Abstract
Background: Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management - especially medication-related events (MREs) - provides an approach to analyze and improve medication safety and quality.
Objectives: The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs.
Methods: We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts.
Results: MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts.
Discussion: Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
Objectives: The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs.
Methods: We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts.
Results: MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts.
Discussion: Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
Original language | English |
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Pages (from-to) | 337-349 |
Number of pages | 13 |
Journal | Nursing Research |
Volume | 66 |
Issue number | 5 |
DOIs | |
Publication status | Published - Sept 2017 |
Externally published | Yes |
Bibliographical note
The authors acknowledge that this work was supported in part by a contract to M. B. W. from the Center for Devices and Radiological Health (Silver Spring, MD) of the Food and Drug Administration, Department of Health and Human Services as part of the MedSun Initiative. Partial support was also provided by a grant to M. B. W. from the Department of Veterans Affairs Health Services Research and Development (Washington, DC; Grant IIR 20 066) and by a grant to T. D. from the Agency for Healthcare Research and Quality (Rockville, MD; Grant P20 HS11750). Manuscript preparation was supported by the Institute for Medicine and Public Health of Vanderbilt University and, for M. B. W., by the Geriatric Education Research and Education Center of the VA Tennessee Valley Healthcare System. The authors have no conflicts of interest to report. Corresponding author: Jie Xu, PhD, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Medical Arts Building, Suite 732, 1211 21st Ave. South, Nashville, TN 37069 (e mail: [email protected]).Keywords
- intensive care
- medication errors
- nursing
- voluntary patient safety event reporting
- workload