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Principles of preparation and administration of selected Medicaments in the Intensive Care
ZÁRUBA, Petr
According to the European Union, medication errors are among the most common adverse events connected with the provision of healthcare services. The safety of nursing care is a basic indicator of the quality of health care providers. One of the basic activities of general nurses is the preparation and administration of medicines, during which, especially in intensive care, even the slightest non-compliance can harm the patient. When preparing and administering medicines it is therefore essential that general nurses consistently follow safety regulations, internal guidelines of health care providers, recommendations of the World Health Organization and national nursing standards, which can effectively prevent potential errors. In clinical practice general nurses may not adhere to these measures for a variety of reasons, so it is important to establish and analyse them. In the theoretical part, the legislative framework for the preparation and administration of medicines in the Czech Republic is defined. This part also describes general principles of handling medicines connected with the problem of medication errors in the context of the quality of health services and defines forms of medicines and their application methods. The practical part of the paper sets out to determine what knowledge nurses working in intensive care have, whether they apply this knowledge in their work process and whether they observe failings of their colleagues relating to the preparation and administration of medicines. With this in mind, four hypotheses and six research questions were established. A quantitative method, non-standardised questionnaire technique was used to collect data. After the quantitative method, the method of qualitative investigation by observation and the technique of an in-depth semi-structured interview were conducted. The research population comprised non-medical health care workers (general nurses and paramedics) working in anaesthesiology-resuscitation departments and intensive care units of district-type hospitals. The quantitative data was processed using descriptive statistics with tables and graphs, while the qualitative data was processed using charts and diagrams.
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Medication Application As a Nursing Activity
BÍLEK, Tomáš
This bachelor thesis focuses on medication administration as a nursing activity and has two main objectives. The first one was to identify mistakes made by nurses when preparing medication or applying medicaments to patients. Another was the analysis of the views of general nurses on the appropriateness of the use of certain medical aids and equipment related to the preparation and administration of drugs and their actual use in their clinical practice when working with patients. This thesis outlines the basic theory of drugs, methods of preparation, various ways of administration to the patient and also possible mistakes that the general nurses may make when handling drugs. Furthermore, the thesis presents results of research conducted during clinical practice in the hospital, which focuses on the proper preparation and administration of drugs by general nurses. The research was based on the covert observation of 20 general nurses working in different hospital wards. It focused on compliance with selected hygiene and safety rules when handling drugs and the use of selected aids to prepare the application of drugs to patients. In addition, the answers from the questionnaire survey, which was attended by 62 general nurses from various medical facilities, but mainly from hospitals, are analysed here. Using statistical methods, hypotheses concerning the influence of age, gender, education and length of practice of general nurses on the use of selected nursing aids and compliance with selected rules were tested. In conclusion, the most important findings concerning the satisfaction of general nurses with the current system of preparation and application of drugs at their workplaces are given, as well as the findings concerning non-compliance with certain hygienic standards. Finally, recommendations are presented that the hospital should adopt in order to increase the awareness of general nurses about this problem and to arrange a remedy.
