Predictors of unit-level medication administration accuracy: microsystem impacts on medication safety.
OBJECTIVE
This study tested multivariate models exploring unit-level predictors of medication administration (MA) accuracy.


BACKGROUND
During MA, nurses are both the last line of defense from medication-related errors and a potential perpetrator of error. Direct observation reveals safe practices and the accuracy of medication delivery.


METHODS
Using a direct-observation, cross-sectional design, data submitted by 124 adult patient care units for 15600 medication doses, from January 2009 to April 2010, were studied.


RESULTS
Distractions and interruptions were the most common safe practice deviation. Characteristics of patient care units and RN hours of care affected nurses' safe practices and MA accuracy. Safe practices predict and mediate MA accuracy. A 5% decrease in safe practice deviations would reduce MA errors by 46% without any change in RN hours of care.


CONCLUSIONS
Nurses' adherence to MA safe practices, combined with unit characteristics and staffing factors, has the potential to dramatically improve MA accuracy.
Author Affiliations: Senior Scientist, Collaborative Alliance for Nursing Outcomes (CALNOC) and Clinical Professor, UCSF School of Nursing (Dr Donaldson), San Francisco; and Research Scientist IV, Cedars-Sinai Medical Center and Burns & Allen Research Institute, and CALNOC Data Management Services Director and Coinvestigator (Dr Aydin); Director, AMF Consulting, Inc, CALNOC Statistician (Dr Fridman), Los Angeles, California.
Nancy
N
Donaldson
Carolyn
C
Aydin
Moshe
M
Fridman
D000328:Adult; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D061214:Patient Safety; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D017751:Safety Management / Q000379:methods*; D016526:Workload