Nurses' self-assessments of adherence to guidelines on safe medication preparation and administration in long-term elderly care

Abstract

Background: Medication-related errors are common in elderly care. Most are detected during the preparation and administration stages of the medication process. Nursing staff have a key role in preventing errors, and it is based on adherence to guidelines.

Aim: The aim was to determine nursing staff's self-assessments of how they adherence to guidelines on safe medication preparation, administration and asepsis in the medication process in long-term elderly care and to identify factors affecting this adherence.

Method: Cross-sectional study was conducted by total sampling at the communal long-term elderly care wards of one healthcare district in Finland in November 2016. Data were collected from nursing staff by using a previously developed web-based questionnaire. The response rate was 39.4% (n = 492).

Results: One-third of the nurses stated that they do not always follow guidelines when preparing medication, and around a half deviate from them occasionally, when administering medication. The most serious deviation on preparation stage was crushing of sustained release and enteric-coated tablets and mixing of crushed tablets together. On administration stage, the deviation of guidelines of giving medicine in recommended time or in relation to food was common. Associations were detected between the adherence to guidelines and the nurses' experience about the adequacy of their knowledge of pharmacology and infection control, and their skill at performing medication calculations.

Conclusion: Deviation from guidelines often causes an error. There is a need to review the teaching of pharmacology, infection control and medication calculations during undergraduate and continuing education. In addition, nursing staff must be reminded about the ethical aspects of safe medication processes and the appropriate attitudes to these processes. Nurses must understand why it is important to follow guidelines when preparing and administering medications, in order to avoid errors.

Keywords: elderly care; medication management; nursing home care.