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Identification of medication errors by nurses during simulated situations
KELBLOVÁ, Kateřina
Current status: Medication errors within the context of safe and high quality health care are one of the most frequently discussed topics of recent years. They are part of the medical process, occur in different forms, affect patients of all ages and decrease the quality of provided health care. Prescriptions of medication in medical documentation have to be clearly legible and include all the required information. Nurses' role within the medicaiton process could be described as an ultimate "safeguard" that can prevent medication errors. Goals: The objectives of this research are to assess nurses' awareness of medication errors, ssess their ability to detect medication errors and find out the level of their knowledge regarding the correct procedures and measures following medication error detection.Methodology: The research was conducted using a qualitative research method. The in-depth interviews with nurses were carried out at a surgical critical care unit at the hospital in Jindrichuv Hradec. Following the collection of a sufficient amount of data the interviews were coded using the "pen and pencil" technique and then divided into categories.Research file: In order to achieve the highest level of objectivity the research was carried out with a group of nurses who work at the same unit of a hospital department. The research file included nurses who had varied levels of education and numbers of years of experience. Results: Surgical critical care unit nurses are not aware of the exact definition of medication errors. Only one nurse was able to discuss adverse events with related consequences. The remaining nurses' awareness of medication errors corresponded to the classification described in the relevant foreign and Czech academic literature. None of the interviewed nurses detected all the errors included in the simulated scenarios. Only one nurse, who is currently completing her qualification in this specialty, detected a wrongly prescribed antidote. The simulated scenarios also included a group of high-risk medications that is commonly used at the unit. The first medication included in this group was a 7.45% solution of potassium (KCl). A majority of the participants detected the high concentration of this high-risk medication. Another high-risk medication was a 10% concentrate of NaCl in an infusion; this error was also detected by the majority of the nurses. The third high-risk medication was a wrongly prescribed insulin (it lacked the detailed description of units, time and route). This prescription error was not detected by the majority of participating nurses. Another type of medication error included in the simulated scenarios was a group of medications used specifically in critical care. Only half of the participating nurses successfully detected the errors related to the prescription of this group of medications. The last type or medication errors focused on incomplete prescription by doctors. The most frequently detected error was a prescription of an opiate that lacked the route and the least frequently detected error was a wrong prescription of an infusion administration. It is evident that the nurses always inform the doctor when they detect a medication error. They are more willing to inform the ward sister in cases of incidents caused by somebody else. Only a small group of nurses are willing to inform the senior consultant, the head nurse or the hospital management. Only one nurse associated medication error reporting with an audit. However the majority of nurses agrees that it is important to report any medication errors.Conclusion: The analysed data suggested that the nurses were aware of medication errors. The analysis of the results of the simulated scenarios suggested that nurses' ability to detect medication errors in prescriptions was related to the number of years of experience and the level of education.
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Selected risks in nursing practice
HLADÍKOVÁ, Šárka
Current state: High percentage of risk is associated with providing medical care and therefore it may harm both the patient and the nursing staff (Drahoš, 2007). Objectives: To assess the most frequent risks in nursing care that may harm patients during their hospitalization. Furthermore, the aim is to find out whether the occurrence of these risks changes depending on the type of care provided and also whether the nurses' understanding of the principles of administration of oral medication is affected by the length of their work experience. Methods: The empirical part of this thesis was based on the quantitative research study - data collection method via structured questionnaires. The study was then supplemented by observation of nurses using the audit technique. The research group-participants: The questionnaire was designed for general nurses working in selected wards of Ceske Budejovice Hospital, plc. During the Semester-in-Practice Externship, six nurses in 'The administration of oral medication'audit. Results: The result of the aritmetic mean, results in the nurses stating the risk of fall in patients as the highest risk (3,56), risk of medication error (3.01). According to the addressed nurses from the internal department, the following risks belong to the group of the most significant risks to the patients of the internal department- risk of injury to the patient during hospitalization, risk of nosocomial infection, risk of falls in patient and risk of immobilization syndrome. According to the questionnaire research results, some differences were shown in the knowledge of principles of safe administration of oral medication in connection with the length of work experience of the addressed nurses. Nurses with the longest practise (over 11years) most frequently chose the correct answer in the following parts: expired drug usage and checks, medical refrigeration temperature, preparation and disposal of left-over medication, how to care for tablet splitter, correct action taken when a patient refuses to take medication and filling in the daily medication report. On the other hand, nurses with practise of 5-10 years more often correctly answered questions regarding drug administration system, safe usage of medical trolley cart and optimum storage conditions in medicine fridge. Nurses with the shortest work experience (under 5 years) proved to have the weakest knowledge of administration of oral medication. A conclusion that can be drawn from the audit results is as follows: the most common errors committed by the nurses are usage of generic drugs, lack of hand disinfection, touching medication with bare hands, preparation of meds in corridors instead of at the patient's hospital bed and incorrect drug disposal when the left-over tablets were put back in the packet. Conclusion: From the statistically significant connection between the probability of the risk and the department (type of care), it came to light that risk of injury to patients during their hospitalization, risk of nosocomial infection, risk of falls in patient, risk of immobilization syndrome and risk of aggressive behaviour are more common risks in internal wards rather than in surgical wards. Nurses with work experience over 11 years proved to have the best knowledge of principles of safe administration of oral medication. The audit proved that despite their good knowledge of safe drug administration procedures, the nurses do not always follow these in the workplace. My thesis is a proposal for standard care procedure 'administration of oral medication'.
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