Human Factors focus on the interaction of the elements in the sociotechnical work system and how people perform processes in this system (Carayon et al., 2006). If you have the evening shift alongside a nurse, they have a higher workload, because a majority of the activity on this ward demands a nurse, because of competence and such. 45389) approved the study. In a fast-paced healthcare environment, administering medications is a high-risk nursing task. This may be exemplified by the RN who in a potential situation would consider using the mobile phone to message an image to a colleague rather than asking the manager to double‐check a medication to be a reasonable solution. There were eight staff nurses, three nurse assistants, two nurse managers and two doctors. We continuously receive new guidelines relating to medications, with new demands on documentation. Medication administration is ingrained in normal clinical activities, and isolated work processes may be challenging to define. There are three nurses in the nurse station, allocating tasks at the start of the morning shift. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispe… The interviews were digitally recorded and lasted from 30 min ‐ 1 hr. Over time, this behaviour may evolve to be a part of normal operations, stretching the boundaries of safe medication administration. It may lead to increased freedom and flexibility when performing tasks, but may also lead to less structure, less use of guidelines, checks and regulations. Shortly after, the first author briefed the entire staff on both wards during regular staff meetings and asked whether they would consider participating in interviews. According to WHO (2016), MAE’s are preventable at different levels. Many factors influence safe medication management. Data collection was performed by a single researcher with a nursing background, which may introduce bias. Not all staff members can set up an intravenous line or administer all type of medicines. Medication Administration in Nursing Homes. This guidance sets out good practice measures for the safe management and handling of medicines in care homes (with nursing) for older people by care assistants. Staff shortage, lack of competence and scarce resources may impede the staff’s ability to be adaptive and find workarounds (Hollnagel, 2009). The medication administration process is not to be taken lightly. NURSING HOME SAMPLE POLICY & METHODS Drug Administration POLICY: All medications are to be administered only as prescribed and only by licensed medical or nursing personnel. Medication administration in nursing homes is a complex process taking place in a complex system with inherent vulnerabilities, placing high demands on the sociotechnical work system and the staff (Carayon et al., 2014; Choo et al., 2010; Grigg et al., 2011; Odberg et al., 2017). Medication errors may occur during any phase of the medication process: prescribing, transcribing, dispensing, administering, monitoring, and reporting. However, the declining number of RNs in nursing homes requires RNs to delegate some aspects of medication administration to other nursing staff members, including unlicensed assistive person-nel (UAP). All participants gave their informed consent and were informed of data confidentiality and of the opportunity to withdraw at any time. People who provide care in care homes, including care home staff (including nurses employed by the home), GPs, community nursing teams and specialist nurses The first author, dressed in work attire, followed staff members around conducting partly participating observations during medication administration‐related tasks (Hammersley & Atkinson, 2007). The first author is a male registered intensive care nurse with no prior familiarity with or knowledge of any of the wards or the participants in the study. The opposite happens if there are many substitute nurses; the continuity of care may be disrupted and a proportionally higher fraction of the total workload is taken on by the regular staff members. They must undergo 50 hours of training and then engage in administering medication under the supervision of a nurse (Iowa Code § 135C.34). A QUAL–qual mixed study design was applied. CONCLUSIONS: In order to improve safe medication management by tailored interventions in nursing homes, through the use of a standard questionnaire, nurses and nurse assistants can give an overview of … An example of analysis is shown in Table 1. This flexibility depended on the capabilities of the workgroup on a specific shift, as well as their training and competence. The most striking finding is how the nurse in charge is left to compensate for the degree of skills and competencies of their team members. When aiming to describe the nurse role in medication administration, three main categories emerged: compensating, flexible and adaptable. Computerised clinical decision support systems to improve medication safety in long‐term care homes: A systematic review, Patient safety in primary health care: A systematic review, An update: Application of human factors concepts in the healthcare industry, Mixed method design: Principles and procedures, Clinical review: Medication errors in critical care, Standards for reporting qualitative research: A synthesis of recommendations, Medication administration and interruptions in nursing homes: A qualitative observational study, Resilience in everyday operations: A framework for analyzing adaptations in high‐risk work, Improving patient safety through teamwork and team training, Safe medication management: Evaluation and development of medication competence in registered nurses, Nurses' experiences and perspectives on medication safety practices: An explorative qualitative study. The data collection took place in 2016, consisting of 140 hr of observations supplemented by 16 semi‐structured interviews of staff members. If there are NA’s present, they are most often engaged in clinical work, close to the patient, reporting