Nursing thesis download by Willie Evangelista

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Medication errors 1 Critical care nurse perception of medication errors Critical care nurse perception of medication errors

Transcript of Nursing thesis download by Willie Evangelista

Medication errors 1

Critical care nurse perception of medication errors

Critical care nurse perception of medication errors

May, 2006

Medication errors 2

Aim: This study describes Jordanian critical care nurse perceptions about medication

errors, this study was undertaken to ask nurses about what they believe constitutes a

medication error, what is reportable, and what barriers to reporting exist.

Background: Any practicing nurse knows that the causes of medication errors are

both varied and complex. Medication errors have serious direct and indirect results,

and are usually the consequence of breakdowns in a system of care.

Method: A self-report survey method with convenience sampling used to collect data

form 83 critical care nurses from two private hospitals in Amman for this descriptive

study.

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Findings: Findings reveal that there are differences in the perceptions of nurses about

the causes and reporting of medication errors. Causes include nurse miscalculates the

dose, physician prescribes the wrong dose, and illegible physician handwriting. Only

41.8% of the 83 nurses believed that all drug errors are reported, and reasons for not

reporting include fear of manager and peer reactions.

Conclusion: The study findings can be used in programs designed to promote

medication error recognition and reduce or eliminate barriers to reporting.

Key words: medication errors, nursing, , reporting.

SUMMARY

What is already known about this topic:

Medication errors have serious direct results such as patient harm as well as

increased healthcare costs and indirect results include harm to nurses in terms

of professional and personal status, confidence, and practice.

Medication errors represent the largest single cause of errors in the hospital

setting.

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There is no strong relationships between nurse characteristics and number of

medication errors. This would seem to indicate that any nurse is potentially at

risk for making a medication error.

Prevention of medication errors is linked to accurate reporting of medication

errors.

What this paper adds:

There is a gap between the nurse’s perceived knowledge and his or her actual

knowledge about medication errors.

There is differences in reporting medication errors as well as perceived

barriers to reporting.

Strong barriers to reporting did not include fear of disciplinary action but were

more in line with interpersonal reactions from managers and staff.

Nurses tend to inform physicians rather than complete incident report

regarding medication errors.

INTRODUCTION AND PEARPOSE:

Drug administration forms a major part of the clinical nurse's role. Medication

administration by the nurse is only one part of a process that also involves doctors and

pharmacists (Betz et al. 1985). Medication errors have serious direct and indirect

results, and are usually the consequence of breakdowns in a system of care. Direct

results include patient harm as well as increased healthcare costs. Indirect results

Medication errors 5

include harm to nurses in terms of professional and personal status, confidence, and

practice (Mayo et al. 2004).

Ten to 18% of all reported hospital injuries have been attributed to medication

errors (Hume 1999). Five percent of all medication errors reported to the US Food

and Drug Administration (FDA) in 2001 were fatal (Thomas et al. 2001). United

States data from 1993 indicate that 7391 patients died from medication errors, and

patient stays associated with medication errors increased by 4.6 days, with a resulting

cost increase of $4685 per patient (Hume 1999). Medication errors represent the

largest single cause of errors in the hospital setting, accounting for more than 7000

deaths annually (Kohn et al. 1999).

There is a large number of studies examine medication errors from several

aspects, but none of them examine the critical care nurse perceptions of medication

errors. So, this study examined the perceptions of medication errors among critical

care nurses in multiple settings. More specifically, it was designed to investigate what

nurses believe constitutes a medication error, what is reportable, and what barriers to

reporting exist.

REVIEW OF LITREATURE:

Medication errors are typically defined as deviations from a physician’s order.

Hospital medication error rates can be as high as 1.9 per patient per day (Fontan, et al.

2003).

A single patient can receive up to 18 doses of medication per day (Marino et

al. 2000), and a nurse can administer as many as 50 medications per shift (Morris

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1991). This places the nurse at the front line when it comes to drug administration

accountability (Benner et al. 2002).

