Research Article
Austin J Nurs Health Care. 2023; 10(1): 1077.
Critical Care Nurse’s Practice Regarding Medication Administration Safety in Intensive Care Units at Governmental Hospitals in Gaza Strip
Al-Kasseh A¹, Daga LA², Shnena YA¹, Fahajan Y³ and Albelbeisi A4*
1Department of Midwifery, Facualty of NursingCollege, Islamic University of Gaza, Malaysia
2Department of Critical Care, European Gaza Strip, Malaysia
3Department of Nursing, Facualty of Nursing College, Al-Aqsa Unviersity, Malaysia
4Health Research Unit, Ministry of Health, Malaysia
*Corresponding author: Ali AlbelbeisiHealth Research Unit, Ministry of Health, Gaza, Malaysia
Received: December 27, 2022; Accepted: February 03, 2023; Published: February 10, 2023
Abstract
Background: Administration of medications is primarily the nurse’s responsibility. This study aimed to assess intensive care nurses’ practice of safe medication administration in governmental hospitals in the Gaza Strip.
Methods: This study utilized descriptive, cross-sectional, analytical design. The sample of the study consisted of 116 ICU nurses from five governmental hospitals (Al Shifa Hospital, Indonesy Hospital, Shohada Al Aqsa hospital, European Gaza Hospital, and Nasser Hospital). For data collection, the researcher used Patient Safety Assessment in Medication Administration Questionnaire and Observation Checklist. A pilot study was conducted on 20 nurses, and reliability of the Patient Safety Assessment in the Medication Administration Questionnaire was 0.908.
Results: The results showed that 66.4% of study participants were male nurses and 33.6% were female nurses, mean age was 28.97 years, 85.4% have bachelor degree, mean experience was 4.18 years, mean income was 1431.64 New Shekel, and 67.2% are working mixed shifts (morning, evening, and night). The practice of safety medication administration indicated that the highest score was in right route (93.8%), the right time (91.8%), right patient (90.7%), right way (89.5%), right recording of administered medication (88.9%), right answer (86.7%), right guidance (86.5%), right dose (86%), right medication (85.3%), and the overall score was 88.6%. Also, observation of nurses indicated high practice of safe medication administration with an average score of 83.6%. There were statistically insignificant differences in the practice of safe medication administration related to the hospital, gender, qualification, age, experience, and income.
Conclusion: The study concluded that intensive care nurses handling medication safely at a moderate level and more. The authors demonstrated the need to provide adequate number of qualified nurses in Intensive Care Units, and encouraged nurses to participate in training programs about safe medication preparation and administration.
Keywords: Safe Medication Administration; Nurses; Intensive Care Units; Gaza Strip
Introduction
Patient Safety (PS) consists of the identification, analysis and management of patient-related risks and incidents, in order to make patient care safer and minimize harm to patients [1]. Medication safety is a part of PS and is defined as freedom from accidental injury during the course of medication use; activities to avoid, prevent, or correct adverse drug events which may result from the use of medications [3]. Unsafe medication practices and MEs are the most important preventable factor that influences Patient safety [2].
The administration of medications is primarily the nurse’s responsibility, on which nurses spend up to 40% of their time on administering medication [4]. Medication Errors (MEs) account for 78% of the serious MEs in an ICU, in addition to accidental patient fall are among the most common adverse events reported in hospitals, complicating approximately 2% of hospital stays [5]. Medication Administration Errors (MAEs) are the most common types of medication errors posing dangerous consequences for patients, health professionals and health institutions [6].
Intensive Care Units (ICUs) provide lifesaving care for critically ill patients; it is associated with significant risks for adverse events and serious errors with multiple interactions occurring between multidisciplinary health care providers, patients, and medical devices with increasingly complex interface [7]. In the ICUs, hospitalized patients receive more drugs than patients in other units, and are most vulnerable to being exposed to medication errors due to care complexity, severe illness, and providing life-sustaining treatment [8].
ICU nurses work in a complex work environment that changes moment by moment [9], and many organizational factors such as nurse workload or distractions during medication tasks may increase the risk for errors [10]. Thus, understanding the issue of workload and complex interactions are necessary to reduce errors during medication administration [11]. Also, human factors contributing to errors, such as neglecting instructions and double-check procedures, are still common [12].
Nurses represent the last safety check in the chain of events in the medication administration process [13]. Therefore, this study aimed to assess the practice of ICU nurses regarding safe medication administration in governmental hospitals in the Gaza Strip (GS).
Methods and Materials
This study utilized descriptive, cross-sectional, analytical design. The population of the study consisted of all the critical care nurses who are working in ICUs at governmental hospitals in Gaza Strip. Their total number is about 122 nurses. The sample of the study is the same as the population (census). 116 nurses participated in the study with a response rate 95%. The study was conducted in ICUs at governmental hospitals in Gaza Strip. The study has been conducted during the period from August 2021 to March 2022. Male and female nurses, who are working in ICU at governmental hospitals in Gaza Strip. The researcher used an observation check list to measure safety practice of medication administration in the ICU.
