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

Hill, Karen Jane (2016-12)

Thesis (MCur)--Stellenbosch University, 2016.

Thesis

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.

AFRIKAANSE OPSOMMING : Die proses van medikasietoediening is reeds beskryf met betrekking tot medikasievoorskrifte, -bestelling, -verskaffing-, -toediening en -optekening. Die Wêreldgesondheidsorganisasie beskou pasientveiligheid as ʼn toenemende wêreldwye bron van kommer. ʼn Navorsingstudie wat in die Verenigde Koninkryk uitgevoer is, het getoon dat komplikasies verbonde aan die toedien van medisyne ʼn pasient se hospitaalverblyf van 4.6 tot 10.3 dae kan verleng. Daar is reeds omvattende navorsing oor hierdie verskynsel in die openbare sektor gedoen, maar min is in die privaat gesondheidsektor uitgevoer, waar pasient tevredenheid beskou word as verbandhoudend met hul persepsies van die gehalte van die diens waarvoor hulle betaal, wat indirek deur bestaande sakemodelle beïnvloed word. Die doel van hierdie studie was om die perspektiewe te verken van verpleegkundiges wat in privaat gesondheidsorginstellings in Wes Kaap Provinsie, Suid-Afrika werk rakende die heersende elemente verbonde aan menslike faktore wat met foute in die toedien van medikasie geassosieer kan word. Alle ingeskrewe verpleegkundiges (IV’s) en geregistreerde verpleegkundiges wat in die sale en intensiewesorg-eenhede van die drie deelnemende hospitale werk, is genooi om aan die studie deel te neem. Albei groepe verpleegkundiges is ingesluit om begrip te bevorder van die menslike faktore wat die verpleegkundiges se vermoe beïnvloed om medisyne veilig aan pasiente toe te dien en enige opvallende elemente te bepaal wat meer algemeen in een van die groepe kan voorkom. Die aard van die rolle en omvang van praktyke van die twee verpleegkundige-kategoriee lei tot die moontlikheid van verskillende uitdagings onder die twee groepe. ʼn Kwantitatiewe benadering met ʼn beskrywende ontwerp is vir die studie gekies. ʼn Nie-waarskynlikheid gerieflikheidsteekproefnemingsmetode is gebruik. Altesaam n=329 (82.25%) van die totale populasie (N=400) het selfadministratiewe data-insamelingsvraelyste met Likert-styl- en twee oop vrae voltooi. Geldigheids- en betroubaarheidstoetsing van die data-insamelingsinstrument is uitgevoer en bevestig deur insette van kundiges op die gebied van verpleegkunde, geneeskunde, die reg en farmakologie. Die uitvoer van ʼn loodsondersoek en berekening van die Cronbach-alfakoeffisienttoets, wat tellings voortgebring wat tussen 0.755 en 0.925 wissel. Beskrywende en inferensiele ontleding is gedoen om die bevindinge van die studie te interpreteer. ʼn Statistikus is geraadpleeg vir die statistiese ontleding, wat Mann-Whitney-toetsing ingesluit het om moontlike verwantskappe tussen gekose komponente van die demografiese data van die studiepopulasie en die elemente wat as die algemeenste beskou is, te bepaal. Die resultate het die volgende sleutelkommergebiede getoon wat ʼn gereelde of algemene rol in die voorkoms van foute met die toediening van medisyne speel (soos deur die verpleegkundiges ervaar): die farmaseutiese-voorsieningsketting (75.68%), pasient-verpleegkundige-werklading (74.46%), leesbaarheid van voorskrifte (71.12%), werksdruk (69.60%), afleiding (67.77%) en moegheid of uitputting (67.47%). Benewens hierdie bevindinge het die studiepopulasie die impak uitgelig wat plaasvervanging van medisyne in die vorm van generiese medisyne in medisyneveiligheid speel. Die gebrek aan bygewerkte generiese medisyne lyste van generiese medisyne hou sowel ʼn bedreiging as ʼn uitdaging met betrekking tot pasientveiligheid in. Alhoewel die huidige studie se resultate ooreenstem met die van ‘n soortgelyke studies verkry is, is daar ʼn duidelike behoefte aan verspreiding van die algehele konsep van voorvalbestuur onder personeel wat met pasiente werk. Daar is bewys dat die skepping van ʼn ‘regverdige kultuur’ negatiewe gevolge verminder en personeel bemagtig met betrekking tot monitering en verbetering van hul eie en ander se kliniese prestasie, waardeur pasientveiligheid en -versorging verbeter word. Hierbenewens, en in die Suid-Afrikaanse konteks, doen die studieresultate aan die hand dat dit noodsaaklik is om die rol en verantwoordelikhede van die IV’s in sowel die sale as die intensiewesorg-eenhede in die privaat gesondheidsorginstellings te ondersoek. Die resultate toon ʼn hoer vlak kommer rakende die gevolge van menslike faktore soos verpleegkundige-pasient-verhouding, werksdruk en afleidings vir die saalgebaseerde IV’s teenoor die IV’s in die intensiewesorg-eenheid.

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