Sources of errors include illegibly written orders, dispensing errors,

calculation errors, monitoring errors, and administration errors (i.e., giving the wrong

medication to the patient). Physicians, pharmacists, unit clerks, and nurses can be

involved in the occurrence of medication errors (Mayo et al. 2004).

No studies have demonstrated strong relationships between nurse

characteristics (i.e., age, years of practice, and education) and number of medication

errors (Osborne et al. 1999). This would seem to indicate that any nurse is potentially

at risk for making a medication error (Mayo et al. 2004).

Prevention of medication errors is linked to accurate reporting of medication

errors. Reporting medication errors is dependent on individual nurse’s decision

making. Medication errors are typically reported through institutional reporting

systems such as incident reports (Wakefield et al.1996). Moore (1998), however,

estimated that organizations relying on incident reports to provide data miss up to

95% of the medication errors. Several studies have demonstrated underreporting

among nurses (Gladstone 1995; Osborne et al. 1999; Kapborg et al. 1999).

Nurses themselves believe only 25% of all medication errors are reported

using incident reports (Osborne et al. 1999). Nurse managers and physicians also

believe that medication errors are underreported by nurses (Kapborg et al. 1999).

It is estimated that 95% of medication errors are not reported because staff

fear punishment (Gladstone 1995; Osborne et al. 1999; Kapborg et al. 1999).

Disciplinary actions including job loss also affect reporting rates. Interestingly,

Osborne et al, (1999) found that 15.8% of the nurses in their study were unsure as to

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what situation constituted a medication error, and 14% were not sure when to report

the error.

Most of these studies have limitations that include an inadequate number of

sites (e.g., one hospital) and units (e.g., one medical and surgical unit). It is difficult to

know to what degree the local culture influences nurse perceptions about medication

errors in these limited site studies. Nonrandom sampling and small sample sizes raise

additional methodological issues (Mayo et al. 2004).

Reporting systems are dependent on the nurse’s (1) ability to recognize an

error has occurred, (2) belief that the error warrants reporting, (3) belief that she/he

has committed the error, and (4) willingness to overcome the embarrassment and fear

of retaliation for having committed a medication administration error (Kapborg et al.

1999).

METHODS:

Sample and setting: The target population is all registered nurses working in

critical care units (intensive care unit ICU, coronary care unit CCU) in Jordan. The

accessible population was 83 registered nurses works in critical care units (ICU and

CCU) at two privet hospitals in Amman, data collected in April and May, 2006.

A convenience sample used through many visits to selected hospitals (two

privet hospitals in Amman). Although “the convenient sample provides little

opportunity to control bias” (Burns et al. 2001, p.374), “The convenience sample is

the most commonly used sampling in nursing” (Polit et al. 1995, p.233), And it save

time and money (Marie 1992).

Design: quantitative cross sectional descriptive design was used, in order to

identify what nurses believe constitutes a medication error, what is reportable, and

what barriers to reporting exist.

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Descriptive studies are appropriate in health care systems that have few

resources, such as the Jordanian in which satisfying basic human needs come first

(Mrayyan 2003).

Instrument: The Modified Gladstone survey used to collect data for this

study. This instrument measured (1) nurse perceived causes of medication errors (10

items), (2) percentage of drug errors reported to nurse managers (1 item), (3) types of

incidents that would be classified as (a) medication errors, (b) reportable to

physicians, or (c) reportable using an incident report (6 items), (4) nurse views about

reporting medication errors (6 items), and (5) nurses biographical data. (See Appendix

1). Instrument content validity was determined acceptable by Osborne et al. (1999)

and Goldstone (1995). In addition, Osborne et al, (1999) established reliability using

the test-retest method (0.78) in their sample.

An official permission from author obtained by sending an email to him

asking him to use his instrument, she gratefully replied by the approval.

Procedure: A self-report survey method used to collect data for this

descriptive study. Institutional Review Board approval from the University of Jordan

obtained and permission to conduct the study obtained from the hospitals directors.

