medication administration documentation such as a paper or computer-based medication administration record (Lawton & Shields, 2005).
Evidence of this is the development of system workarounds that bypass the intentional blocks to medication administration presented by the BCMA system. Despite this benefit, nurse dissatisfaction with the BCMA systems may impact overall compliance with the systems and decrease the overall effectiveness of the systems. The BCMA system includes a server and a wireless handheld device (or a tethered device) coupled with software that interfaces with a hospital’s information system. One preliminary investigation regarding satisfaction of nurses who use BCMA systems have shown that nurses who previously documented medications using a paper-based system were satisfied with BCMA systems (Rough, Ludwig, & Wilson, 2003).
In a longitudinal, descriptive study, Fowler, Sohler, and Zarillo (2009) used the MAS-NAS Scale to evaluate nursing satisfaction with a BCMA system and Category C medication error rates.
Workarounds occur as a result of problems with technology, task, organization, patient issues, and the environment (Koppel, et al., 2008). The development of workarounds may be an indication that nurses feel that the system is not adequately supporting the medication administration process (Halbesleben, Wakefield, & Wakefield, 2008).
Nurses working on a 28-bed cardio-vascular step-down unit were recruited as a control group. Sample policy and procedure documents provided by the vendor were reviewed and modified by a small focus group including the nurse manager, a small group of staff nurses, and the nurse informatician. The first five questions measured the nurses’ perception of how easy the medication administration process was.
The eighth question on the survey asked the subjects to rate satisfaction with the current overall medication administration process on their unit on a Likert-type scale from 1 (Poor) to 5 (Excellent). Independent t-tests were used to analyze differences in the individual items on the questionnaire between the experimental and control groups before and after implementation of the BCMA system.
A total of 33 staff members returned surveys on the BCMA and 26 returned the surveys on the control unit (Table 1).
First, nurses’ satisfaction with their ability to determine which medication was due decreased with use of the BCMA. Nurses indicated a decrease in the overall satisfaction with the medication process following implementation of the BCMA system. To date, this is the first case control study evaluating the satisfaction of nurses following implementation of a new BCMA system. The control group had no significant changes in responses following the study, lending confidence that the decrease in the satisfaction with the experimental group was due to the implementation of the BCMA system rather than other factors. Due to the significant investment of money required to purchase and implement these systems, discussion of negative outcomes is often not desired or encouraged. Due to the nature of the BCMA pilot program, the number of subjects available for study was limited. There was no follow up for nursing staff that did not complete their survey, and the sample size was too small to determine statistical reliability of the instrument. Waiting 6 months or longer to measure satisfaction post BCMA may have yielded different results. However, this study demonstrates that BCMA systems may have a negative impact on nurses’ attitudes toward the medication administration process and may make the work processes more difficult. Medication administration errors (MAEs) in the ED are common, with errors occurring most often in the prescribing and administration phase [4]. Evidence of links between stress in the clinical workplace and medication error is also emerging.
In addition data were collected on nurses’ sociodemographic data including sex, marital status, age, education level, years of experience, working unit, and the most frequent shift they work. The Medication Administration Error Survey was translated into Arabic language and accordingly, minor changes were made for a few unclear words. Finding of the current study illustrated that participants perceived physician communication reason as the highest ranked factor influencing the occurrence of MAEs.
Moreover, all medications have side effects, and rare but potentially fatal side effects are unlikely to show up in preliminary clinical trials.
Also, the finding of this study showed a significant difference between nurses’ marital status and physician communication as factor influencing occurrence of MAEs, since single nurses had higher ranking for this factor than married ones. This result is consistent with the study of Flor et al in 2012, Zein Eldin and Abd Elaal in 2013 [25,26].This result is in contrast with Al-Youssif et al. A person who works a 12-hour shift and has a long commute may need to stay awake for up to 18 consecutive hours.
Developing and disseminating the patient safety guidelines in all hospital setting especially in nursing and pharmacy departments.
A baseline assessment of patient safety culture among nurses at Student University Hospital. The participants (BCMA n= 33; control n= 26) were given the questionnaire 1 month prior and 5 months following the implementation of a pilot unit. The IOM recommended systemic changes to hospital processes including medication administration (Kohn, Corrigan, & Donaldson, 1999).
