Prevalent elements related to human factors associated with medication administration errors in private healthcare institutions within the Western cape, South Africa: a nursing perspective

[摘要] ENGLISH SUMMARY : The process of medication administration has been described in terms of medication prescribing, ordering, supplying, administration and documentation (Gordon, 2014). The World Health Organization views patient safety as a growing global concern. A research study conducted in the United Kingdom reported that complications related to medication administration could increase a patients' hospital stay from 4.6 to 10.3 days (McCleod, Barber & Franklin, 2014). The volume of research that has been conducted into this phenomenon is extensive in the public sector but little in the private healthcare sector; where patient satisfaction is deemed to be linked to their perceptions of the quality of the service they are paying for, which is indirectly affected by the business models in place.The purpose of this study was to explore the perspectives of the nurses working in private healthcare institutions in the Western Cape, South Africa, regarding the prevalent elements relating to human factors that may be associated with medication administration errors.Enrolled Nurses (EN) and Registered Nurses (RN) working in the wards and intensive care units of the three participating hospitals were invited to participate. Both groups of nurses were included to deepen the understanding of the human factors affecting the nurses' abilities to safely administer medication to patients, and to determine any stand out elements that might be more prevalent in one of the groups. The nature of the roles and scope of practice of the two nursing categories lends itself to the possibility of challenges varying within the groups.A quantitative approach with a descriptive design was selected for the study. A non-probability convenience sampling method was utilized. A total of n=329 (82.25%) of the total population (N=400) completed self-administered data collection questionnaires with Likert style and two open-ended questions. Validity and reliability testing of the data collection instrument was conducted and confirmed though input from nursing, medical, legal and pharmacy experts. The conducting of a pilot study and calculation of the Cronbach alpha coefficient test produced scores ranging between 0.755 to 0.925.Descriptive and inferential analysis was done to interpret the study findings. A statistician was consulted for the statistical analysis, which included Mann-Whitney testing to determine possible associations between selected components of the demographic data of the study population and those elements deemed to be the most prevalent.The results highlighted the following key areas of concern as playing a regular or common role in the incidence of medication administration errors (as perceived by the nurses): the pharmacy supply chain (75.68%), patient-nurse workload (74.46%), prescription legibility (71.12%), work pressure (69.60%), distractions (67.77%) and tiredness or exhaustion (67.47%). In addition to these findings, the study population highlighted the impact that medication substitution in the form of generics is playing in medication safety. The lack of up to date lists of generic medications is posing both a threat and a challenge in terms of patient safety.Whilst the results presented were in line with those identified in similar studies, there is a clear need for the total concept of incident management to be disseminated to the staff working with the patients. The creation of a 'Just Culture has been proven to reduce adverse events and empower staff in terms of monitoring and improving their own, and others, clinical performance thereby improving patient safety and care.In addition, and within the South African context, the study results suggest the need to explore the role and responsibilities of the EN's in both the wards and intensive care units (ICU) in the private healthcare institutions. The results show a higher level of concern regarding the effects of human factors such as nurse-patient ratio, work pressure and distractions for the ward based EN as opposed to the EN based in the ICU.

[发布机构] Stellenbosch University