verbally to the nurse on the team. and you may need to create a new Wiley Online Library account. Some argue that nurses (RN) may have insufficient knowledge and skills to perform safe medication management (Andersson, Frank, Willman, Sandman, & Hansebo, 2018; Simonsen, 2016); others point to normalization of risk‐inducing behaviour and interruptions (Odberg et al., 2017), or use of technology, design flaws, time constraints, poor communication, lack of leadership, as well as outdated policies and guidelines (Al‐Jumaili & Doucette, 2017; Carayon et al., 2014; Keers, Williams, Cooke, & Ashcroft, 2013; Lapkin, Levett‐Jones, Chenoweth, & Johnson, 2016; Marasinghe, 2015). If a nurse spots a weakness in a colleague or does not trust him or her to do a specific task, they do it themselves instead. Work system factors such as competence, leadership and staffing may influence the ability to perform safe medication administration. You do more of the same, but you have more responsibility and more tasks as a nurse. Learn more. Findings in the current study document this complexity and elaborate on how the staff and particularly the RN’s adjust to shifting circumstances in their work environment. Like other health care facilities, nursing homes can be hotspots for medical mistakes. People who reside in nursing homes are in vulnerable positions. Individual characteristics of the staff, therefore, vary significantly from shift to shift, having a impact on performance variability and degrading the ability to prepare for unexpected conditions. I started out as an NA, which I appreciate. Right medication. This discrepancy underlines the importance of communication across levels and management capable of addressing the needs of the staff (Backman, Sjögren, Lövheim, & Edvardsson, 2017; Hollnagel, 2012). In the current study, the nurse managers of both nursing homes “imagined” how the wards should be run (WAI), something that not always translated to how it was actually done (WAD). It is hard to identify who is the leader, but after a while, the nurse with seniority becomes the centre of attention and makes final decisions on which patients they will have responsibility for. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. The Norwegian Social Science Data Service (NSD; No. Evening shifts, night shifts and weekends were often reported as vulnerable depending on workload and status of the current patients. Examples are, observations of pre‐visitation, transcribing medicines or staff preparing medicines before administering them. The current study identified six areas (subcategories) necessitating adaptive behaviour to ensure safe medication administration. At the same time, all staff members acknowledge that complex healthcare environments and nursing sciences are in constant flux due to advances both medically and procedurally. As a consequence, the staff may be balancing precariously close to unsafe medication administration in their daily routines without knowing. Furthermore, the training and skill maintenance in medication administration‐related tasks are to some degree random in that it is voluntary to participate. In nursing homes, medication errors are one of the most common types of mistakes made by staff members. The nurse also compensates for the other team members’ strengths and weaknesses. Some nurses thrive on this, making them feel competent and taking the role as leaders. Excerpt from observational notes: The MD generally accepts this as normal routine provided the RN’s are able to substantiate the drug alterations. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Flexibility mirrors the freedom staff members experience in structuring their workday and performing medication‐related activities. The nurses have a fuller picture encompassing all six stages of the medication administration process, and they also consider it a much more complex process as documented in the following interview excerpts with a nurse: The NA’s see themselves in the light of the nurses and perceive their duty to assist the nurses. The paper was prepared according to SRQR guidelines (O’Brien, Harris, Beckman, Reed, & Cook, 2014). Figure 1 illustrates the balancing act of safe medication administration documented in the study. State regulation § 2600.190(a) requires that in order for a non-medically licensed, certified, or registered staff person to administer certain medications, the staff person must complete a Department-approved medication administration training course within the past two years. Many residents need frequent or constant personal or nursing … Staff stability and shared mental models are often recognized as a key factor to ensure safe care in healthcare environments (Salas & Frush, 2013). … However, they are trained in-house to handle medication in general and the robot packages in specific. 1. (717) 697-3223 info@KeystoneElderLaw.com Facebook The objective of this study was to expand the knowledge of the nurse role during medication administration in the context of nursing homes. Medication administration in nursing homes is a complex process taking place in a complex system with inherent vulnerabilities, placing high demands on the sociotechnical work system and the staff (Carayon et al., 2014; Choo et al., 2010; Grigg et al., 2011; Odberg et al., 2017). In short, adaptability is about how the staff adapt to changing workloads during the various shifts and how they perceive the relationship with their co‐workers as a critical factor in collaborating and performing medication administration safely. The leadership and style of management seem to affect how the staff perform and delegate tasks. Such high workloads may have positive professional outcomes, as the staff claim to work more smoothly. Iowa allows medication aides in nursing homes, but requires them to be certified nurses ' aides first. An inductive content analysis was performed. The skills and competencies available on a particular shift result from the