Verbal consent obtained from each participant. The researcher offered adequate

information about the study purposes and its significance. Participation was voluntary.

Participants were assured that their responses would be confidential and information

that might reveal their identity would not be recorded, and only aggregated data

would be communicated (see appendix 2).

The time frame of this study was 3 months, between March 2006 and May

2006.

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Data Analysis: the statistical package for social sciences (SPSS) version 12

used for coding, data entry, and to compute the descriptive statistics. Descriptive

statistic (means, stander deviations (SD), range, median, and frequencies) used to

describe the sample. The mean and SD for each item in the survey calculated.

FINDINGS:

Eighty-three critical care nurses responded to the survey, representing a 92%

return rate. RN mean age was 25.8 years (range = 21– 52 years; SD = 5). Male nurses

participant were 67.5% (n= 56), while female nurses participant were 32.5% (n = 27).

Participants had been practicing for an average of 3.63 years (range = 1 month – 32

years; SD = 5.1). Nurses were primarily had Baccalaureate degree 98.8%. Regarding

work setting the sample distribute as following: ICU nurses 38.6% (n = 32), CCU

nurses 26.5% (n = 22), and ICCU nurses 34.9% (n = 29).

As part of the demographic survey, RNs were also asked the number of

medication errors they could remember making over the course of their career. The

mean number of errors recalled was 4.07 per nurse (range = 0–25; SD = 3.9).

However, most nurses (65%) recalled making 2 to 5 errors over their career.

Table 1 portrays the ranked causes of medication errors as perceived by the

participating RNs. Nurses ranked the listed causes from 1 to 10, with 1 indicating

most frequent cause and 10 indicating least frequent cause. Mean scores were

calculated for each item and are listed in the table. The top 3 ranked (out of 10)

perceived causes of drug errors were the following: (1) nurse miscalculates the dose,

(2) physician prescribes the wrong dose, and (3) physician’s writing on the doctor’s

order form is difficult to read or illegible.

Table 1. Ranked causes of medication errors*.

Item Mean SD

Medication errors 10

1. Drug errors occur when the nurse miscalculates the dose.

2.Drug errors occur when the physician prescribes the wrong dose.

3. Drug errors occur when the physician’s writing on the doctor’s

order form is difficult to read or illegible.

4. Drug errors occur when there is confusion between 2 drugs with

similar names.

5. Drug errors occur when the nurse fails to check the patient’s

name band with the Medication Administration Record (MAR).

6. Drug errors occur when nurses are tired and exhausted.

7. Drug errors occur when nurses are distracted by other patients,

coworkers, or events on the unit.

8. Drug errors occur when the nurse sets up or adjusts an infusion

device incorrectly.

9. Drug errors occur when nurses are confused by the different types

and functions of infusion devices.

10. Drug errors occur when the medication labels/packaging are of

poor quality or damaged.

4.47

4.98

4.99

5.11

5.29

5.48

5.90

6.10

6.30

6.31

2.50

2.89

2.48

2.24

3.42

3.16

2.92

2.70

2.95

2.73

* Ranking: 10 indicates least frequent cause; 1, indicates most frequent cause.

Based on 6 quite different scenarios presented to the nurses, Table 2 represents

how nurses classified each scenario as a medication error (yes or no responses) and if

they would or would not report the situation to a physician or complete an incident

report.

Table 2. Classifying and reporting of medication errors

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Items

Yes %

(n)

No %

(n)

1. A patient misses his midday dose of oral ampicillin

because he was in x-ray for 3 h.

- Drug error

- Notify physician

- Incident report necessary

2. Four patients on a busy surgical unit receive their 6 PM

done of IV antibiotics 4 h late.

- Drug error

- Notify physician

- Incident report necessary

3. A patient receiving TPN feeding via an infusion pump is

given 200 ml/h instead of the correct rate of 125 mL/h for the

first 3 h of the 24-h infusion. The pump was reset to the

correct rate after the change of shift at 7 AM when the

oncoming nurse realized that the pump was set at the

incorrect rate.

