Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Conclusion: Regular, standardised training incorporating clear
guidelines on issues including tablet crushing and minimisation of
potential distractions would prevent many MAE’s. Training should
also cover covert administration of medications and the use of
Health Care Support Staff in administration.
Keywords: Drug administration, Medication error, Adverse Drug
Event, Nursing Practice, Elderly Mentally Ill
BACKGROUND
Adverse Drug Events (ADE’s) cause significant patient morbidity and
mortality (Phillips et al, 2001) and occur at all stages of medicines
management from prescribing to dispensing and administration. The
administration of medications is usually done by nurses (Hand &
Barber, 2000). A Medication Administration Error (MAE) has been
defined as ‘a deviation from a prescriber’s valid prescription or the
hospital’s policy in relation to drug administration, including failure
to correctly record the administration of a medicine’ (Haw et al,
2005). MAE’s are estimated to occur in 5% of all administered doses
in UK general hospitals (Department of Health, 2004). However,
observational research, in which researchers directly observe nurses
administering medication to patients, suggests the true rate may be
as high as 19% (Barker et al, 2002). A series of literature reviews
(O’Shea, 1999; Pape, 2001; Armitage & Knapman, 2003; McBride &
Foureur, 2006) have summarised a number of studies of medication
administration and MAE’s in general hospitals. Surprisingly, little is
known about medication administration in psychiatric settings, and
none of the review papers address this.
AIMS
We decided to study medication administration and MAE’s in a
psychiatric setting. We surveyed nurses about their views and
training needs in relation to medication administration for older
adults with mental illness. We also observed nursing practice on two
inpatient wards in order to describe issues and difficulties
experienced by nurses undertaking medication administration to
older adults with mental illness.
LITERATURE REVIEW
A literature search (CINAHL, British Nursing Index, AMED, PsycInfo
and MedLine) only found eight studies of medication administration
and MAE’s in psychiatric or learning disability settings.
MAE’s detected by incident report (Haw et al, 2005; Sawamura et
al, 2005; Ito & Yamazumi, 2003; Maidment & Thorn, 2005) or chart
review (Grasso et al, 2003) indicate that the most common types of
MAE in psychiatry are wrong drug, improper dose, and omission
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