managers’ pre‐planning but get randomized as circumstances change; staff may become ill, forcing changes. A pilot study was conducted in a nursing home ward providing a similar contextual setting as the current study to test the data collection methods. Human Factors theory often uses the analogues “blunt end” and “sharp end” to encapsulate much of the same meaning (Rankin et al., 2014; Reason, 2000). At other times, only one person, usually a nurse, has the necessary skills to perform specific activities vital to a patient. Most often, they have a sheet of paper with pre‐authorization from the doctor on various drugs. Changing circumstances meant that the staff had to improvise and prioritize. The study applied a qual‐qual mixed method design (Morse, 2016) using partly participant observations (Hammersley & Atkinson, 2007) supplemented by semi‐structured interviews for data collection. However, the basic principles of active treatment and ensuring the basic needs of the residents are universal (Malmedal, 2014). To counter this, nurses exhibit role compensation and flexibility and are highly adaptable during all the stages of administering medicines. It gave me a lot of the basic skills necessary, but of course, there is a lot more responsibility as a nurse. Punch card medication carts, unit dose medication carts on wheels & auto-packaging carts for nursing homes, hospitals, long-term care & assisted living. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Everything has consequences if we are not thorough in following up. If they considered the doctor to be “weak,” they compensated by taking on tasks that were not theirs initially. Examples in the current study indicate that even though managers endeavour to structure the workday of the staff, they simultaneously encourage flexible behaviour without giving clear indications of where this delineation ought to be. Assigning the task of medication administration to the CMA allows for the nursing staff … Long-term care nurses care for patients in need of extended care, including geriatric, wound care, chronic diseases and disabilities. If you do not receive an email within 10 minutes, your email address may not be registered, Regulations governing pharmacy practice in nursing facilities have evolved over time to ensure that the special needs of nursing facility residents are met. I would have done something like that if the situation demanded it. This invisible role designation led to a hierarchical structure, especially evident on shifts with a single nurse. If we have a nurse on that shift, she will have the final say. Having good personal chemistry with colleagues was necessary for the staff to thrive. The flexibility of task assignment is therefore dependent on the skills and competencies needed in the various tasks related to medication administration. Each of these main categories contains subcategories describing different aspects of the nurse role and the collaboration needed to perform medication administration. Varying workload, staff stability, the degree of leadership, available competence and dynamic events in the workday are compensated by the RN’s to ensure fulfilment of all tasks related to medication administration at all times. Due to the complexity of medication administration, the acknowledgement of MAE’s in primary care and the essential role of the RN, the objective of this study was to expand knowledge of the nurse role during medication administration in the context of nursing homes. 2. The following research question guided the study: How can the nurse role during medication administration in nursing homes be described? COVID-19 - Medication Administration Classes All in-person Regional Office Medication Administration classes have been canceled until further notice. When the staff know each other, they are less vulnerable if something unpredictable happens. Working off-campus? Specific requirements must be followed to avoid, insofar as possible, medication pouring and medication administration errors. DAAs are used to organize oral medications according to the day of the week and time of day that they must be taken [ 9 ]. Check the order. Findings in the current study document this complexity and elaborate on how the staff and particularly the RN’s … The main category “adaptable” contains two related categories: Staff stability and Vulnerable shifts. Skilled nursing facilities in the United States have often been criticized for providing inadequate nurse staffing levels leading to lower quality of care. care home staff administering medicines (including covert administration) and non-prescription products; training and competency of care home staff; Who is it for? He does not take hasty or quick decisions and may sow doubt by the way he acts. Consequently, the staff members may have different skill sets and competencies. Please check your email for instructions on resetting your password. There is an apparent lack of studies investigating the nurse role during medication administration in nursing homes. Under high workload, administrative tasks related to medication administration took precedence for the RN’s, thus delegating the remaining workload to the other staff members. Workarounds and adaptations are often described as “filling in the gaps” to cover for design flaws or internal or external pressure and complexity (Rankin, Lundberg, Woltjer, Rollenhagen, & Hollnagel, 2014). It is highly structured and regulated by standards of nursing practice. This has led to more responsibility and a need for updated competence. A complete and accurate medication list is the foundation for addressing medication reconciliation and medication management issues. An important finding was how the leadership was distributed and invisible, leading to flexibility when delegating tasks and responsibilities. Without it, medication administration may spiral into an unregulated activity, having both positive and negative effects—the positive effects being apparently increased resilience when facing unexpected events, the negative effects being the erasing of borders between safe and unsafe acts. A clear leader with a hands‐on approach may impose more direct control and strictures in relation to the myriad of regulations and guidelines on medication administration, while a more distant leader lets the staff regulate more independently. Overall research acknowledges the importance of the nurse role in maintaining and improving medication safety in health care (Choo et al., 2010; Grigg et al., 2011; Kowalski & Anthony, 2017; Smeulers et al., 2014). They describe it as working in silent agreement. METHODS: 1. Assessing, improving, and implementing quality nursing home resident care is an ongoing effort for many professionals in the industry. 