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Study: Nurses’ practice environment vital to identifying medication errors

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A research team including educators from Rutgers University College of Nursing, Newark, N.J., has published a study that reports nurses’ practice environments are an important factor in the identification of medication errors.

Medication errors, an ever-present threat to patient safety that can originate at the prescribing, transcribing, dispensing or administration stage, most likely are identifed by RNs, the study said.

Despite studies illuminating the critical role of nurses in the interception of medication errors, little is known about organizational factors that facilitate nurses’ efforts in this vital safety function. A substantial body of research indicates that characteristics of the nursing practice environment are an important organizational determinant of quality nursing care and patient outcomes, but there has been little research investigating the impact of the practice environment on nurses’ error interception practices.

The study, “Nurses’ Practice Environments, Error Interception Practices, and Inpatient Medication Errors,” was published in the June issue of the Journal of Nursing Scholarship and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. It took a close look at acute care hospitals to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses’ error interception practices and rates of nonintercepted medication errors.

The study found that nurses’ error interception practices are associated with lower rates of nonintercepted medication errors, further quantifying the important role of nurses in enhancing patient safety. Those practices include independent comparisons between the medication administration record and patient record at the beginning of a nurse’s shift; determining the rationale for each ordered medication; requesting that physicians rewrite orders when improper abbreviations are used; and ensuring that patients and families are knowledgeable regarding the medication regimen so they can question unexplained variances.

The findings add to a body of evidence indicating a supportive practice environment is associated with a higher quality of nursing care. This is reflected in factors such as teamwork between physicians and nurses; nurses’ opportunities to participate in hospital- and unit-level decisions; continuity of patient care assignments; CE opportunities; and the retention of nurse administrators who are visible and accessible, who listen to nurses’ concerns, and who have high expectations of their nurses.

The research team included Linda Flynn, RN, PhD, FAAN, professor and associate dean, Rutgers.; Yulan Liang, PhD, University of Maryland, School of Nursing, Baltimore; Geri L. Dickson, RN, PhD, consultant, New Jersey Collaborating Center for Nursing at Rutgers; Minge Xie, PhD, professor and director, Rutgers, Office of Statistical Consulting; and Dong-Churl Suh, PhD, professor, Chung-Ang University, College of Pharmacy, Seoul, South Korea.

“Nursing practices that identify and intercept medication errors not only benefit patients, they benefit a hospital’s bottom line,” said Flynn, one of the study’s principal investigators. “Healthcare administrators should carefully consider available strategies to ensure supportive work environments for nurses.”

Researchers found nurses’ interception practices have a significant effect on the rate of medication errors. More frequent engagement by nurses in interception practices was associated with fewer documented medication errors per 1,000 patient days; for example, for 100 units of interception practice for 1,000 patient days, medication errors decreased by an average of 19.

The decrease not only enhances patient safety but has fiscal implications, as well.

The study says medication errors are costly, frequently resulting in longer lengths of stay and an estimated $4 million per hospital in additional annual patient care costs.

The study was conducted in a sample of 82 med/surg units from 14 acute care hospitals in New Jersey. RNs on those units were surveyed, producing a sample of 686 staff nurses. Data collected for the eight-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. •

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