- Drug error

- Notify physician

- Incident report necessary

4. A patient admitted with status asthmaticus on 08/13 at 2

AM is prescribed albuterol (ventolin) nebulizers every 4 h.

The nurse omits the 6 AM dose on 08/13 as the patient is

asleep.

28.9 (24)

73.5 (61)

21.7 (18)

80.7 (67)

68.7 (57)

32.5 (27)

84.3 (70)

75.9 (63)

66.3 (55)

71.1 (59)

26.5 (22)

78.3 (65)

19.3 (16)

31.3 (26)

67.5 (56)

15.7 (13)

24.1 (20)

33.7 (28)

Medication errors 12

- Drug error

- Notify physician

- Incident report necessary

5. A physician orders oxycodone hydrochloride and

acetaminophen (Percocet) 1–2 tabs for post-operation pain

every 4 h. At 4 PM the patient complains of pain, requests 1

pill and is medicated. At 6:30 PM the patient requests a

second pain pill. The nurse administers the pill.

- Drug error

- Notify physician

- Incident report necessary

6. A patient is receiving a routine 9 AM dose of digoxin

every day. Yesterday’s digoxin level was 1.8 (the high side

of normal). A digoxin level was drawn at 6 AM today. At 9

AM the nurse holds the digoxin because the lab value is not

available yet.

- Drug error

- Notify physician

- Incident report necessary

59 (49)

72.3 (60)

30.1 (25)

48.2 (40)

69.9 (58)

55.4 (46)

26.5 (22)

85.5 (71)

16.9 (14)

41 (34)

27.3 (23)

69.9 (58)

51.8 (43)

30.1 (25)

44.6 (37)

73.5 (61)

14.5 (12)

83.1 (69)

TPN, total parental nutrition.

Some scenarios elicited common responses in terms of classifying medication

scenarios. For example, most nurses (84.3%) responded that they would classify a fast

running TPN (total parental nutrition) rate (200 mL/h for 3 hours instead of the

correct 125 mL/h) as a drug error; 75.9% would notify the physician; and 66.3%

would complete an incident report. On the other hand, most nurses (73.5%) would not

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classify as a medication error the withholding of a routine morning dose of digoxin

because the digoxin blood level report was late. However, in this case 85.5% would

notify the physician, but only 16.9% would complete an incident report.

For other scenarios, nurses had quite disparate responses. For example, nurses

were split (48.2% versus 51.8%) in their classification of a scenario involving pain

control medication. However, once again more nurses would notify the physician

(69.9% versus 30.1%), yet were split (55.4% versus 44.6%) when it came to

completing an incident report.

In the all 6 scenarios, more nurses would notify physicians than not notify

them no matter how they first classified the scenarios. In 4 out of the 6 scenarios,

more nurses would not complete an incident report; this decision mirrored their

original classification of the scenario as either being a medication error or not being a

medication error.

In addition to evaluating scenarios, nurses were also asked, “In your

estimation, what percent of all drug errors are reported to the nurse manager by the

completion of an incident report?" The mean percentage was 41.83, indicating that

less than half of the nurses believed that all drug errors are reported to a nurse

manager using an incident report.

Table 3 presents additional nurse responses to statements about reporting

medication errors. Most nurses indicated that they knew what constituted a

medication error (85.5%) and when to report an error using an incident report

(77.1%). Reasons for not reporting errors included “afraid of manager reaction”

(73.5%), “afraid of coworkers’ reactions” (67.5%), and “not thinking an error was

serious enough” (56.6%). However, the majority of nurses (73.5%) do not seem to

fear disciplinary action (losing one’s job) because of committing an error.

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Table 3. Reporting medication errors

Items

Yes %

(n)

No %

(n)

- I am usually sure what constitutes a medication error.

- I am usually sure when a medication error should be

reported using an incident report.

- Some medication errors are not reported because nurses are

afraid of the reaction they will receive from the Nurse

Manager.