Results
Table 1 showed that 52 (44.8%) of the study participants were aged 26 – 30 years, 34 (29.3%) were aged 25 years and less, and 30 (25.9%) were aged 31 years and more, mean age was 28.97 ± 5.231 years. In addition, 99 (85.3%) have bachelor’s degree, 12 (10.3%) have postgraduate studies (Master degree or PhD), and 5 (4.3%) have diploma certificate. Furthermore, 78 (67.2%) of study participants have 1 – 4 years of experience in ICU, 21 (18.1%) have 5 – 9 years of experience in ICU, 17 (14.7%) have 10 years and more experience in ICU, and the mean years of experience was 4.18 ± 4.047. The results also showed that 51 (44%) of study participants have a monthly income of 1201 – 1700 NIS, 47 (40.5%) have an income of 1200 NIS and less, 18 (15.5%) have an income of more than 1700 NIS, and the mean income was 1431.64 ± 382.620 NIS. Moreover, 78 (67.2%) of study participants work mixed shifts (morning, evening, and night), 30 (25.9%) work morning shift only, and 8 (6.9%) work evening-night shifts.
Variable
Number
Percentage (%)
Gender
Male
77
66.4
Female
39
33.6
Age
25 years and less
34
29.3
26 - 30 years
52
44.8
31 years and more
30
25.9
Total
116
100
Mean age= 28.97 years SD= 5.231 years
Qualification
Diploma
5
4.3
Bachelor
99
85.4
Master/ PhD
12
10.3
Total
116
100
Experience in ICU
Less than 5 years
78
67.2
5 – 9 years
21
18.1
10 years and more
17
14.7
Total
116
100
Mean= 4.18 years SD= 4.047 years
Income
1200 NIS and less
47
40.5
1201 – 1700 NIS
51
44
3
More than 1700 NIS*
18
15.5
Total
116
100
Mean= 1431.64 SD= 382.620 NIS
Work shifts
Morning
30
25.9
Evening-night
8
6.9
Mixed shifts
78
67.2
Total
116
100
*NIS=New Israeli Shekel
Table 1: Sociodemographic characteristics of study participants (n= 116).
Table 2 showed that the highest score was in right route with mean score 4.68 and mean score 93.8%, followed by right time with mean score 4.58 and mean percent 91.8%, right patient with mean percent 4.53 and mean percent 90.7%, right way with mean score 4.47 and mean percent 89.5%, right record of administered medication with mean score 4.44 and mean percent 88.9%, right answer with mean score 4.33 and mean percent 86.7%, right guidance with mean score 4.32 and mean percent 86.5%, right dose with mean score 4.30 and mean percent 86%, and the lowest score was in right medication with mean score 4.26 and mean percent 85.3%. The overall mean score was 4.43 and mean percent 88.6%, which indicated a high level of practicing safety medication administration among ICU nurses.
Domains
Mean
SD
Mean %
Rank
Right patient
4.53
0.665
90.7
3
Right medication
4.26
0.593
85.3
9
Right route
4.68
0.409
93.8
1
Right time
4.58
0.501
91.8
2
Right dose
4.30
0.599
86.0
8
Right record of administered medication
4.44
0.642
88.9
5
Right guidance
4.32
0.612
86.5
7
Right way
4.47
0.817
89.5
4
Right answer
4.33
0.681
86.7
6
Overall average
4.43
0.434
88.6
Table 2: Level of practice of safety medication administration.
Table 3 showed the activities performed by the nurse during medication preparation and administration. Activities such as identifying the patient by full name, checking the prescribed medication against the Kardex, following the guidelines for the constitution or dilution of medication, reading the name of the drug before preparation and matching it with the Kardex, calculating the specific dose accurately, checking the IV cannula or central line for patency, and Administer IV medication according to the designed flow rate showed the highest weighted mean (=90%). Whereas, the lowest weighted mean was noted in activities such as identifying the patient by file number (MRN), cleansing (scrub) administration port of IV tubing with alcohol swab, and taking the medication to the patient on the medication trolley (≤60%).
No.
