Despite advances in medication administration safety, such as use of electronic orders, electronic pharmacy systems, and bar coding, medication errors still occur. The frequency and severity of these errors have been explored in various studies, and it is estimated that medication errors cause or contribute to the deaths of 7,000 patients each year in the USA. Nurses are the final checkpoint in the medication administration process and play an important role in the final safety check.
A research team led by Linda Flynn, PhD, RN, FAAN from Rutgers University noted that RNs often intercept---and prevent--- medication errors; however, little was known about the nursesâ€™ practice environment and how it influenced their error interception practices. With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), the researchers conducted a study of 82 medical-surgical units recruited from 14 U.S. acute care hospitals in New Jersey to examine relationships among characteristics of the nursing practice environment, nurse staffing levels, nursesâ€™ error interception practices, and rates of non-intercepted medication errors.. Data collected for the eight-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. Nurse survey data from 686 staff nurses included the Practice Environment Scale of the Nursing Work Index as a measure of environmental characteristics, and a metric of nursesâ€™ interception practices was developed for the study.
The researchers found that nursesâ€™ error interception practices included independent comparisons between the medication administration record and the patientâ€™s medical record, determining the rationale for each ordered medication, requesting that physicians rewrite orders when improper abbreviations were used, and ensuring that patients and families were knowledgeable regarding the medication regimen so that they can question unexplained variances. Researchers found that nursesâ€™ interception practices had a significant effect on the rate of medication errors. More frequent engagement by nurses in interception practices was associated with fewer documented medication errors per 1,000 patient days. For 100 units of interception practice for 1,000 patient days, medication errors decreased by an average of 19.