Academic journal article Journal of Nursing Scholarship

Nurses' Practice Environments, Error Interception Practices, and Inpatient Medication Errors

Academic journal article Journal of Nursing Scholarship

Nurses' Practice Environments, Error Interception Practices, and Inpatient Medication Errors

Article excerpt

Abstract

Purpose: Medication errors remain a threat to patient safety. Therefore, the purpose of this study was to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses' error interception practices, and rates of nonintercepted medication errors in acute care hospitals.

Design: This study, using a nonexperimental design, was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals. Registered nurses (RNs) on the 82 units were surveyed, producing a sample of 686 staff nurses.

Methods: Data collected for the 8-month study period included the number of medication errors per 1,000 patient days and the number of RN hours per patient day. Nurse survey data included the Practice Environment Scale of the Nursing Work Index as a measure of environmental characteristics; a metric of nurses' interception practices was developed for the study. All survey measures were aggregated to the unit level prior to analysis with hierarchical linear modeling.

Findings: A supportive practice environment was positively associated with error interception practices among nurses in the sample of medical-surgical units. Importantly, nurses' interception practices were inversely associated with medication error rates.

Conclusions: A supportive practice environment enhances nurses' error interception practices. These interception practices play a role in reducing medication errors.

Clinical Relevance: When supported by their practice environments, nurses employ practices that can assist in interrupting medication errors before they reach the patients.

Key words

Medication errors, nursing practice environment

Medication errors remain one of the leading threats to patient safety, contributing to more than 7,000 inpatient deaths per year in the United States (US). On average, a U.S. hospital patient is subjected to at least one medication error per day; making medication errors the most common cause of preventable adverse patient events (Institute of Medicine [IOM], 2006). There is, however, considerable variation in medication error rates across hospitals, indicating that organizational factors may contribute to this lapse in patient safety (IOM, 2006).

Although medication errors can originate at the prescribing, transcribing, dispensing, or administration stage, research has demonstrated that it is registered nurses (RNs) who are most likely to identify and intercept inpatient medication errors, regardless of source, before the errors reach the patient (Cullen, Bates, & Leape, 2001; Rothschild et al., 2005). Yet, despite studies illuminating the critical role of nurses in the interception of inpatient medication errors, little is known regarding organizational factors that facilitate nurses' efforts in performing this vital safety function. Although 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 (Aiken, Clarke, & Sloane, 2002; Flynn, 2007; Kutney-Lee et al., 2009), there has been little research investigating the impact of the practice environment on nurses' error interception practices. The focus of this study was to disentangle the effects of the practice environment, nurses' error interception practices, and RN staffing levels on rates of nonintercepted medication errors in acute care hospitals.

Background

According to the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP; 2005), a medication error is any preventable event that may lead to inappropriate medication use or patient harm. Included in the Council's definition of medication error are those errors that occur but are intercepted before the error reaches the patient. Reason (1990), a pioneer of error theory, focused on a systems approach to intercepting errors, explaining the need for organizations to develop layers of defenses aimed at identifying and interrupting errors before they cause injury. …

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