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
errors. Reported errors and chart review tend to grossly
underestimate MAE rate when compared with direct observation
(Flynn et al, 2002). Our recent observational study (Haw et al,
submitted) undertaken in an inpatient unit for the elderly mentally
ill found an error rate of 25.9% based on a total of 1423 observed
doses. Prior to this, observational studies in mental health settings
were virtually non-existent. Thurtle’s (2000) study of MAE’s in
learning disability group homes consisted of only sixteen
observations. Branford et al (1997) observed the general
characteristics of medication administration in day centres for
people with learning disabilities but reported no empirical data on
MAE’s. Haglund et al (2004) observed medication administration on
two short-stay acute psychiatric wards in an ethnographic study,
but only reported a very brief description of nursing practice.
Interviews with nurses and patients suggested that time spent
undertaking medication administration is an opportunity to develop
interpersonal contact with patients. The authors concluded that
nurses should be given guidelines about how to perform routines
connected with medication administration.
A recent report (Commission for Social Care Inspection, 2006) has
again highlighted the issue of medicines management in UK elderly
care settings. In elderly psychiatric care, issues of capacity,
consent, and patient confusion compound the difficulties of
medication administration (Dewing, 2002; Griffith, 2003a). Other
issues include the covert administration of medicines (Treloar et al,
2001), tablet crushing (e.g. Griffith, 2003b), swallowing difficulties
(Mistry et al, 1995), hiding, spitting out, or chewing medication
(Wright, 2002) and use of Health Care Support Staff (HCSS) to
assist with medication administration (CSCI, 2006b). Little is known
about the prevalence of such difficulties in care environments for
older adults with mental illness or the nurses’ related training
needs.
METHODS
Design
We used information from our literature searches to devise a
questionnaire to investigate nurses’ views about medication
administration and their training needs using a cross-sectional
survey design.
Our observational study of nursing practice during medication
rounds was quantitative, but data was supplemented by descriptive
accounts of nursing activity made by the researchers. The full
methodology of the observational study is reported elsewhere (Haw
et al, submitted).
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