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
capsules (30.0%), omission errors (28.6%) and failure to sign the
medication chart (23.3%). Most (n=255) errors were rated as of
minor or negligible severity (69.1%) while 27 (7.3%) errors could
have resulted in slight harm and one (0.3%) could potentially have
resulted in serious harm. For the eighty six (23.3%) clerical errors it
was not possible to rate error severity. The frequency of errors
made by individual nurses varied from none to one in every two
doses administered. The median error rate was one error in every
six doses administered. Prescriptions involving topically applied
lotions and creams were particularly prone to omission error (50/52
or 96.2% of all doses prescribed).
Thematic analysis of our descriptive notes suggested that a number
of issues made medication administration in this setting difficult:
Noise and environmental distraction
We noted numerous examples of noise and other obvious
distractions. Specific examples included one patient shouting sexual
remarks loudly and repeatedly, and another frequently screeching.
There were several instances of patients using verbal and physical
aggression in the close vicinity of the nurse undertaking medication
administration. Distractions were not solely caused by patients; we
noted noise from the activity of workmen, distractions caused by
other staff making unrelated enquiries during medication
administration, telephone calls and pagers. The environment on
both wards was often bustling. This was particularly noticeable
when medication was administered in the dining room at meal times
(occasionally on Ward A and almost always on Ward B).
Administration in the dining room on Ward B contributed to
cramped conditions, and this was exacerbated by heat and poor
lighting.
Patient characteristics
Administration of medications to 32 patients was observed. Twentyone
(63.6%) were judged by their consultant psychiatrist to lack
capacity to consent to treatment. We noted numerous examples of
patients appearing confused, for example patients approaching the
medicines trolley and attempting to touch medicines. Thirteen
(40.6%) patients reportedly regularly refused or spat out medicines.
Thirteen (40.6%) patients had swallowing difficulties (dysphagia).
We observed a number of patients spitting out or refusing
medicines.
Medication issues
Of 1044 doses of medicine given in tablet or capsule form, 265
(25.4%) were crushed or opened. Crushing or capsule-opening had
not been authorised by a doctor on the prescription chart on 106 of
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