Due to supportive efforts by the FDA and the Joint Commission (JC), an increase in the number of hospitals purchasing BCMA systems is expected.
Years after implementation of the first BCMA systems there is still widespread variation in how the systems are used (Carayon, et al., 2007).
Implementation of the BCMA prevents workarounds (shortcuts) and other personalized methods used by nurses to administer medications (Englebright & Franklin, 2005). Evaluation of nurse satisfaction with the BCMA system and the nurses’ perception of these systems to reduce medication errors may be important in the future design and implementation of these systems.
The system is often integrated with a patient unit-based automatic dispensing machine (ADM) and a pharmacy packaging and dispensing robot. In the case of a new medication order, the nurse is prompted to confirm the new medication with the physician’s written order.
The researchers measured satisfaction four months prior to implementation of the BCMA and six months after and reported a 42% improvement in nurse satisfaction with medication administration and documentation after implementation of the BCMA system. Category C errors are medication errors that occur and reach the patient, but do not cause harm. The image profile of the model included three aspects: system functionality, systems usability, and systems impact on nursing practice. The successful implementation of BCMA systems that maintain or improve nursing satisfaction require healthcare leaders to address issues that limit workarounds. For this study the researcher evaluated the success of BCMA implementation based on the nurses’ views of the relative advantage, compatibility, complexity, and observability. Implied informed consent was assumed when subjects completed a questionnaire developed by the researcher. Prior to implementation of the BCMA, medications were ordered on a paper-based physician order sheet and scheduled on an electronic medication administration record (MAR) by pharmacists. The control unit did not implement the BCMA system and served to demonstrate any impact of extraneous variables on nurse satisfaction with the existing medication process in the facility.
Workflow process changes were introduced to the nursing staff during the software training activities. The survey questions were developed by the researcher, and content validity was tested by colleagues in informatics.
Paired t-tests were used to analyze differences the values for individual items on the questionnaire between the experimental group before and after implementation of BCMA and the differences in values for the control group before and after implementation.
Twenty-five surveys were collected prior to the implementation on the experimental unit and 22 were collected on the control unit. There were no differences in either group related to perceived medication errors or near misses.
Anecdotal evidence suggests that the inability of nurses to view medications due and medications given previously was due to design of the software rather than the screen size on the handheld devices.
Randomization of subjects may be difficult, but the continued use of carefully chosen control groups will provide higher levels of evidence for research in this area. Implementation of new technologies requires an honest evaluation of the impact these new systems have on current practice in order to maximize the benefits these systems provide to quality and cost-effective healthcare.
Methods used to provide education and change processes can be enhanced to improve the overall satisfaction with these new technologies. Although surveys were given to all nurses on the units using their unit mailboxes, completion of the questionnaires was voluntary and the return rate of the questionnaires was low. Measurement of satisfaction and attitudes for this study could not be delayed since the pilot project was ended 5 months after implementation.
Therefore, introducing BCMA systems into patient care areas may have unintended consequences, such as workarounds, that may reduce the effectiveness of the system.  So before any decisions are made regarding the overall effectiveness of BCMA, hospitals first need to determine whether the benefits are negated by nurses’ resistance to the change and how that resistance can be minimized. She has worked in the Clinical Informatics Systems department of a 300 bed tertiary care center and served as Clinical Information Systems Manager for four years at the same facility. However, high patient acuity, crowding, and frequent interruptions are pervasive in the ED’s clinical environment. Also it was tested for content validity by five experts in the same field of the study of nursing at Alexandria Faculty of Nursing. A pilot study was carried out on 10 nurses who were working in other unit rather than the studied units and the necessary modifications were made. Discrete items concerning nurses responses for each domain were summed together to have the domain total score.
In fact, once a medication has been removed from its packaging, it’s hard to identify and can be easily confused with another one [11].
