Nurses’ violations of a medication administration protocol in Italy: an observational study

Abstract

The most common errors in hospitals involve the medication administration process and many of these errors are committed by nurses. Errors often result from violations of standardized procedures, safety regulations, or protocols defined within a specific healthcare context for increasing patients’ safety. Usually, it is difficult to quantify and analyze violations because they often do not produce immediate consequences for patients’ safety. The aim of this research was to investigate the self-perceived and actual rate and nature of violations of a standardized medication administration protocol. For this, we conducted a study based both on systematic covert observations and self-reported measures in a sample of nurses working in different wards of two hospitals in Italy. The main results indicate that, even though the perceived level of adherence to the standardized medication administration protocol was high, the actual rate of adherence was very low. In particular, we observed that nurses are rather observant regarding items that have a clear relation to hazard, and less observant for those that have more to do with their own responsibilities than safety. Moreover, differences in nurses’ adherence to the medication administration protocol found among the different wards and the two hospitals suggest that, other than individual factors, organizational and environmental conditions also play a crucial role in the occurrence of violations. Interruptions to work activities were also observed revealing that most of them are not generated by external factors, as expected, but by violations themselves.

Identifying violations and their causes is of crucial importance to finding strategies to reduce them, and consequently to reduce errors that imperil patients’ safety.