ABSTRACT
INTRODUCTION: Administering medication is one of the high risk areas for any health professional. It is a multidisciplinary process, which begins with the doctor's prescription, followed by review and provision by a pharmacist, and ends with preparation and administration by a nurse. Several studies have highlighted a high medication incident rate at several healthcare institutions. METHODS: Our study design was exploratory and evaluative and used methodological triangulation. Sample size was of two types. First, a convenient sample of 1000 medication dosages to estimate the medication error (95% CI). We took another sample from subjects involved in medication usage processes such as physicians, nurses, pharmacists, and patients. Two sets of instruments were designed via extensive literature review: a medication tracking error form and a focus group interview questionnaire. RESULTS: Our study findings revealed 100% compliance with a computerized physician order entry (CPOE) system by physicians, nurses, and pharmacists. The main error rate was 5.5% and pharmacists contributed an higher error rate of 2.6% followed by nurses (1.1%) and physicians (1%). Major areas for improvement in error rates were identified: delay in medication delivery, lab results reviewed electronically before prescription, dispension, and administration.
ABSTRACT
Hospitals are facing serious challenges to provide high quality care with current nursing shortages. Nursing shortages are of major concern for Nursing Management, clinicians and administrators as they lead to impact on quality of care. Under-stressed, frustrated and demoralized nurses give rise to concern for hospital Nursing Management in providing quality care according to set standards. A descriptive qualitative research design was used to explore the registered nurses' perceptions regarding the high turnover rates among nurses at a Tertiary Care University Hospital. Data was collected from nurses working at various speciality areas, which were: Critical Care, Medical and Surgical Care, Ambulatory Care, Maternal/Child and Emergency departments. A convenience sample of 45 registered nurses from nine subspecialty groups was selected for a focus group interview and five focus groups were selected for a study population. Findings of exit interviews (from 1 September 2001 to 28 February 2002) were also included in the data analysis. These exit interviews of RNs were conducted by Nurse Recruiter at the time of their resignations. The data analysis showed that the most dissatisfying factors at work and within the work setting were identified as: high workload, stress associated with high workload, biased Nursing Management, lack of appreciation and monetary incentives, finally a rigid attitude of Nursing Management. However, the most satisfying factors were: working with an internationally reputable organization, patients' positive feedback and availability of required material or equipment. The study participants recommended that nursing retention could be improved at the Tertiary Care University Hospital by launching the following strategies by Nursing Management: reducing workload by adequate nurse-patient ratios according to international standards, promoting respect of nurses in front of patients and other staff, rewards and recognition of nurses, simplifying nursing documentation, increasing recreational activities for nurses and empowering nurses and Nursing Management group.
