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
medication administration in the past 12 months. Of these, four
(15.4%) had received some formal training, 10 (38.5%) had
received ‘on the job’ training, for instance with a colleague, and 19
(70.4%) had undertaken self-directed learning such as reading
articles or using the internet. Some nurses reported receiving more
than one type of training. Fifteen of the 23 (65.2%) nurses who had
received some form of training said that the training received was
adequate and relevant to their role.
Our questionnaire included a list of nineteen issues that can cause
difficulty in medicines administration and we asked respondents
whether, in their experience, each item occurred frequently,
occasionally or never. Table 1 shows that the items most often cited
as ‘frequent issues’ were related to characteristics of the patient
group (‘confused patients who do not understand the need to take
medication’, ‘patients with swallowing difficulties’ or ‘patients
refusing to swallow medicines’), the crushing of tablets as part of
overt or covert administration, and environmental factors including
noise and distraction.
Finally, we asked under which circumstances respondents would
surreptitiously administer medication. Twenty four (88.9%)
respondents said they would administer disguised medication
without the patient’s knowledge if a multidisciplinary team decision
had been made to do so. Thirteen (48.1%) respondents stated that
they would administer disguised medication if the patient lacked
capacity to make an informed decision. Of these, six commented
that this would be contingent upon the multidisciplinary team
having made the decision to do so. Five respondents (18.5%) would
administer disguised medication ‘to a patient who has capacity to
make an informed decision but refuses’. Eleven (40.7%)
respondents had seen disguised medicines being given but most of
these had not viewed this in their current workplace.
Observational study
Of 12 nurses who were approached, nine (75.0%) agreed to
participate. Participants had been registered from 6 months to 21
years. We observed 36 medication rounds (20 on Ward A and 16 on
Ward B). Five each of the 8am 12am 5pm and 10pm rounds were
viewed on Ward A and four each on Ward B. In total, we observed
1423 medication events (1312 administrations of medicines and
111 omissions).The number of medication rounds observed per
nurse ranged from 1 to 6 (median = 4). The median number of
medication events observed per nurse was 146 (range 14 to 309).
Administration to 32 patients was observed and there were 369
MAE’s (25.9% of all events) in total. The most common types of
errors were the unauthorised crushing of tablets or opening of
- 257 -