Critical Appraisal of Nurses' Perspectives and Experiences on Medication Safety Practices

This paper is a critical appraisal of the article - Smeulers, M., Onderwater, A. T., Zwieten, M. C., & Vermeulen, H. (2014). Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study. The study aimed to investigate on nurses’ perspectives and experiences in eliminating medication administration errors. The research was conducted at a tertiary care university hospital situated in Netherlands. A qualitative interview was conducted among twenty nurses between the months of March and December 2011. From the analysis, three major themes were evident: Ability of nurses to work safely, nurses roles, and responsibilities and acceptance of nurses to comply with safety practices.

Running head: CRITICAL APPRAISAL 1
Critical Appraisal
Name
Institutional Affiliation

CRITICAL APPRAISAL
2
Introduction
Nurses are charged with the responsibility of administering medication and prescribed
drugs to patients. Medication error is defined as any event that can be prevented and is likely to
cause harm to patients or consumers (Keers, Williams, Cooke & Ashcroft, 2015). In the process
of drug administration, many errors are likely to occur depending on many factors, some of
which will be discussed in this study. Medication errors result into health care expenses and cost
the lives of patients. Approximately 20 percent of medication errors arise from medication
administration and during medication prescription by nurses (Schnock et al., 2016).
This paper is a critical appraisal of the article - Smeulers, M., Onderwater, A. T.,
Zwieten, M. C., & Vermeulen, H. (2014). Nurses' experiences and perspectives on medication
safety practices: an explorative qualitative study. Journal of nursing management, 22(3), 276-
285. In order to solve these errors, there was need to carry out a study on the possible causes of
medication administration errors and the best solutions to the problem. To implement safety
practices by nurses, it is important to study how they perceive medication administration errors
(Berdot et al., 2016). This study was carried out in a health care of a college institution that had
twenty nurses who had different views on health safety and possible solutions to medication
administration errors. Medication errors can be prevented when preventive measures are taken
(van der Veen et al., 2017).
Research Problem
Medication errors occur to any person and at any given place; it could be at home, health
facility, doctor’s office, or even the senior hospitals. Children are at a higher risk of medication
errors since they require a variety of drug doses than adults. The most common cause of

CRITICAL APPRAISAL
3
medication administration errors is poor communication. It could be poor communication
between doctors and patient or nurses and doctors. Drug names that sound alike may also result
into MAEs (Ohashi, Dalleur, Dykes & Bates, 2014). Many attempts have been used to prevent
medication administration errors but most of them have failed. Knowledge is the best defense to
solve medication errors. This will help improve accuracy.
Bar-coded administration for many years was believed to be the most effective way of
preventing medication administration errors, but it was later realized that it had some faults. It
could not be used in cases where one lacked limbs to be used for entry of information.
Furthermore, in cases of power blackout or low battery, the bar code machine would be
inefficient (van der Veen et al., 2017). Some of the risk factors that are because of medication
administration errors include unexpected harm especially when the correct process of
administering a drug was used but the drug is a wrong one. Allergic reactions may occur to a
patient who is using medication for the first time (Parand, Garfield, Vincent & Franklin, 2016).
It was therefore necessary to carry out a study that would device the best way to curb
medication administration errors since the devised methods yielded minimal results. The main
aim of this study is to investigate on nurses’ perspectives and experiences in eliminating
medication administration errors (Raban & Westbrook, 2014).
Research Design and Methodology
A qualitative interview was conducted among twenty nurses between the months of
March and December 2011 (Smeulers, Onderwater, Zwieten & Vermeulen, 2014). The research
was conducted at a tertiary care university hospital situated in Netherlands (Smeulers,
Onderwater, Zwieten & Vermeulen, 2014). Each ward contains 30 beds and each nurse is

CRITICAL APPRAISAL
4
designated patients whom they prescribe and administer medication. Nurses record and
document the prescriptions and administrations of each patient on paper. Clinicians prescribed
medication through an electronic prescribing system (Bogner, 2018).
Those who participated in the study involved qualified nurses. To obtain varied ideas,
nurses from different levels of seniority and different departments were selected. Nursing ward
managers and nursing managers were reached through email requesting them to take part in a
study that aims to improve medication safety (Kelly, Harrington, Matos, Turner & Johnson,
2016). Stratified sampling was then used o obtain names of other nurses who would take part in
the study. These nurses represented different departments and training seniority. They also had
to have varying attitude on medication safety. All participants were requested via email and text
messages to take part in the research (Nanji, Patel, Shaikh, Seger & Bates, 2016).
Individual interviews were done to all the twenty nurses. Each interview lasted between
30 to 60 minutes. The interview was semi structured and this gave the interviewees a chance to
speak openly with the guidance of two of the researchers (Smuelers et al., 2014). The topic was
divided into different sections after collection and analysis of data from around 10 interviewers.
The participants were advised to reflect upon the topic towards the end of the study. Participants
were informed that the aim of the study was to obtain their perspectives and experiences on
eradication of medication errors. With the consent of interviewees, the interview sessions were
recorded for analysis (Smuelers et al., 2014).
Data analysis and interview process were done in parallel. Guidelines of qualitative
research were used for data analysis with the help of software. Each interview was coded and
the codes compared until uniform results were reached. Consensus meetings were also held to

