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
265 (40%) occasions. Nurses frequently voiced doubt about the
correct procedures for crushing tablets. Medicines were served in
food, for example stirred into yoghurt or mixed on a spoon with
jam, on 179 occasions (13.8% of all oral doses), but this was
almost always authorised. Food portions with medication in them
were frequently left partially uneaten making it difficult to ascertain
the dose ingested. Crushed or liquid medications placed in patients’
food did not appear to be done so covertly. Some patients received
multiple medications (range 1 to 14 items) at one time.
Single or dual nurse administration
We observed three distinct practices related to single or dual nurse
administration. In single nurse administration the administering
nurse prepared medications and then gave them to the patient. In
dual nurse administration two nurses undertook the medication
round together. Sometimes, the second nurse checked the actions
of the first (e.g. right drug, right dose) and usually acted as a
‘runner’ by taking and giving medicines to the patient. A third
practice utilised HCSS to undertake the role of ‘runner’ and give
medications to patients that had been prepared by a registered
nurse. Administration of multiple medications was the norm, and
the 1322 doses offered to patients during our observation
comprised 404 interactions. Single nurse administration accounted
for 108 interactions and dual nurse administration for 207. A HCSS
administered medication prepared by a nurse on the remaining 89
occasions. On 49 (55.1%) of these 89 occasions the HCSS was in
direct sight of the administering nurse, and was out of her sight on
40 (44.9%) occasions.
DISCUSSION
Nurses working in an inpatient service for older adults with mental
illness frequently experience difficulties when administering
medicines. However, only just over half of respondents in our
survey (55.6%) stated that the training they had received was
adequate and relevant to their role. Most training undertaken was
self-directed (70.4%). The overall MAE rate was high (25.9%; one
error in every 4 doses) and there was wide variation in the number
of MAE’s made by nurses, suggesting considerable differences in
their training experience. This suggests a lack of appropriate and
relevant training. Our study demonstrates the need for regular
training for nurses incorporating clear guidelines about medication
administration. The development of training interventions and
guidelines should incorporate our findings from the observational
study.
The crushing of tablets and opening of capsules was common. This
may partly explain the relatively high MAE rate in this study
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