The nursing shortage has increased workloads by increasing the number of patients for which a nurse is responsible. This could be due to physicians either male or female underestimating nursing as profession which result in poor relationship between younger nurses and physicians however, as new graduated nurses become older and experience nurses receive more respect from them. Moreover, Tully in 2009 and Hartel et al in 2011 [27,28] stated that fatigue and sleep deprivation also may diminish a nurse’s ability to recognise subtle patient changes.


Actually, reducing these errors requires the commitment of everyone with a stake in keeping patients safe. The researchers recommended for provision of on-going education & training on practice of safe medication administration for all nurses especially in urgent care units. Bar-coded medication administration will probably be utilized in the majority of hospitals by 2024 (Roark, 2004). Problems with the BCMA technology may create additional frustration for the already busy bedside nurses. Once the nurse verifies the medication, the nurse scans the medication that is due to be administered.
Observations by Coyle and Heinen (2005) indicated nursing satisfaction with a BCMA system, but did not include specific timing of the observations or any attempts to quantify satisfaction.
They found no difference in satisfaction for the period prior to implementation compared to 6 and 9 months following implementation of BMCA.
These problems occur because the process has not been reengineered properly (Vogelsmeier, et al., 2008).
The questionnaire was administered to one unit that was implementing the BCMA system (experimental unit) and one unit that was not (control unit), before and 5 months after the implementation. Nurses were required to verify the scheduled medications against the paper-based physician orders at the beginning of each shift. During the implementation, vendor and hospital informatics personnel were available 24 hours per day, 7 days per week.
Reliability and validity statistics were not computed on the survey due to the low sample size (Feldt & Ankenmann, 1998).
Following the implementation of BCMA, 33 surveys were collected on the experimental unit and 14 on the control unit.
There were significant amounts of missing data, particularly in the results of the control group surveys. This research provided information that may assist in the future development and implementation of systems that will maximize the benefits rather than introduce new error into an already problematic medication administration system. Unless implementation staff and software developers acknowledge the impact these systems have on nurses and make adjustments to improve satisfaction, the intended improvements in care of our patients as a result of these new technological innovations may never be realized. There were no limitations on communications between the experimental or control groups, so cross contamination of the groups may have occurred. The MAS-NAS Scale developed by Hurley and colleagues (2006) demonstrates reliability and validity but was unfamiliar to the researcher at the time of this study. Ultimately, the healthcare system studied in this research opted to develop a medication bar-coding system rather than to purchase. Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Statement of the American Academy of Nursing and the American Organization of Nurse Executives for the Food and Drug Administration regarding bar code labeling for human drug products. Preventing medication errors in hospitals through a systems approach and technological innovation: A prescription for 2010.
Using a bar-coded medication administration system to prevent medication errors in a community hospital network. Severity of medication administration errors detected by a bar-code medication administration system. Interruptions in the ED are conservatively estimated to be as frequent as every minute for attending physicians and every 14 minutes for resident physicians. Clearly, adverse drug events that occur in the ED are a significant public health problem and need to be reduced, but this must be accomplished without making the ED less efficient [9]. The questionnaire was hand delivered to each study participant in the morning and afternoon shifts and it was completed through self-report method.
Descriptive statistics in the form of frequencies and percent were used to describe the categorical data variables while mean and standard deviation was used to describe domains scores. Many nurses still feel that physicians don’t understand, respect, or care to listen to nursing perspectives on patient care that lead to misunderstanding and conflict between nurses and physicians. Also Anderson and Townsend in 2010 [20] reported that, nurses perform many tasks that take them away from the patient’s bedside, such as indirect activities, answering the telephone. As a result, the nurse may not notice an adverse reaction to a drug quickly enough to avoid a devastating outcome. The physician who wrote the prescribed medications, pharmacist who dispensed it and the nurse who received the medications and administered to the patient, all play an important role in preventing MAEs. There was a decrease in the overall satisfaction with the medication process following implementation of the BCMA system (p = .001). The author of this paper hypothesized that an increasing level of frustration felt by the nurse may lead to a decrease in the level of satisfaction with the medication administration process overall. For example, a patient’s armband is removed from the patient’s wrist and taped to the bed or doorjamb. The researchers found that Category C errors increased following BCMA implementation, but hypothesized that this was due to increased reporting and surveillance.
