Authored by Sultan Alan
The study aims to identify knowledge levels of midwives working in
delivery rooms on drug safety practices. The Population of
the study consisted of 33 midwives who work at a delivery unit of a
public hospital in Adana. 21 midwives who willingly accepted
to participate in the study between 1-22 March 2016 formed the sample.
It was found that 42.9% of the participants stated they
do not do errors, 52.4% notify adverse effects, 33.3% notify the doctor
of the patient about their drug error, 47.6% have good
knowledge level regarding drug interactions and side effects of the
drugs, none of the participants answered two of the eight rights
of drug administration principles, namely; right drug form and right
documentation principles. A statistically significant positive
correlation was found between their working years in the delivery room
and knowledge of drug administration principles (p<0.05).
In conclusion, delivery nurses should receive in-service training on
drug administration principles and drug safety, and they should
be encouraged to report drug errors in order to improve the situation.
Health services are provided within a very complex system.
This complex system at times may result in medical errors. As a
result of these errors, morbidity may increase; injuries and even
death may be possible. The Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) defines medical error as “any
harm to a patient as a result of an improper and unethical behavior
of a healthcare professional, their negligence, and insufficiency in
occupational practices.” The errors encountered during provision
of health services may be categorized as medical practice errors,
drug administration errors, hospital infections, surgical safety,
identity check errors, falls, and transfusion errors. Drug errors
rank high among medical errors in relation to patient safety. Patient
safety includes all the precautions taken by health institutions and
their personnel in order to prevent any harm to people that may
be caused by health care services. The USA National Coordinating
Council for Medication Error Reporting and Prevention (NCC
MERP) defines drug error as; “any preventable event that may
cause or lead to inappropriate medication use or patient harm
while the medication is in the control of the healthcare professional,
patient, or consumer [1, 2]. Medical errors discussed within the
scope of patient safety are an important topic for all healthcare
professionals, but especially for midwives and nurses. Because
midwives and nurses take responsibility in the care of patients
directly, engage in drug practices and observe patients closely after
administration of drugs. Wrong practices of midwives and nurses
may endanger patients’ lives [1].
Drug practices are among important nursing roles and they
cover the prescription, distribution, administration of drugs, their
monitoring and control processes. Errors may arise at any phase
of these processes. Factors leading to errors may be listed as too
many documents, lack of standard procedures, resistance against
the application of protocols, relying on memory, long working
hours, work overload, keeping modified information and technical
errors. The studies conducted in the last 20 years underline that the
errors are more system related [1,3-5]. Nurse-Midwife related drug
errors may be listed as the wrong drug, wrong dose, wrong route, wrong time, wrong speed, wrong patient or not administering the
drug for patients at all, not registering the drug and not observing
the drug’s effect. Midwives and nurses need to administer drugs in
line with “eight rights principle” in order to prevent drug errors.
These are right drug, right patient, right dose, right route, right
time, right drug form, right documentation and right response.
Drug practices are among treatment roles that are conducted based
on doctors’ requests for midwives and nurses. In carrying out
these roles, they have responsibilities such as checking patients’
identity before administering the drug, having knowledge of the
administered drug and its effects. Moreover, drug errors must be
registered and reported. Root causes of reported errors must be
analyzed, corrective and preventive work should be carried out
for error factors and thus, repetition should be prevented [6-9].
In terms of patient safety, any drug error that harms the patient
is of great importance for the patient, healthcare professionals,
and institutions. Considering the scope of the problem and in an
attempt to guide the development of proper knowledge, skill, and
attitudes for midwives, this study was conducted with midwives
working in delivery rooms.
This descriptive study aims to identify knowledge levels of
midwives working in delivery rooms on drug safety practices.
The population of the study consisted of 33 midwives who work
at a delivery unit of a public hospital in Adana. 21 midwives
who willingly accepted to participate in the study between 1-22
March 2016 formed the sample. The data were collected via a
form that consists of a total of 28 items; 4 items on demographic
characteristics and 24 questions on drug monitoring, safe drug
practices, drug errors and error reporting. The data form was
prepared in accordance with the literature; multiple choice
questions were used for drug safety and drug errors, while an
open-ended question was used for error reporting. The data were
collected as a result of 20-minute interviews with all the midwives
in a room where privacy was ensured. The data was analyzed on
SPSS for Windows 22 program using percentile, arithmetic average,
Mann Whitney-U Test, Correlation and Chi-square tests. In all the
analysis, 0,05 was considered the biggest critical significance level.
The average age of the participants was 37.76±7.334, the
average years of experience in the unit were 5.47±6.057 and the
average years of occupational experience was 16.10±8.173. 85.7%
of the participants reported participating in a training on drug
safety (Table 1). It was found that the most common drug error for
the participants is 47.6% administer drugs at wrong time, 90.5%
of the participants access to sources related to drugs via doctors/
pharmacists, 85.7% ask if the patient has a history of food or drug
allergies before administering a drug, 38.1% return left-over and
unused drugs of inpatients to pharmacy, 95.2% store the drugs
under proper conditions and check the date of expiry.
