Medication administration safety in medical and surgical units of the Gauteng Province

Abstract

Background: Several international studies have been published on the incidence of medication administration, as well as causes and solutions thereof. However, no similar research has been conducted in Africa, and nothing is known about the context-specific features of this patient-safety threat in South Africa. Aim: To develop an intervention to improve medication administration safety in public hospitals of the Gauteng Province. Design: A mixed method design, incorporating descriptive, explanatory, exploratory and contextual strategies was used. Methods: Phase 1: A systematic review was conducted to determine the causes of medication administration errors. Phase 2: The incidence of medication administration errors was determined by direct observation. Phase 3: Calculation skills of medication administrators were tested. Phase 4: Perceptions of safety culture, medication administration error incidence, an overall grade on medication administration safety, causes of errors, incidence of error reporting and reasons of non-report were explored by means of surveys. Phase 5: Solutions to the problem were explored through semi-structured interviews with subject matter experts. Setting and participants: Phase 1 (Systematic review): 70 international research studies were included. Phase 2 (Direct observation): Eight public hospitals within the Gauteng Province that met all the inclusion criteria were selected randomly. Ten parenteral and ten enteral medication administrations were observed in one medical and one surgical unit of each of these hospitals (n = 315). Phase 3 (Knowledge testing): Medication administrators from units as sampled in phase 2 were included (n = 25). Phase 4 (Survey): An all-inclusive sample of medication administrators from all medical and surgical units of hospitals as was sampled in phase 2 was included to complete the survey (N = 683, n = 280). The response rate was 41%. Phase 5 (Semi-structured interviews): Fifteen unit managers from units sampled for phase 2 of the research were interviewed. Results: Phase 1: Communication factors, human factors, environmental factors and medication-related factors were identified as causes of medication administration errors. Phase 2: 296 errors were identified, of which most were wrong-time errors (n = 127, 43%). Phase 3: 32% (n = 16) completed dosage calculations incorrectly. Phase 4: Medication administration safety was perceived as very good. Environmental factors impacted most on patient safety (M = 2.89). The three main causes of medication administration errors were workload (M = 3.39), stock distribution problems (M = 3.18) and illegible prescriptions (M = 3.05). Errors were only reported sometimes, with fear being the main cause of non-report. Phase 5: Adherence to existing protocols, auditing, education and training, collaboration, communication, the use of known products, resource- and time management could offer a way forward. The results of the five phases were converged to create an intervention aimed at improving medication administration safety in South Africa. Conclusions: Medication administration errors pose a great threat to patient safety in public hospitals in the Gauteng Province. Both similarities with and differences to international literature were noted, which led to the need for an intervention that is developed for this specific setting.