Precautions for minimising errors

Precautions for minimising errors were reflected in two main themes; rights of medication administration and double-checking for some medications.

Rights of medication administration

Nurses considered all the five rights of medications as important rules for safe medication administration and precautions to minimise medication errors expanding on the information provided by the quantitative data. Experience of medication administration was the first issue concerning nurses as well as care when undertaking medication administration. They all stated that they followed and checked the doctor orders, right dosage, right patient, right time, and the patient‘s name before preparing medication. Nurses usually double-checked after

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preparing the medication and documented their procedure on the patient‘s file. As one nurse said:

“ Actually , we give medication using all the accepted routes we can use, orally, subcutaneous, IM, IV, when we give according to the five rights , we check and double-check

the patient’s name , be right about the medication, dosage, route also, time if the patient refuses we also have to know the patient’s right…making sure that there are two of you looking at it, to see what you are giving is the correct medication...If the medication is not

available in the pharmacy we know we should inform the colleagues and doctor” AZ-M.

The five rights were all important, from nurses‘ perspectives. Nurses believed that the nurse should follow these orders as a means of avoiding any medication error. However, these rights were not the only thing nurses should do and they (nurses) believed that they do follow and care for patients starting from his/her admission to completing the care package and discharging the patient. For example:

“...Following the doctor’s orders since working in the general wards for example IPD... I have handled the patient from the beginning of the admission during the treatment until the

discharge. We know the patient...we need to follow the doctor’s order but during giving medication you need to remember the dosage, right patient, right dosage, right route, right time, frequency, documentation...and history of the patient, if there is any allergy you need to

be guided...because of this care you will avoid any medication error but first thing you need to follow is the doctor’s order...” IN_F

Nurses in the study reported that they were trained and able to give medications properly by all routes although this right of medication was not rated as most important to them:

“We are all trained and have fair experience to give all medications by all routes, but I think we need refresher training and support from our hospital managers to sort our job and help

to concentrate on medication and other procedures.” (AL_F).

Double-checking for some medications

There were many views on the double-checking of IV medication on different wards and the majority of medications administered in the selected hospitals, were administered IV. In

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addition to double-checking as part of rules and regulations, nurses also understood that intravenous medications might have to be checked even if the nurse was well trained, therefore, it was perceived important to double-check IV medication prior to its administration. As this nurse explained:

“I believe some of the IV medications are dangerous, and should be checked by rules...it is not just reading a packet, and showing the correct medication and correct dose and preparing the correct volume...this is slightly stricter with the IV drugs, so for that reason we

ask the people to double-check it”(BR_M)

The interviewees clearly expressed the view that the five rights have a crucial effect on their performance and play an essential part in administering medication safely. The majority of nurses believed that they have sufficient knowledge and experience to administer the medication safely:

“ Yes, sure I am doing my medication according to time of medicines for each patient, usually before administering medication I have a look to the order and double check and check the 5 rights and administer medication carefully with good concentration,

then the end stage is documented in the daily nursing notes in the patients file” (BR_M).

Nevertheless, when nurses were asked whether they could give medication independently, there were some situations in which they needed to double-check with other nurses. For example, rules in specific departments or specialities for checking or giving medications may influence nurses‘ need for assistance in medication administration. As this nurse described:

“Before me giving the patient I have to check and double-check the five rights and after I have to check again” MM_F.

Similarly, nurses mentioned their familiarity with medications as means of minimising errors, especially those nurses who started their job very recently. Nurses believed that on the whole they did not need to ask other professionals (such as doctors, pharmacists, supervisors) for help, however, in some cases e.g. a new medicine, help would be sought. This could be from a supervisor, a text book or other senior staff. As these quotations illustrate:

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―…Almost all nurses can give them independently, if its new medicine, if its first time I think I need to ask and double-check with my supervisor about it, but next time no need…” HM_M

“…sometimes we need help yeh… If any new medication that I am not familiar with before giving the medication I should ask the pharmacy. According their instructions I will give

the medication…”MR_M

Although nurses mentioned before that they follow the rights of medication administration and they avoid errors, there were certain situations in which they asked for help, in particular when administering new medications. If assistance was not available, this could be one potential cause of making and underreporting medication errors.