- Some medication errors are not reported because nurses are

afraid of the reaction they will receive from their peers.

- Have you ever failed to report a drug error because you did

not think the error was serious to warrant reporting?

- Have you ever failed to report a medication error because

you were afraid you might be subject to disciplinary action or

even lose your job?

85.5 (71)

77.1 (64)

73.5 (61)

67.5 (56)

56.6 (47)

26.5 (22)

14.5 (12)

22.9 (19)

26.5 (22)

32.5 (27)

43.4 (36)

73.5 (61)

Most nurses indicated that they knew what constituted a medication error

(85.5%), but when they asked in the first scenario about patient misses his midday

dose of oral ampicillin because he was in x-ray for 3 hours, most nurses (71.1%)

responded that they would not classify it as medication error, 73.5% would notify the

physician; and only 21.7% would complete an incident report. This raise a question,

are nurses really know what constituted a medication error or not?

LIMITATIONS:

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The sample size of this study was small, and therefore, the findings may not be

generalizable to nonrepresented critical care nurses. The use of convenience sample

method, which may increased the probability of bias, and this might not be

representative for the population, and this may have affected the results. Regarding

the ranking of medication errors, there may be additional causes that were not

identified on this study’s survey. However, the top ranked causes from this study

could be a starting point for organizations to address system issues. In addition, the

scenarios were brief and did not provide situational details.

CONCLUSION:

Any practicing nurse knows that the causes of medication errors are both

varied and complex. Because medication errors are such a concern to the public,

healthcare organizations, and nurses themselves, this study was undertaken to ask

nurses about what they believe constitutes a medication error, what is reportable, and

what barriers to reporting exist.

All nurses in an organization may need help in identifying what is a

medication error, when to report it, and to whom. This study calls attention to the

need to clarify with nursing staff what constitutes a medication error. Interestingly,

nurses were “usually sure what constitutes an error”(85.5% yes, 14.5% no) yet were

not in high agreement with one another when given actual medication scenarios (i.e.,

48.2% yes, 51.8% no). This study has identified a gap between the nurse’s perceived

knowledge and his or her actual knowledge. It is clear that nurses need specific

information about what constitutes medication errors. The information gained from

this study can be used in educational programs designed to promote the recognition of

these errors.

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Now that we know nurses differ in their perceptions as to what constitutes a

medication error, do organizations have clear guidelines available as to what

situations represent medication errors? Regardless of our personal opinions, traditions

related to nursing’s 5 rights of medication administration, or our unstated

expectations, this study demonstrates that nurses are not “on the same page” as to

what is a medication error and when to report to it.

This study identified differences in reporting medication errors as well as

perceived barriers to reporting. However, strong barriers to reporting did not include

fear of disciplinary action but were more in line with interpersonal reactions from

managers and staff. Discussions among staff and nurse managers medication errors is

desperately needed.

From this study, there is several questions to raise with nurses include the

following: (1) How do nurses define medication errors? (2) Is there a unique and

different definition for reportable medication errors versus non-reportable errors? (3)

Why is there a difference in nursing judgment between reporting medication errors to

physicians and reporting medication errors using incident reports? (4) What can

organizations do to promote the reporting of medication errors and near misses?

While this study has generated some important questions, it also has provided

some insights into medication errors and reporting. The knowledge gained from this

study can contribute to educational programs that promote the recognition of

medication errors. The knowledge also can assist with system redesigns to reduce or

eliminate barriers to reporting medication errors. Patient safety programs can be

strengthened through accurate, and comprehensive reporting, ultimately ensuring the

highest quality patient care.

Medication errors 17

REFERANCES:

Benner, P., Sheets, V., Uris, P., Malloch, K., Schwed, K., &Jamison, D. (2002). Individual, practice, and systems causes of errors in nursing. Journal of Nursing Administration 32(10),509– 523.

Betz, R., & Levy, B. (1985). An interdisciplinary method of classifying and monitoring medication errors. American Journal of Hospital Pharmacy. 42(8): 1724-1732.

