A multi-disciplinary approach to medication safety and the implication for nursing education and practice.
BACKGROUND
Medication management is a complex multi-stage and multi-disciplinary process, involving doctors, pharmacists, nurses and patients. Errors can occur at any stage from prescribing, dispensing and administering, to recording and reporting. There are a number of safety mechanisms built into the medication management system and it is recognised that nurses are the final stage of defence. However, medication error still remains a major challenge to patient safety globally.


OBJECTIVE
This paper aims to illustrate two main aspects of medication safety practices that have been elicited from an action research study in a Scottish Health Board and three local Higher Education Institutions: firstly current medication safety practices in two clinical settings; and secondly pre and post-registration nursing education and teaching on medication safety.


METHODS
This paper is based on Phase One and Two of an Action Research project. An ethnography-style observational method, influenced by an Appreciative Inquiry (AI) approach was adapted to study the everyday medication management systems and practices of two hospital wards. This was supplemented by seven in-depth interviews with nursing staff, numerous informal discussions with healthcare professionals, two focus-groups, one peer-interview and two in-depth individual interviews with final year nursing students from three Higher Education Institutions in Scotland.


RESULTS
This paper highlights the current positive practical efforts in medication safety practices in the chosen clinical areas. Nursing staff do employ the traditional 'five right' principles - right patient, right medication, right dose, right route and right time - for safe administration. Nursing students are taught these principles in their pre-registration nursing education. However, there are some other challenges remaining: these include the establishment of a complete medication history (reconciliation) when patients come to hospital, the provision of an in-depth training in pharmacological knowledge to junior nursing staff and pre-registration nursing students.


CONCLUSIONS
This paper argues that the 'five rights' principle during medication administration is not enough for holistic medication safety and explains two reasons why there is a need for strengthened multi-disciplinary team-work to achieve greater patient safety. To accomplish this, nurses need to have sufficient knowledge of pharmacology and medication safety issues. These findings have important educational implications and point to the requirement for the incorporation of medication management and pharmacology in to the teaching curriculum for nursing students. There is also a call for continuing professional development opportunities for nurses working in clinical settings.
School of Health in Social Science, University of Edinburgh, Doorway 6, Teviot Place, EH8 9AG, UK. Electronic address: radhika2@staffmail.ed.ac.uk.
Radha
R
Adhikari
School of Health in Social Science, University of Edinburgh, Doorway 6, Teviot Place, EH8 9AG, UK. Electronic address: Jennifer.Tocher@ed.ac.uk.
Jennifer
J
Tocher
School of Health in Social Science, University of Edinburgh, Doorway 6, Teviot Place, EH8 9AG, UK. Electronic address: pam.smith@ed.ac.uk.
Pam
P
Smith
NHS Comely Bank Centre13 Crewe Road South,EdinburghEH4 2LD, UK. Electronic address: Janet.Corcoran@nhslothian.scot.nhs.uk.
Janet
J
Corcoran
Western General Hospital, Crewe Road, Edinburgh,EH4 2XU, UK. Electronic address: Juliet.macarthur@luht.scot.nhs.uk.
Juliet
J
MacArthur
D001291:Attitude of Health Personnel; D004506:Education, Nursing / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D008508:Medication Errors / Q000451:nursing* / Q000517:prevention & control; D059065:Medication Reconciliation; D008509:Medication Systems; D009741:Nursing Staff, Hospital / Q000193:education; D061214:Patient Safety; D010601:Pharmacology, Clinical / Q000193:education; D012606:Scotland
Medication management; Medication reconciliation; Medication safety; Patient safety