title: Self-reported violations during medication administration in two paediatric hospitals.
abstract: BACKGROUND
  Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
  
  
  OBJECTIVE
  To assess the extent of violations in the medication administration process among nurses.
  
  
  METHODS
  Participants were 199 nurses from two US urban, academic, tertiary care, free-standing paediatric hospitals who worked in a paediatric intensive care unit (PICU), a haematology-oncology-transplant (HOT) unit or a medical-surgical (Med/Surg) unit. In a cross-sectional survey, nurses were asked about violations in routine or emergency situations in three steps of the medication administration process.
  
  
  METHODS
  Self-reported violations of three medication administration protocols were made using a seven-point 0-6 scale from 'not at all' to 'a great deal'.
  
  
  RESULTS
  Analysis of variance identified that violation reports were highest for emergency situations, rather than for routine operations, highest by HOT unit nurses, followed by PICU nurses and then Med/Surg unit nurses, and highest during patient identification checking, followed by matching a medication to a medication administration record, and then documenting an administration. There was also a significant three-way interaction among violation situation, step in the process, and unit.
  
  
  CONCLUSIONS
  Protocol violations occur throughout the medication administration process and their prevalence varies as a function of hospital unit, step in the process, and violation situation. Further research is required to determine whether these violations improve or worsen safety, and for those that worsen safety, how to redesign the system of administration to reduce the need to violate protocol to accomplish job tasks.
authors.affiliation: Human Factors Practice, Exponent Failure Analysis Associates, Chicago, IL USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Alper
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.forename: Neal
authors.initials: N
authors.lastname: Patel
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Kathleen
authors.initials: K
authors.lastname: Skibinski
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.forename: Ben-Tzion
authors.initials: BT
authors.lastname: Karsh
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004630:Emergencies / Q000523:psychology*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D015278:Intensive Care Units, Pediatric / Q000592:standards; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D057566:Self Report; D011795:Surveys and Questionnaires; D014481:United States; D019037:Urban Health Services