Abstract
Objectives: Paediatric inpatients are particularly vulnerable to medication-related harm. Virtually no research on weekend medication practices has been published. The aim of this study was to compare nurses’ medication administration practices during the weekend with those on weekdays to identify implications for practice.
Methods: We undertook a direct observational study of 227 nurses as they prepared and administered medications across 8 wards in a major Australian paediatric hospital between April and June 2016. Following informed consent, trained observers recorded all details of drugs administered to patients using a handheld tablet with specially designed data collection software (POSSUM – precise observation system for the safe use of medicines1). Nurses’ compliance with procedures, such as checking a patient's identification (ID), as well as interruptions to nurses (defined as ceasing a medication task in response to external stimuli not related to the medication task underway), and multi-tasking (e.g. conducting two tasks in parallel) were recorded. Observations were conducted between 7:00 and 21:00.
Results: In total 1676 medication doses during the week and 471 on the weekend were observed (total 2147 administrations to 781 individual patients). Analgesics (24%) and antibacterials (16%) accounted for 40% of all administered drugs. Analgesics were more likely to be observed being administered during the week compared to at the weekend (respectively 25%[95% CI:23–27] versus 20% [16–23];p = 0.02), and antibacterials were more frequent on the weekend (15%[13–17] versus 21% [17–24]; p = 0.003).
Compliance with correct patient ID checks significantly varied by ward (ranging from 40% to 84% of all administrations). This variation was consistent on the weekends and weekdays. We found no significant difference in compliance with patient ID checking on the weekend (62% [58–66]) compared to weekdays (63% [61–65]).
The rate of interruptions to nurses during the week was significantly higher than on weekends (respectively 55/100 administrations [50–60] versus 37 [30–44];p < 0.0001). The rate of multitasking on weekdays was also significantly higher than that on weekends (26/100 administrations, [23–29] versus 15 [11–19];p < 0.0001).
Conclusion: Compliance with core medication safety procedures did not significantly differ between weekends and weekdays. However, there was considerable variation between wards which persisted across both time periods suggesting that safety compliance may be a reflection of ward culture. For nearly 40% of drugs administered to children, correct ID checks were not performed. This represents a significant hazard for children in hospital. The lower rate of interruptions during the weekend should reduce the risk of errors shown to be associated with interruptions.2 The variance in the use of analgesics and antibacterials on weekends versus weekdays is worthy of further investigation. The next stage of this research is to compare medication error rates on the weekend with weekdays.
Methods: We undertook a direct observational study of 227 nurses as they prepared and administered medications across 8 wards in a major Australian paediatric hospital between April and June 2016. Following informed consent, trained observers recorded all details of drugs administered to patients using a handheld tablet with specially designed data collection software (POSSUM – precise observation system for the safe use of medicines1). Nurses’ compliance with procedures, such as checking a patient's identification (ID), as well as interruptions to nurses (defined as ceasing a medication task in response to external stimuli not related to the medication task underway), and multi-tasking (e.g. conducting two tasks in parallel) were recorded. Observations were conducted between 7:00 and 21:00.
Results: In total 1676 medication doses during the week and 471 on the weekend were observed (total 2147 administrations to 781 individual patients). Analgesics (24%) and antibacterials (16%) accounted for 40% of all administered drugs. Analgesics were more likely to be observed being administered during the week compared to at the weekend (respectively 25%[95% CI:23–27] versus 20% [16–23];p = 0.02), and antibacterials were more frequent on the weekend (15%[13–17] versus 21% [17–24]; p = 0.003).
Compliance with correct patient ID checks significantly varied by ward (ranging from 40% to 84% of all administrations). This variation was consistent on the weekends and weekdays. We found no significant difference in compliance with patient ID checking on the weekend (62% [58–66]) compared to weekdays (63% [61–65]).
The rate of interruptions to nurses during the week was significantly higher than on weekends (respectively 55/100 administrations [50–60] versus 37 [30–44];p < 0.0001). The rate of multitasking on weekdays was also significantly higher than that on weekends (26/100 administrations, [23–29] versus 15 [11–19];p < 0.0001).
Conclusion: Compliance with core medication safety procedures did not significantly differ between weekends and weekdays. However, there was considerable variation between wards which persisted across both time periods suggesting that safety compliance may be a reflection of ward culture. For nearly 40% of drugs administered to children, correct ID checks were not performed. This represents a significant hazard for children in hospital. The lower rate of interruptions during the weekend should reduce the risk of errors shown to be associated with interruptions.2 The variance in the use of analgesics and antibacterials on weekends versus weekdays is worthy of further investigation. The next stage of this research is to compare medication error rates on the weekend with weekdays.
| Original language | English |
|---|---|
| Article number | ISQUA17-1976 |
| Pages (from-to) | 17 |
| Number of pages | 1 |
| Journal | International Journal for Quality in Health Care |
| Volume | 29 |
| Issue number | Supplement 1 |
| DOIs | |
| Publication status | Published - 28 Sept 2017 |
| Event | ISQua’s 34th International Conference - London, United Kingdom Duration: 1 Oct 2017 → 4 Oct 2017 |