title: Multifactorial influences on and deviations from medication administration safety and quality in the acute medical/surgical context.
abstract: OBJECTIVE
  Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care.
  
  
  METHODS
  An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n=30). Observations focused on nurses' interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses.
  
  
  RESULTS
  Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration.
  
  
  CONCLUSIONS
  Nurses' abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error.
  
  
  CONCLUSIONS
  Nurses displayed behaviours that increased medication administration quality and safety; however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.
authors.affiliation: Deakin University, Burwood, Victoria, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Popescu
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D019985:Benchmarking; D055318:Evidence-Based Nursing; D006801:Humans; D007407:Interviews as Topic; D008510:Medication Systems, Hospital / Q000458:organization & administration / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards*; D013527:Perioperative Nursing / Q000458:organization & administration / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D017751:Safety Management / Q000458:organization & administration / Q000592:standards