护士对抗生素给药“五项权利”的遵守情况及影响其行为的因素调查：马拉维一家三级医院的混合方法案例研究

The examination of nurses' adherence to the 'five rights' of antibiotic administration and factors influencing their practices: a mixed methods case study at a tertiary hospital, Malawi.

作者信息

Mula Chimwemwe T, Solomon Vernon, Muula Adamson S

机构信息

University of Malawi, Kamuzu College of Nursing, Blantyre, Malawi.

University of KwaZulu Natal, Durban, South Africa.

出版信息

Malawi Med J. 2019 Jun;31(2):126-132. doi: 10.4314/mmj.v31i2.4.

DOI:10.4314/mmj.v31i2.4

PMID:31452845

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6698626/

Abstract

BACKGROUND

Adherence to 'Five Rights' of medication administration guidelines namely the right drug, the right patient, the right dose, the right time and the right route is the basic nursing standard and a crucial component in medication safety. Specifically for antibiotics, this helps to minimize resistance and reduce hospital costs. There is a dearth in literature on how nurses apply this standard when administering antibiotics to inpatients. This study explored nurses' adherence to the 'Five Rights' of antibiotic administration and factors influencing their practices.

METHODS

This was a cross sectional case study using prospective observation of 23 nurses and 49 patients with pneumonia and follow up interviews with 13 nurses. Participants were selected between November 2015 and February 2016. The study setting was two medical wards of a tertiary hospital. Observations were guided using a checklist to collect quantitative data. This was followed by semi-structured in-depth interviews with nurses.

RESULTS

From the quantitative data, untimely administration of antibiotics was common, with only 10.1% of patients given antibiotics at the right time. Nurses gave the right (prescribed) antibiotics in 67.3% of the patients and 59.2% of the patients received the required doses. 69.4% of the patients received the antibiotics using the right route. The right documentation of dose initiation and continuation occurred in 38.5% and 24.5% respectively. From follow up interview data, two main themes were identified: Competency gap with subthemes namely inconsistent undestanding of three/four times a day dosing schedules and knowledge translation gap; Conflict between medication administration times and ward routines.

CONCLUSIONS

We found poor compliance with the 'Five Rights' of antibiotic administration. This has been attributed to both a competency gap and challenges within the hospital system.

摘要

背景

遵循药物管理指南的“五项权利”，即正确的药物、正确的患者、正确的剂量、正确的时间和正确的给药途径，是基本的护理标准，也是药物安全的关键组成部分。特别是对于抗生素而言，这有助于将耐药性降至最低并降低医院成本。关于护士在给住院患者使用抗生素时如何应用这一标准的文献较少。本研究探讨了护士在抗生素给药方面对“五项权利”的遵循情况以及影响其操作的因素。

方法

这是一项横断面案例研究，对23名护士和49名肺炎患者进行前瞻性观察，并对13名护士进行随访访谈。研究对象于2015年11月至2016年2月期间选取。研究地点为一家三级医院的两个内科病房。观察过程使用检查表来收集定量数据。随后对护士进行半结构化深入访谈。

结果

从定量数据来看，抗生素给药不及时的情况很常见，只有10.1%的患者在正确的时间使用了抗生素。护士给67.3%的患者使用了正确（处方）的抗生素，59.2%的患者接受了所需剂量。69.4%的患者通过正确的途径接受了抗生素。剂量起始和持续的正确记录分别为38.5%和24.5%。从随访访谈数据中，确定了两个主要主题：能力差距，其亚主题包括对每日三次/四次给药时间表理解不一致和知识转化差距；给药时间与病房日常工作之间的冲突。