Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
Faculty of Health Studies, University of Stavanger, Stavanger, Norway.
J Clin Nurs. 2018 Mar;27(5-6):1113-1124. doi: 10.1111/jocn.14138. Epub 2018 Jan 8.
To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized?
Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety.
A qualitative observational study design was applied.
Data were collected using partial participant observations. An inductive content analysis was performed.
Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes.
A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach.
Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.
深入了解养老院中给药和中断的特点。本研究的以下研究问题为指导：如何描述养老院的给药过程？如何描述养老院给药过程中的中断？
给药是医疗保健环境中的一个重要过程，而早期在养老院中的研究则很少。给药过程容易受到中断的影响，这可能导致药物不良事件。另一方面，中断也可能对患者安全产生积极影响。
采用定性观察研究设计。
使用部分参与者观察收集数据。进行了归纳内容分析。
导致养老院给药观察到的复杂性的因素包括：单一任务数量多、线性程度不同、技术解决方案的可变性、对文档的要求以及员工在执行与药物相关活动时的明显自由。给药过程中的中断很常见，可以被描述为被动（例如，警报和背景噪音）、主动（例如，讨论）或技术中断（例如，使用移动应用程序）。大多数中断都有负面结果，而有些则有积极结果。
一种规范化的过程已经发生，即在执行与药物相关的任务时，工作人员忍受着二流的技术解决方案、噪音和中断。在寻求最小化给药过程中的中断之前，重要的是要理解使用系统方法的元素的相互关联性。
工作人员和管理层需要意识到中断的常态化。对给药复杂性的了解可能会提高认识，并强调保持和提高员工能力的重要性。
