Evaluation of contextual influences on the medication administration practice of paediatric nurses.
OBJECTIVE
This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice.


BACKGROUND
Medication administration is a complex aspect of paediatric nursing and an important component of day-to-day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance.


METHODS
A cross-sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%.


RESULTS
Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0.001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0.001), including choosing between following policy and acting in the best interests of the child (P = 0.002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0.01). Less experienced nurses reported greater confidence with computer literacy (P < 0.001).


CONCLUSIONS
Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.
School of Nursing, Queensland University of Technology, Brisbane, Australia.
Leigh
L
Davis
Robert
R
Ware
Damhnat
D
McCann
Samantha
S
Keogh
Karen
K
Watson
D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D002648:Child; D003197:Computer Literacy; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010371:Pediatric Nursing / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D013997:Time Factors
D004364:Pharmaceutical Preparations