Medication errors 18

Burns, N., & Grove, S. (2001).The practice on Nursing Research :conduct, Critique and Utilization (4th ed) . Philadelphia: W.B Saunders.

Fontan, J., Maneglier, V., Nguyen, V.X., Loirat, C., & Brion, F. (2003). Medication errors in hospitals: computerized unit drug dispensing systems versus ward stock distribution system. Pharmacy World Science 25(3),112–117.

Gladstone, J. (1995). Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. Journal of Advanced Nursing 22, 628–637.

Hume, M. (1999) Changing hospital culture, systems reduce drug errors. Excellent Solution Healthcare Management 2(4) 4–9.

Kapborg, I., & Svennson, H. (1999). The nurse’s role in drug handling within municipal health and medical care. Journal of Advanced Nursing 30(4), 950–957.

Kohn, L.T., Corrigan, J. M., & Donaldson, M. S. (1999) To error is human: building a safety health system. Washington, DC: National Academy Press.

Marie, R. (1992). Foundation of nursing research. (2nd ed). Appleton & lange. East Norwalk.

Marino, B.L., Reinhardt, K., Eichelberger, E.J., & Steingard, R. (2000). Prevalence of errors in a pediatric hospital medication system: implications for error proofing. Outcomes Manage Nursing Practice 4(3),129–135.

Mayo, A., & Duncan, D. (2004). Nurse perceptions of medication errors. Journal of Nursing Care Quality 19(3), 209- 217.

Moore, J.D. (1998). Getting the whole story: the way medication errors are reported affects the results. Mod Health. December 21–28, 1998:46.

Morris, S. (1999). Who’s to blame? Nursing 4(33),8.

Mrayyan, M.T. (2003). Nurse autonomy, nurse job satisfaction and patient satisfaction with nursing care: their place in nursing data sets. Canadian Journal of Nursing Leadership 16 (2), 74 83.

Osborne, J., Blais, K., & Hayes, J.,S.(1999) Nurses’ perceptions: when is it a medication error? Journal of Nursing Administration 29(4), 33–38.

Polit, D., & Hungler, B. (1995). Nursing Research: Principles and Methods (5th ed). Philadelphia. Lappincott Company.

Thomas, M.R., Holquist, C., & Phillips, J. (2001). Medication error reports to FDA show a mixed bag. FDA Safety Page. 145(19), 23.

Medication errors 19

Wakefield, D.S., Wakefield, B.J., Uden-Holman, T., & Blegen, M.A. (1996). Perceived barriers in reporting medication administration errors. Best Practice Benchmarking Healthcare1(4),191–197.

Appendix 1

Nurse Perception of Medication ErrorsModified Gladstone 2001

Why Do You Think Medication Errors Occur?

1. The following ten statements are all possible causes of medication errors. Please read them carefully and Rank #1 to #10. (#1 is the most frequent and #10 the least frequent).

Medication errors 20

a. Drug errors occur when the nurse fails to check the _______patient’s name band with the Medication Administration

Record (MAR.)

b. Drug errors occur when the physician’s writing on the _______

doctor’s order form is difficult to read or illegible.

c. Drug errors occur when the medication labels/packaging_______

are of poor quality or damaged.

d. Drug errors occur when there is confusion between two _______

drugs with similar names.

e. Drug errors occur when the physician prescribes the ________

wrong dose.

f. Drug errors occur when the nurse miscalculates the dose.________

g. Drug errors occur when the nurse sets up or adjusts an________

infusion device incorrectly.

h. Drug errors occur when nurses are confused by the________

different types and functions of infusion devices.

i. Drug errors occur when nurses are distracted by other________

patients, coworkers or events on the unit.

j. Drug errors occur when nurses are tired and exhausted.________

2. In your estimation, what percentage of all drug errors are reported to the Nurse Manager by thecompletion of an incident report? (Please make an X on the line that corresponds most closelyto your estimation.)

