The Severity of Medication Administration Errors Detected Using Three Different Research Methods

2.50
Hdl Handle:
http://hdl.handle.net/10755/603271
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Title:
The Severity of Medication Administration Errors Detected Using Three Different Research Methods
Author(s):
Härkänen, Marja S.; Turunen, Hannele; Vehviläinen-Julkunen, Katri; Turunen, Hannele; Vehviläinen-Julkunen, Katri
Lead Author STTI Affiliation:
Non-member
Author Details:
Marja S. Härkänen, RN, marja.harkanen@uef.fi; Hannele Turunen, RN; Katri Vehviläinen-Julkunen, RN, RM
Abstract:
Session presented on Monday, November 9, 2015 and Tuesday, November 10, 2015: Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. Patient outcomes that are determined to be nursing-sensitive improve with greater quantity or quality of nursing care. (ANA 2015.) Medication administration is an important daily nursing task that involves great potential for errors and patient harm. The aim of this presentation is to describe the severity of medication administration errors detected using three different research methods. The study was conducted in a university hospital in Finland. Three types of data-sets were analyzed: 1) medication-related incident reports (n=671) 2) randomly selected patients’ medical records (n=463) using the Global Trigger Tool (GTT) method and 3) observations (n=1058) of medication administration by nurses’ which were followed by a review of medical record (n=122). In the secondary analysis, only medication administration errors (MAEs) detected by the three aforementioned methods are analyzed and described. Of the 671 medication-related incident reports, 39.8% (n=267) were MAEs. The GTT method revealed 153 medication errors, 26.8% (n=41) of which were MAEs. Observation of 1058 medication administration events revealed 235 medication errors, 61% (n=143) of which were MAEs. The severity of MAEs (n=451) was classified using the taxonomy from The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP 1998). The taxonomy’s classification of the severity of medication errors (patient outcome) ranges from Category A (no error, no harm) to Category I (error, death). Most of the MAEs detected (n=443, 98.2%) reached the patient. Still, 62.1% of MAEs did not cause harm to patients (Categories B and C), although 24.2% of MAEs required patient monitoring to confirm the lack of harm (Category D). MAEs that were more likely to cause harm to patients (Categories E, F, H) occurred in 13.7% of cases. When the severity of MAEs were compared using the different detection methods, the observational method revealed fewer MAEs that were more likely to cause harm (3.5%), whereas the GTT method revealed the most MAEs that were more likely to cause harm (22%) followed by incident reports (18%). Pearson’s Chi-Square test demonstrated a statistically significant difference in the total number of MAEs detected by the different methods and as well as in the number of MAEs that were likely to cause harm (p < .001). MAEs are the type of errors that are the least likely to be prevented before reaching the patient. In this study, the documented severity of MAEs depended on the method used. These findings were expected as the GTT method is specifically designed to identify situations that cause harm to patients, whereas the observation method rarely identifies these situations because of the limited time of observations. More information is required to increase the safety of the medication administration process and to prevent harm to patients.
Keywords:
Medication administration; Patient safety; Clinical practice
Repository Posting Date:
21-Mar-2016
Date of Publication:
21-Mar-2016
Other Identifiers:
CONV15CL2.30
Conference Date:
2015
Conference Name:
43rd Biennial Convention
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Las Vegas, Nevada, USA
Description:
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.titleThe Severity of Medication Administration Errors Detected Using Three Different Research Methodsen
dc.contributor.authorHärkänen, Marja S.en
dc.contributor.authorTurunen, Hanneleen
dc.contributor.authorVehviläinen-Julkunen, Katrien
dc.contributor.authorTurunen, Hanneleen
dc.contributor.authorVehviläinen-Julkunen, Katrien
dc.contributor.departmentNon-memberen
dc.author.detailsMarja S. Härkänen, RN, marja.harkanen@uef.fi; Hannele Turunen, RN; Katri Vehviläinen-Julkunen, RN, RMen
dc.identifier.urihttp://hdl.handle.net/10755/603271en
dc.description.abstractSession presented on Monday, November 9, 2015 and Tuesday, November 10, 2015: Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. Patient outcomes that are determined to be nursing-sensitive improve with greater quantity or quality of nursing care. (ANA 2015.) Medication administration is an important daily nursing task that involves great potential for errors and patient harm. The aim of this presentation is to describe the severity of medication administration errors detected using three different research methods. The study was conducted in a university hospital in Finland. Three types of data-sets were analyzed: 1) medication-related incident reports (n=671) 2) randomly selected patients’ medical records (n=463) using the Global Trigger Tool (GTT) method and 3) observations (n=1058) of medication administration by nurses’ which were followed by a review of medical record (n=122). In the secondary analysis, only medication administration errors (MAEs) detected by the three aforementioned methods are analyzed and described. Of the 671 medication-related incident reports, 39.8% (n=267) were MAEs. The GTT method revealed 153 medication errors, 26.8% (n=41) of which were MAEs. Observation of 1058 medication administration events revealed 235 medication errors, 61% (n=143) of which were MAEs. The severity of MAEs (n=451) was classified using the taxonomy from The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP 1998). The taxonomy’s classification of the severity of medication errors (patient outcome) ranges from Category A (no error, no harm) to Category I (error, death). Most of the MAEs detected (n=443, 98.2%) reached the patient. Still, 62.1% of MAEs did not cause harm to patients (Categories B and C), although 24.2% of MAEs required patient monitoring to confirm the lack of harm (Category D). MAEs that were more likely to cause harm to patients (Categories E, F, H) occurred in 13.7% of cases. When the severity of MAEs were compared using the different detection methods, the observational method revealed fewer MAEs that were more likely to cause harm (3.5%), whereas the GTT method revealed the most MAEs that were more likely to cause harm (22%) followed by incident reports (18%). Pearson’s Chi-Square test demonstrated a statistically significant difference in the total number of MAEs detected by the different methods and as well as in the number of MAEs that were likely to cause harm (p < .001). MAEs are the type of errors that are the least likely to be prevented before reaching the patient. In this study, the documented severity of MAEs depended on the method used. These findings were expected as the GTT method is specifically designed to identify situations that cause harm to patients, whereas the observation method rarely identifies these situations because of the limited time of observations. More information is required to increase the safety of the medication administration process and to prevent harm to patients.en
dc.subjectMedication administrationen
dc.subjectPatient safetyen
dc.subjectClinical practiceen
dc.date.available2016-03-21T16:46:58Zen
dc.date.issued2016-03-21en
dc.date.accessioned2016-03-21T16:46:58Zen
dc.conference.date2015en
dc.conference.name43rd Biennial Conventionen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationLas Vegas, Nevada, USAen
dc.description43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`en
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