Karttunen Markus, Sneck Sami, Jokelainen Jari, Elo Satu
Oulu University of Applied Sciences, Oulu, Finland.
Oulu University Hospital, Oulu, Finland.
Scand J Caring Sci. 2020 Mar;34(1):108-117. doi: 10.1111/scs.12712. Epub 2019 May 6.
Medication-related errors are common in elderly care. Most are detected during the preparation and administration stages of the medication process. Nursing staff have a key role in preventing errors, and it is based on adherence to guidelines.
The aim was to determine nursing staff's self-assessments of how they adherence to guidelines on safe medication preparation, administration and asepsis in the medication process in long-term elderly care and to identify factors affecting this adherence.
Cross-sectional study was conducted by total sampling at the communal long-term elderly care wards of one healthcare district in Finland in November 2016. Data were collected from nursing staff by using a previously developed web-based questionnaire. The response rate was 39.4% (n = 492).
One-third of the nurses stated that they do not always follow guidelines when preparing medication, and around a half deviate from them occasionally, when administering medication. The most serious deviation on preparation stage was crushing of sustained release and enteric-coated tablets and mixing of crushed tablets together. On administration stage, the deviation of guidelines of giving medicine in recommended time or in relation to food was common. Associations were detected between the adherence to guidelines and the nurses' experience about the adequacy of their knowledge of pharmacology and infection control, and their skill at performing medication calculations.
Deviation from guidelines often causes an error. There is a need to review the teaching of pharmacology, infection control and medication calculations during undergraduate and continuing education. In addition, nursing staff must be reminded about the ethical aspects of safe medication processes and the appropriate attitudes to these processes. Nurses must understand why it is important to follow guidelines when preparing and administering medications, in order to avoid errors.
用药相关错误在老年护理中很常见。大多数错误是在用药过程的准备和给药阶段被发现的。护理人员在预防错误方面起着关键作用，这基于对指南的遵守。
目的是确定护理人员对他们在长期老年护理用药过程中遵守安全用药准备、给药和无菌操作指南情况的自我评估，并确定影响这种遵守情况的因素。
2016年11月在芬兰一个医疗区的社区长期老年护理病房采用全样本抽样进行横断面研究。通过使用先前开发的基于网络的问卷从护理人员收集数据。回复率为39.4%（n = 492）。
三分之一的护士表示他们在准备药物时并不总是遵循指南，约一半的护士在给药时偶尔会偏离指南。准备阶段最严重的偏差是碾碎缓释片和肠溶片并将碾碎的片剂混合在一起。在给药阶段，在推荐时间或与食物相关的给药指南偏差很常见。在遵守指南与护士对药理学和感染控制知识充分性的经验以及他们进行用药计算的技能之间发现了关联。
偏离指南往往会导致错误。有必要在本科教育和继续教育期间审查药理学、感染控制和用药计算的教学。此外，必须提醒护理人员安全用药过程的伦理方面以及对这些过程的适当态度。护士必须明白在准备和给药时遵循指南为何重要，以避免错误。
