Mayhem to mindful : improving medication administration safety through action research

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Keeping patients safe is a fundamental component of quality nursing care. Nevertheless medication delivery within a busy clinical environment continues to challenge patient safety and wellbeing. Nurses’ central role in medication administration to inpatients puts them in the ideal position to safeguard patients from prescribing, dispensing and administration errors (Vaismoradi et al. 2016). However, the ward context can inadvertently support work practices that compromise patient safety (Balka, Kahnamoui & Nutland 2007), while the seemingly routine nature of medication administration can decrease nurses’ attentiveness to the medication administration process (Dickinson et al. 2010). An action research study, informed by theoretical constructs from critical social theory (Fay 1987; Habermas 1972; 1984), emancipatory practice development (Manley, McCormack & Wilson 2008) and the transtheoretical model of change (Prochaska, Prochaska & Levesque 2001), enabled frontline nurses to work together to understand and improve the safety of medication administration within one ward in a tertiary children’s hospital in New Zealand. Data were collected from participants and the researcher throughout the research journey using multiple methods including; questionnaire, interview, observation, review of reported medication incident data, meeting notes and reflective notes. Qualitative data were subjected to iterative thematic analysis and quantitative data were analysed according to the data instrument instructions. An exploration of the clinical context and practice demonstrated that nurses’ medication administration was mayhem; a habitual, distracted and inconsistent process undertaken in a chaotic and disruptive environment. For nurses, there was a tension between striving to adhere to best practice in the face of many contextual barriers resulting in inconsistency in the safety of medication administration practice. Mindfulness allowed nurses to make sense of the mayhem of practice. It enabled them to see the mayhem, question practice, and develop safer ways of working to move beyond the MAYHEM to ensure MINDFUL medication administration. The Model for Improving the Safety of Medication Administration (MISMA) was developed to illustrate how becoming mindful can be used as a strategy to improve the safety of medication administration. The model can be used to guide nurses to critically analyse their own and team practice and develop, implement and evaluate evidence based improvements in practice.
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