CRITICAL APPRAISAL
5
reach uniform results from the interview. Themes related to preventive measures of MAEs were
identified during data analysis (Van Cott, 2018).
Research Findings and Results
From the analysis, three major themes were evident: Ability of nurses to work safely,
nurses roles, and responsibilities and acceptance of nurses to comply with safety practices. Some
of the possible ways to curb medication administration errors were derived from the study
(Smuelers, 2014).
Nurse ability to work
Ability of nurse to work with minimal medication errors depends on risk awareness,
circumstance, and environment in which the nurses work. Knowledge of consequences of
medication errors equips nurses with awareness of possible risks of MAEs (Nuckols et al., 2014).
Delayed administration of medication or even failure to administer medication is seen as a
problem that is dangerous to specific medications. When nurses perform a medication error,
awareness should be made and this would lead to special attention to the particular error and
nurses become more cautious. This should be practiced in cases were a particular error is
reported often (Keers, Williams, Cooke & Ashcroft, 2015).
Environment in which nurses work also affects medication safety. Nurse’s workload in
the hospitals makes them have pressure and is likely to get loose focus and administer wrong
medication. Because of this, more nurses should be trained and employed. Short vacations and
retreats would help nurses regain their concentration (Durham, Suhayda, Normand, Jankiewicz,
& Fogg, 2016).

CRITICAL APPRAISAL
6
Nurse’s acceptance of safety practices
Nurses ought to admit when they perform a medication error and report the matter
immediately; this would help rectify the error before it gets worse. They should also accept to
perform practices that promote medication safety. Nurses should use all their senses and be alert
when handling patients (Raban & Westbrook, 2014).
Conclusion
Medication administration errors are harmful to patients and consumers; there was
therefore a need for this study to be conducted. Nurses play a major role in radiating eradication
administration errors. When the nurses are aware of the effects of these errors, they will be
keener. When nurses are burdened with work, they are prone to performing errors due to fatigue,
this problem can be solved by ensuring work is evenly distributed among workers, more nurses
employed and retreats set aside for the sake of refreshing nurses minds. Nurses should also
agree to take precautions as they perform their duties and report any error caused immediately
for quick actions. To ensure medication administration errors are reduced, nurses should adhere
to the above safety practices.

CRITICAL APPRAISAL
7
References
Berdot, S., Roudot, M., Schramm, C., Katsahian, S., Durieux, P., & Sabatier, B. (2016).
Interventions to reduce nurses’ medication administration errors in inpatient settings: A
systematic review and meta-analysis. International journal of nursing studies, 53, 342-
350.
Bogner, M. S. (2018). Human error in medicine. CRC Press.
Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L. (2016). Reducing
medication administration errors in acute and critical care: multifaceted pilot program
targeting RN awareness and behaviors. Journal of Nursing Administration, 46(2), 75-81.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2015). Understanding the causes of
intravenous medication administration errors in hospitals: a qualitative critical incident
study. BMJ open, 5(3), e005948.
Kelly, K., Harrington, L., Matos, P., Turner, B., & Johnson, C. (2016). Creating a culture of
safety around bar-code medication administration: an evidence-based evaluation
framework. Journal of Nursing Administration, 46(1), 30-37.
Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of
perioperative medication errors and adverse drug events. Anesthesiology: The Journal of
the American Society of Anesthesiologists, 124(1), 25-34.
Nuckols, T. K., Smith-Spangler, C., Morton, S. C., Asch, S. M., Patel, V. M., Anderson, L. J., ...
& Shekelle, P. G. (2014). The effectiveness of computerized order entry at reducing

CRITICAL APPRAISAL
8
preventable adverse drug events and medication errors in hospital settings: a systematic
review and meta-analysis. Systematic reviews, 3(1), 56.
Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart
pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-
1020.
Parand, A., Garfield, S., Vincent, C., & Franklin, B. D. (2016). Carers' medication administration
errors in the domiciliary setting: a systematic review. PloS one, 11(12), e0167204.
Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors
during medication administration effective?: a systematic review. BMJ Qual Saf, 23(5),
414-421.
Smeulers, M., Onderwater, A. T., Zwieten, M. C., &Vermeulen, H. (2014). Nurses' experiences
and perspectives on medication safety practices: an explorative qualitative study.
Journal of nursing management, 22(3), 276-285.
Schnock, K. O., Dykes, P. C., Albert, J., Ariosto, D., Call, R., Cameron, C., ... & Husch, M. M.
(2016). The frequency of intravenous medication administration errors related to smart
infusion pumps: a multihospital observational study. BMJ Qual Saf, bmjqs-2015.
Van Cott, H. (2018). Human errors: Their causes and reduction. In Human error in medicine (pp.
53-65). CRC Press.
van der Veen, W., van den Bemt, P. M., Wouters, H., Bates, D. W., Twisk, J. W., de Gier, J.
J., ... & Ros, J. J. (2017). Association between workarounds and medication

CRITICAL APPRAISAL
9
administration errors in bar-code-assisted medication administration in
hospitals. Journal of the American Medical Informatics Association, 25(4), 385-392.