The questionnaire was sent by e-mail to members of the CARING e-mail list, an informatics-focused listserve.
A case study conducted by Bargren and Lu (2009) described system gaps in the BCMA that created a perceived need for nurses to use workarounds. Understanding the impact of BCMA system implementation on nursing satisfaction with the medication administration process will assist with improving the development and implementation of these systems. The time of administration of the questionnaire after the implementation was determined by the date of the end of the pilot study on the BMCA unit. The handheld device displayed the electronic medication administration record and allowed for verification of new orders entered by the pharmacists, double signatures on certain medications, documentation of medication administration, and alerting. Chi-square tests were conducted on gender and licensure variables to determine differences between the experimental and control groups.
There were 19 paired surveys on the experimental unit and 10 paired surveys on the control unit. This limits the ability to draw inferences about the demographic similarities or differences in the two groups.
In this study, nurses were part of the implementation team, but including the nurses at the implementation phase may not be adequate. Evaluation of nurse interaction with bar code medication administration technology in the work environment. Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. Bar-code technology for medication administration: Medication errors and nurse satisfaction.
Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety.
To test for association between sample characteristics and their scores at different domains, independent samples t-test and One Way ANOVA were used. While, Al-Youssif in 2013 [11] illustrated that participants perceived physician-nurse relationship reason as the fourth category of MAEs. When medication errors occur, multifactorial causes in a badly shaped system affect their occurrence, as well as manual prescriptions, lack of bar codes, stress, fatigue, lack of attention and lack of ability. This study demonstrates that implementation of BCMA systems may have negative impact on nurses’ attitudes toward the medication administration process and may make the work processes more difficult.
Instead of scanning an armband on the patient’s wrist, the nurse scans the armband that is taped to the bed (Koppel, Wetterneck, Telles, & Karsh, 2008). The results indicated a statistically significant improvement in satisfaction following deployment. They did not find a decrease in errors related to medications given to the wrong patient (Fowler, Sohler, & Zarillo, 2009). Use of workarounds may encourage other unsafe practices (Halbesleben, Wakefield, & Wakefield, 2008).
The policy in the facility was to document the medication prior to administration in order to take advantage of the functions of the electronic MAR including alerting. Codes were consistent throughout the study to provide paired data for statistical analysis. Independent t-tests were used to compare age and years of experience between the experimental and control groups.
Research investigating the impact of including nurses in the initial design and development of BCMA systems will provide important answers that may guide future development in ways that maximizes the potential of this new technology.
Incidence of adverse drug events and potential adverse drug events: Implications for prevention. Improving patient safety by identifying side effects from introducing bar coding in medication administration.
To identify the relative importance of each domain at committing error, factor analysis was used to express factor loading which is the correlation between each domain and the overall hidden factor.
The third factor was pharmacy processes reason (0.76) for example, pharmacy delivers incorrect doses, and pharmacy does not prepare and label the medication correctly, as well as pharmacists unavailable 24 hours a day. Moreover, poor communication accounts for more than 60% of the root causes of sentinel events reported to the Joint Commission (JC) Anderson and Townsend in 2010 [20]. Effective implementation of BCMA systems requires an understanding of the impact of the system on nursing work processes.
This could result in a patient receiving the wrong medication, one that was intended for the previous occupant of the bed. Of note, the results indicated that the nurses viewed the new system as time consuming, but safer. Their results indicated that when nurses valued the safety features of the system, they viewed the system as more useable (Marini, Hasman, Huijer, & Dimassi, 2010). The use of workarounds indicates a lack of confidence in the system and may be an indication of decreased satisfaction. Compliance with intended use of bar code medication administration in acute and long-term care: An observational study.
The last factor was nurse staffing (0.72) was perceived as the least reason of MAEs occurrence. By using workarounds, nurses bypass safety features of the system and therefore negate the overall purpose of the BCMA.  A key to successful implementation and use of a BCMA system is to understand the level of satisfaction the nurses have with the system and how effective they view the system in preventing errors.
Selected interviews of participants corroborated the results of the study (Hurley, et al., 2007). Using bar-code technology and medication observation methodology for safer medication administration.



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