McLeod, MC; (2013) Medication administration processes and systems – exploring effects of systems-based variation on the safety of medication administration in the UK National Health Service. Doctoral thesis , UCL (University College London).

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Abstract

Medication administration errors (MAEs) in hospitals account for the majority of reported medication-related patient harm in the UK. Research suggests error-prevention strategies should focus on reducing error-producing conditions associated with systems and processes. However, medication administration is complex, and potential systems and process variations exist across the National Health Service (NHS) which present a barrier to prioritising and developing interventions to reduce error. This thesis investigates variations in hospital medication systems and their potential effects on the safety of medication administration. It also includes a systematic review summarising hospital MAE rates and the effects of methodological variations on reported MAE rates. An initial observational study of nurses administering medications on one ward identified several process variations and system factors that may contribute to MAEs, including potential inefficiencies and dose omissions related to medication storage. A novel meta-analysis of the literature revealed an MAE rate of 5.6% of non-intravenous doses. Dose omission was most common, of which 52-67% were because the drug was unavailable. A census of ward-based medication systems in English NHS hospitals identified the extent of inter- and intra-hospital variation, particularly in medication storage and medication safety related processes. A separate observational study documented variations among nurses in how they utilised systems, including the use of ‘temporary’ drug trolley alternatives. An ethnographic study of drug administration in three different hospital medication systems then revealed systems-related factors that both facilitated and hindered medication administration. Overall, the extent of a number of variations in hospital medication systems has been described, including more subtle variations than previously reported. Many variations were associated with both positive and negative effects on the safety of medication administration, which were often affected by situational factors. This emphasises the importance of considering potential unintended consequences of sociotechnical interactions when developing and implementing systems-based interventions to reduce MAEs.

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