title: Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study.
abstract: OBJECTIVE
  To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals.
  
  
  METHODS
  Two NHS teaching hospitals in the North West of England.
  
  
  METHODS
  Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site.
  
  
  METHODS
  Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation.
  
  
  RESULTS
  In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors.
  
  
  CONCLUSIONS
  Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs.
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Keers
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK Pharmacy Department, University Hospital of South Manchester NHS Foundation Trust, MAHSC, Manchester, UK NHS England, Skipton House, London, UK.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Williams
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK Infectious Diseases and Immunity Section, Division of Infectious Diseases, Department of Medicine, Imperial College London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cooke
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
mesh_terms: D061605:Administration, Intravenous; D002983:Clinical Competence; D032882:Comprehension; D003299:Cooperative Behavior; D011307:Drug Prescriptions; D004739:England; D005260:Female; D006761:Hospitals; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D009726:Nurses; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D036301:Qualitative Research; D016526:Workload; D017132:Workplace
keywords: QUALITATIVE RESEARCH