1% ________________________________________________________100 % (1.11)

Medication errors 21

NURSES’ PERCEPTIONS ABOUT MEDICATION ERRORS:

It is not always clear to nurses whether what they view as a minor drug discrepancy should be reported as a medication error. In the following examples you are asked to indicate:

a. Whether or not a medication error occurred.

b. Whether or not the physician should be notified.

c. Whether or not an incident report should be completed.

Please answer “YES” or “NO” for each of the following statements:

3. A patient misses his midday dose of oral ampicillin because he was in X-Ray for three hours.

a. Drug Error Yes No

b. Notify Physician Yes No

c. Incident Report Necessary Yes No

4. Four patients on a busy surgical unit receive their 6:00pm doses of IV antibiotics 4 hours late.

a. Drug Error Yes No

b. Notify Physician Yes No

c. Incident Report Necessary Yes No

5. A patient receiving TPN feeding via an infusion pump is given 200 ml/hr instead of the correct rate of 125 ml/hr for the first three hours of the 24-hour infusion. The pump was reset to the correct rate after the change of shift at 7:00am when the oncoming nurse realized that the pump was set at the incorrect rate.

a. Drug Error Yes No

b. Notify Physician Yes No

c. Incident Report Necessary Yes No

6. A patient admitted with status asthmaticus on 08/13/97 at 2:am is prescribed ventolin nebulizers every four hours. The nurse omits the 6:00am dose on 08/13/97 as the patient is asleep.

a. Drug Error Yes No

b. Notify Physician Yes No

c. Incident Report Necessary Yes No

7. A physician orders percocet 1-2 tabs for post-op pain every 4 hours. At 4:00pm the patient complains of pain, requests one pill and is medicated. At 6:30pm the patient requests the second pain pill. The nurse administers the pill.

a. Drug Error Yes No

b. Notify Physician Yes No

Medication errors 22

c. Incident Report Necessary Yes No

8. A patient is receiving a routine 9 am dose of digoxin everyday. Yesterday’s digoxin level was 1.8 (the high side of normal). A digoxin level was drawn at 6 am today. At 9 am the nurse holds the digoxin because the lab value is not available yet.

a. Drug Error Yes No

b. Notify Physician Yes No

c. Incident Report Necessary Yes No

What are your views about reporting medication errors? Please check the most appropriate response:

9. I am usually sure what constitutes a medication error Yes No

10. I am usually sure when a medication error should be Yes No reported using an incident report

11. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from the Nurse Manager.

12. Some medication errors are not reported because Yes No nurses are afraid of the reaction they will receive from their coworkers.

13. Have you ever failed to report a drug error because Yes No you did not think the error was serious to warrant reporting?

14. Have you ever failed to report a medication error Yes No because you were afraid that you might be subject to disciplinary action or even lose your job?

Your training and experience. Please fill in the answers below.

15. Age _______

16. Gender _______ M _______ F

17. Check highest level of education

_______ Bachelor of Science Degree in Nursing

_______ Master of Science in Nursing

_______ Other: (specify)

18. How long have you been a practicing nurse? _______ Years

19. How many medication errors do you remember making over the course of your career? (Circle the Correct answer.)

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0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, more than ten, please specify _______.

20. What is your primary hospital work setting?

Thank you!

Medication errors 24

Appendix 2

Informed consent

Dear registered nurse,

We are master student in the faculty of nursing "Jordan University". we are

going to conduct a study about Critical Care Nurse Perception of Medication Errors.

As you know there is increasing attention to increasing medication errors, so

our purpose to investigate your perception and understanding of medication error that

might happened with you .better understanding will decrease rate and seriousness of

medication error. As a result, our patient outcome might be improved. This survey

will be conducted through distribution a questionnaire for registered nurses working

in critical care settings (ICU and CCU).

Taking part in this project is entirely up to you, and even if you begin the

survey, you may stop at any time, even there is no risk of participation and all

gathered data will be completely confidential, and will not be used to another purpose.

Your involvement in this study may improve our nursing profession in the future ,

while you will not have any immediate benefits