2. Check the name on the order and the patient. Nursing homes experience increased pressure to receive more patients needing more complex active medical treatment, compared with a few years back (Syse & Gautun, 2013). What are nursing homes not allowed to do? They were informed of the objective and content of the study and agreed to participate. The seeming resilience nurses exhibit, may be brittleness, extending the boundaries of day‐to‐day clinical activities close to the borders of safe medication administration. A stable staff also know the patients and can work more efficiently and may provide better care. There is seldom a right or wrong, but the nurses have to substantiate their opinions or when they make alterations. In order to maintain effective operations, the nurses were flexible and had a shifting responsibility. Nursing facility residents have special care needs that in many cases require more intensive medication management and alternative forms of medication administration. The team on a specific shift have a shared world of experience and skill where the staff works. At other times, the nurses make changes or adjustments themselves, based on observations and patient needs and inform the doctor on a later occasion. ôöşpQ £ùÑ$TıÂÜæé±n¹?ßûªj²Ky²Ë•ŸıøÛpkV"ÎYvSæhÎãm}1D`U>âO€ Betc endstream endobj 32 0 obj <> endobj 33 0 obj <>stream The nurse is responsible for determining the degree to which an individual is self-directive. Performance variability in a system should aim to be proportional to the system complexity, meaning that the staff of the nursing homes should have appropriate skills, resources and flexibility at hand to meet any unforeseen events (Braithwaite, Wears, & Hollnagel, 2016; Grigg et al., 2011). Although most residents are elderly, many are younger. The elderly and permanently disabled may reside in these facilities. The nurse role is compensating, flexible and adaptable. Use the link below to share a full-text version of this article with your friends and colleagues. The vulnerable shifts are to some degree predictable, but still pose challenges to the staff. Consequently, they consider the nurses to be their superior in all settings, referring to them if questions or problems arise. Participants working more than a 50% position for more than a year were interviewed. This is the term used when describing the process of dispensing medication to nursing facility residents according to … Available skills and competencies on a given shift are demarcated partly by the professions in the team. At the same time, we need to keep tabs on everything; it always comes down to the economy, who pays for what. The main findings indicate that the RN has a central role at all the stages of medication administration and that this role goes beyond the job description. The Administration of Medication in the Nursing Home In most nursing facilities, the medication is given when the nursing staff member completes what is known as a “med pass”. Consequently, some shifts end up being vulnerable. Drug administration is the act in which a single dose of an identified drug is given to a patient. No data from the pilot study were used in the current study. In contrast, CNAs provide a majority of the day-to-day direct resident care. The staff may perceive this as distant management and thus use considerable internal resources to structure their workday. The researcher encountered no such situations. Symbicort or other inhaled steroid combo is given with patients having respiratory issues with Covid-19. By law, an “advanced unlicensed assistive person” who has completed a certified training program can assist licensed nurses as permitted by … The researcher was aware of the potential Hawthorne effect throughout the observations. Nurse managers had indirect control of staff allocation and task delegation in that the staff often made their own decisions and planned contrary to prior assignments. Fundamentals of Nursing, Medication Administration, College of Southern Maryland. The main categories in the current study describe role compensation, flexibility and adaptability as crucial when describing the nurse role in medication administration. Use 2 identifiers. 3. Rights of Medication Administration. Number of times cited according to CrossRef: A work system analysis of the medication administration process in a Norwegian nursing home ward, https://doi.org/10.1016/j.jamda.2016.12.069, https://doi.org/10.1136/bmjqs-2013-001828, https://doi.org/10.1111/j.1365-2834.2010.01164.x, https://doi.org/10.1111/j.1365-2648.2007.04569.x, https://doi.org/10.1016/j.ergon.2011.01.014, https://doi.org/10.1007/s40264-013-0090-2, https://doi.org/10.1097/01.NAJ.0000512274.79629.3c, https://doi.org/10.1186/s12913-017-2556-x, https://doi.org/10.1136/bmjopen-2014-006539, https://doi.org/10.1590/0102-311X00114113, https://doi.org/10.1097/ACM.0000000000000388, https://brage.bibsys.no/xmlui/handle/11250/2428043, https://apps.who.int/iris/bitstream/10665/252274/1/9789241511643-eng.pdf?ua=1, Differences in individual competencies. Adaptive behaviour to ensure safe medication administration record aim of always having nursing... 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