Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
To assess the extent of violations in the medication administration process among nurses.
Design, Setting, & Participants
Participants were 199 nurses from two U.S. urban, academic, tertiary care, free-standing pediatric hospitals who worked in: a pediatric intensive care unit (PICU), a hematology-oncology-transplant (HOT) unit, or a medical-surgical (Med/Surg) unit. In a cross-sectional survey, nurses were asked about violations in routine or emergency situations in three steps of the medication administration process.
Main Outcome Measure
Self-reported violations of three medication administration protocols were made using a 7-point 0-6 scale from “not at all” to “a great deal.”
Analysis of variance identified that violation reports were highest for emergency situations, rather than for routine operations, highest by HOT unit nurses, followed by PICU nurses, and then Med/Surge unit nurses, and highest during patient identification checking, followed by matching a medication to a medication administration record, and then documenting an administration. There was also a significant 3-way interaction among Violation Situation, Step in the process, and Unit, which is explained in detail in the Results.
Protocol violations occur throughout the medication administration process and their prevalence varies as a function of hospital Unit, Step in the process, and Violation Situation. Further research is required to determine whether these violations improve or worsen safety, and for those that worsen safety, how to redesign the system of administration to reduce the need to violate protocol in order to accomplish job tasks.