Laura Arkin is the director of quality services at the Orlando Health Jewett Orthopedic Institute, Orlando, FL. Daleen Penoyer is the director of the Center for Nursing Research at Orlando Health, Orlando, FL. Andrea A. Schuermann is the manager of quality process improvement and patient safety at Orlando Health South Seminole Hospital, Longwood, FL. Victoria Loerzel is a professor and the Beat M. and Jill L. Kahli Endowed Professor in Oncology Nursing in the College of Nursing at the University of Central Florida, Orlando. The authors receive ongoing support through a research grant from Sigma Theta Tau International Nursing Honor Society, Theta Epsilon chapter. Contact author: Laura Arkin,
Am J Nurs. 2023 Dec 1;123(12):18-28. doi: 10.1097/01.NAJ.0000996552.02491.7d.
Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.
The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.
A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.
A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.
The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
在当今复杂的医疗环境下，护士每天都必须进行药物准备和给药等复杂任务。尽管 20 多年来一直努力减少用药错误，但众所周知，此类错误仍然普遍存在。直接护理护士的意见可能阐明存在改进机会的地方，并指导未来的改进努力。
本研究旨在探讨直接护理护士对药物安全实践和错误的看法和经验。
在一个大型医疗保健系统中，对从事直接护理工作的护士进行了定性描述性研究。使用半结构化访谈问题，通过焦点小组和一对一会议收集参与者的数据，并使用定性直接内容分析进行分析。
共有 21 名直接护理护士参与。出现了四个主要主题，这些主题影响着护士的药物安全实践和错误：护理环境、护士能力、系统影响和错误范式。这些主题通常相互关联。大多数参与者描述了混乱的环境、沉重的护理工作量以及干扰和中断，这些都增加了药物错误的风险。许多人似乎不确定什么是错误，或者可能是什么错误。
药物安全实践的复杂性使得实施改进策略变得困难。了解直接护理护士的观点和经验对于有效实施这些策略至关重要。基于研究结果，潜在的解决方案应包括积极解决安全用药实践的环境障碍，确保更强大的药物管理教育和培训（包括关于药物错误的定义和报告的重要性的指导），并在直接护理护士的参与下修订政策和程序。