The study indicated that 71.4% of the participants educate
patients about the administered drugs, 52.4% report adverse effects,
yet only 9.5% report the adverse effects to pharmacovigilance unit,
19% witness drug errors of their colleagues, 9.5% does not report
drug errors that they witness, 42.9% of the participants do not do
drug errors, 33.3% report drug errors to the patient’s doctor and
14.3% report drug errors (Table 2).
Regarding the administered drugs, 95.2% of the participants
had good level of knowledge of drugs’ purpose and administration
method, 71.4% of effect duration, 47.6% of side effects, 57.1%
on counter indications, 47.6% of drug interactions, 61.9% on
drug-related warnings and precautions and 66.7% on special
circumstances regarding drugs (Table 3).
It was found that none of the participants know all of the 8 rights
of drug principles, 33.3% know right drug, right dose, and right
patient principles, 38.1% know right time principle, 28.6% know
right route principle and none of the participants know right drug
form and right documentation principles (Table 4). A statistically
significant positive correlation was found between participants’
working years in the delivery room and their knowledge of drug
administration principles (p<0.05).
Table 4:Analysis of Drug Errors and Drug Error Reporting by the Participants.
There may be many reasons causing drug errors. Complex
procedures, insufficient knowledge of nurses and midwives,
inadequate number of nurses and midwives, work overload,
long working hours, lack of standard drug protocols, constantly
changing equivalent drugs may be listed among drug error factors.
The literature on drug administration errors indicates that the
most common drug error is the administration of drugs at a wrong
time [1,10-12].
In [3] study 72.6%, in [4] study 25%, in [5] study 10.6%, in [7]
study 5% and in [13] study 1.5% of the participants stated that the
most common drug error is administering the drug at a wrong time.
In our study, it was found that 47.6% of the participants named the
most common drug error as administering the drug at a wrong
time.
In their study [13] found that 24.3% of the participants know
that they should report adverse effects, 2.4% report adverse effects,
84.2% check expiry dates of the drugs. [4] found that 46.6% of the
participants know that they should report adverse effects and 33.3%
know that they should report adverse effects to pharmacovigilance
specialist, 76.6% ask patients about their drug and food allergy
histories before administering a drug, 40.0% return drugs to
pharmacy when they are not used as a result of patients’ death
or discharge or change in the treatment, 83.3% store the drugs
under proper conditions, 94.0% have good knowledge level on
administration methods of drugs. Our study indicated that 52.4% of
the participants know that they should report adverse effects, 9.5%
know they should report adverse effects to pharmacovigilance
specialist, 85.7% question food and drug allergies of patients,
38.1% return drugs to pharmacy when they are not used as a
result of patients’ death or discharge or change in the treatment,
95.2% store the drugs under proper conditions, 95.2% have good
knowledge level on administration methods of drugs. In [2] study
%93.8, in [13] study 58.7% of the participants stated they do not
make drug errors. In our study, 42.9% of the participants stated they
do not make drug errors. The study conducted by [14] indicated that
there is a negative, statistically significant correlation between the
education level of nurses and their drug errors and as the education
level increases, drug errors decrease. In our study, no statistically
significant correlation was found between the education level of
participants and drug errors. [15] study found that the healthcare
professionals who have 10 years or more occupational experience
make fewer drug errors. In our study, no statistically significant
correlation was found between occupational years and drug errors.
In their study, [16] indicated that generally drug errors
are not reported, only a small proportion; 25.0% of the drug
errors are reported. In our study, it was found that only 14.3%
of the participants report drug errors with a notification form. A
statistically significant positive correlation was found between
their professional years in the delivery room and knowledge of
drug administration principles (p<0.05). Thus, as the participants’
number of professional years in the delivery room increases, their
knowledge on drug principles increases as well. In conclusion, all
of the 8 right principles have to be followed in administering the
drugs to patients. Improving knowledge levels of midwives on
drugs within their field and forming standard protocols for drug
practices would significantly contribute to the prevention of drug
administration errors. This study indicated that the knowledge
level of midwives working in delivery rooms regarding drug safety
practices is not sufficient.
Midwives that work in delivery rooms should be encouraged
to report the errors in order to facilitate the improvement and
provision of training on side effects and monitoring of drugs.
The reporting system should be developed in order to ensure the
reporting of all the errors or other factors identified prior to the
errors. The most effective approach in preventing drug errors is
not condemnation or punishment but rather a focus on improving
knowledge, skills, and abilities. Approaches such as voluntariness,
no exposure, no punishment, encouraging self-sufficiency, learning
opportunities based on errors, updating knowledge, skills, and
abilities should be followed.
https://irispublishers.com/sjrr/fulltext/analysis-of-knowledge-attitude-and-behaviours-of-midwives-working-in-delivery-rooms-on-drug-practices-and-patient-safety.ID.000518.php
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