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
compared with studies in settings with fewer incapacitated,
dysphagic and non-concordant patients. Adherence to clear
guidelines on crushing tablets, including ensuring the prescriber has
authorised crushing (who has in turn ascertained the safety of
crushing), would have eliminated many of the errors in the current
study and ongoing training should address this.
In our study we observed both single and dual nurse administration,
with dual nurse administration being most common. We also
observed the use of HCSS to assist in administration. Kruse et al
(1992) found that double-checking by a second nurse significantly
reduces the incidence of medication errors. Training should address
the issues of double-checking and the appropriate role of HCSS in
the medication administration process. In particular, delegation of
the physical act of giving medication may diminish the valuable
interpersonal contact time between registered nurses and their
patients.
About one in five (18.5%) respondents said they would administer
disguised medicines to a patient who had capacity to consent but
refused them. Some respondents commented on the circumstances
under which such administration might be justifiable, usually citing
issues of physical emergency such as a diabetic collapse where
administration against the explicit wishes of the patient might be
life-saving, or in the patient’s best interest. Such views are not
without controversy: Kellett (1996) describes a case where a nurse
was suspended for administering disguised tranquilising medicine to
a hypomanic 91-year old man in a day hospital on the instruction of
the consultant. The judgement remained on the nurse’s record even
though the consultant was found to be behaving professionally. Our
finding indicates that ongoing training should address professional
guidance on covert administration of medicines (United Kingdom
Central Council for Nursing & Midwifery, 2001) and the legal and
ethical issues of covert administration.
Study Limitations
There are a number of limitations to this exploratory study. The
survey was small-scale and was conducted on one site in a hospital
caring for some very challenging patients. The hospital is a
charitable sector provider and results may not generalize to NHS
settings. Response rate was moderate (55.1%), and was limited by
participant anonymity and our subsequent inability to send
personalised reminders. We do not know if non-respondents differed
from respondents. Generalisation of findings from our observational
study to other areas may also be limited by its scale and
independent sector setting. We only report on observable
behaviours and not on unobservable processes. The presence of
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