Activity
Al Shifa
Al Aqsa
EGH
Nasser
Indonesy
Mean
1
Identify the patient by full name
100.0
100.0
100.0
80.0
100.0
96.0
2
Identify the patient by file number (MRN)
85.7
0
100.0
0
60.0
49.14
Check the prescribed medication against the kardex
100.0
100.0
80.0
100.0
100.0
96.0
4
Prepare the medication for one patient at a time
85.7
75.0
100.0
60.0
100.0
84.14
5
Follow the guidelines for constitution or dilution of medication
85.7
100.0
100.0
100.0
100.0
97.14
6
Read the name of drug before preparation and match it with the kardex
100.0
100.0
100.0
80.0
100.0
96.0
7
Read the route of administration before preparation of medication
100.0
75.0
100.0
100.0
100.0
95.0
8
Wash hands with soap and water or alcohol rub before preparation of medication
100.0
50.0
80.0
40.0
40.0
62.0
9
Read the expiration date and confirm the medication is not expired before preparation of medication
100.0
100.0
100.0
20.0
20.0
68.0
10
Read the amount/concentration of stock drug in the vial before preparation
85.7
50.0
100.0
100.0
100.0
87.14
11
Calculate the specific dose accurately
100.0
100.0
100.0
100.0
100.0
100.0
12
Cleanse vial of IV/IM medication and withdraw the required dose accurately
71.4
75.0
100.0
80.0
100.0
85.28
13
Take the medication to the patient on the medication trolley
85.7
75.0
60.0
0
60.0
56.14
14
Clean the administration site of IM injection with alcohol swab
100.0
100.0
100.0
60.0
80.0
88.0
15
Cleanse (scrub) administration port of IV tubing with alcohol swab
85.7
0
60.0
20.0
40.0
41.14
16
Check the IV cannula or central line for patency
85.7
100.0
100.0
100.0
100.0
97.14
17
Administer IV medication according to the designed flow rate
100.0
100.0
100.0
100.0
100.0
100.0
18
Sign the administered medication immediately after administration
100.0
100.0
100.0
100.0
100.0
100.0
19
Evaluate the effectiveness of the administered medication
100.0
100.0
80.0
40.0
100.0
84.0
20
Report any abnormal or unexpected side effects caused by the medication
100.0
100.0
100.0
40.0
100.0
88.0
Average score
94.0
80.0
93.0
66.0
85.0
83.6
Table 3: Activities performed by the nurse during medication preparation and administration.
Discussion
This study aimed to assess the practice of safe medication preparation and administration among ICU nurses in governmental hospitals in GS. The sample of the study consisted of 116 ICU nurses. The results reflected high level of practicing safety medication preparation and administration among ICU nurses. The highest score was in right route, followed by right time, right patient, right way, right record of administered medication, right answer, right guidance, right dose, and the lowest score was in right medication.
The researcher observed the ICU nurses during preparation and administration of medication. The results of observation showed high performance in some activities and low performance in other activities. Activities done by all the nurses included calculating the specific dose accurately, administering IV medication according to the designed flow rate, and signing the administered medication immediately after administration.
Activities done by the majority of nurses included following the guidelines for constitution or dilution of medication (97.14%), checking the IV cannula or central line for patency (97.14%), identifying the patient by full name (96%), checking the prescribed medication against the kardex (96%), and read ing the name of drug before preparation and match it with the kardex (96%).
Other activities done by nurses less frequently including identifying the patient by file number (49.14%), cleanse (scrub) administration port of IV tubing with alcohol swab (41.14%), take the medication to the patient on the medication trolley (56.14%), and washing hands with soap and water or alcohol rub before preparation of medication (62%).
The highest average score of performance regarding medication preparation and administration was in Al Shifa Hospital (94%), followed by EGH (93%), Indonesy Hospital (85%), Shohada Al Aqsa Hospital (80%), and the lowest score was in Nasser Hospital (66%). The overall average score among all the hospitals was 83.6%.
These results disagreed with the results of Mukherjee et al. (2020) which revealed that all the observed nurses did not check the expiry date of the medication, none of the nurses made double check of medication, in 96.7% of the observed events, aseptic techniques were not followed during the preparation of IV medication, in 90% of the events proper hand washing was not performed prior to medication preparation and in 86.7% of events, hand washing was not performed after preparation of IV medication. In addition, the results of Wondmieneh et al. (2020) found that only 24% of the observed nurses washed their hands before preparation of medication, 84.9% administered the right medication to the right patient, 76.9% administered the right dose, 85.8% used the right route, 65.3% administered medication at the right time, and 48% documented the necessary information.
Conclusion
The study concluded that observation of nurses during preparation and administration of medication showed high performance in dose calculation, administration of IV medication according to designed flow rate, documentation of given medication, and checking the IV site for patency before administration of medication.
Moreover, ICU nurses practiced safe medication administration to high extent, and above moderate barriers to safe medication administration, because that they follow the guidelines of medication preparation and administration to high extent, and that would decrease the possibility to make errors.
Recommendation
The study authors recommend the ICU nurses to participate in periodical training programs about safe medication preparation and administration to keep their knowledge and skills updated, to get a preceptor-ship of new nurses to improve their skills and competence in safe medication preparation and administration, and to esure double-check of high alert medication to avoid errors and unwanted complication that may threaten patient’s life.
Ethical Approval
Before starting the study, ethical approval to conduct the study was approved by the Ministry of Health. The study participants were requested to sign an informed consent that states the purpose of the study as well as the voluntary nature of participation and confidentiality of the information gathered.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
Concepts, design, manuscript preparation, reviewing the questionnaire, and manuscript editing done by all authors.
Conflict of Interest
There are no conflicts of interest to be declared.
Acknowledgments
The research team would like to thank the nursing directors and critical care nurse nurses at the government hospitals and all the participants for their cooperation during the process of data collection.
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