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May 15, 2024

Assignment Task Overview:

Medication administration is a critical nursing intervention and a core competency for all registered nurses (Nursing and Midwifery Council [NMC], 2018). Despite its importance, medication administration remains a common source of patient harm in hospital settings (Roughead et al., 2013). This paper aims to review the best available evidence on this topic to gain insights into this clinical issue and propose strategies for preventing medication administration errors in practice. The nursing intervention will be evaluated against the Medications Administration Guidelines by the Royal Society of Pharmacists and Royal College of Nursing (2019).

Complexity of Medication Process:

The NMC (2018) highlights the complexity and high-risk nature of the medication process, which involves multiple interactions. Adhering to the “9 Rights” during medication administration demands considerable cognitive attention (Elliott & Lui, 2010), particularly when multiple medications are involved (Rohde & Domm, 2018). According to the RSP/RCN (2019) guidelines, organizations must implement strategies to mitigate risks associated with medication delivery. However, nursing practice often faces interruptions or task-switching challenges (Hopp et al., 2005). Studies by Hedberg and Larsson (2004) suggest nurses experience interruptions 2.8 times per hour, while Alvarez and Coiera (2005) report interruptions as frequent as 14 times per hour. These interruptions can compromise patient safety, especially during critical tasks like medication administration (Raban & Westbrook, 2014).

Search Strategy:

The search for evidence to inform practice involved library activities in weeks 3 (library search) and 4 (database searching).

Practice-relevant evidence can be drawn from research, clinical experiences, patient perspectives, and local guidelines/policies (Aveyard & Sharp, 2017; Rycroft-Malone, 2004). However, this annotated bibliography prioritizes primary research evidence for its objectivity (Davis, 2016). MEDLINE (or CINAHL) health databases were utilized for this search.

Database Search Methodology:

The topic was deconstructed into keywords and linked using Boolean operators for an effective database search (Davis, 2016). An example of the search terms and keywords is provided in the appendix.

Ethical Considerations:

Although the study was deemed an audit and did not require ethical approval, nurses involved in observations provided consent—a practice uncommon in audits (Grant et al., 2013; Twycross & Shorten, 2014). Disguised observations were conducted to mitigate the Hawthorne effect (Payne & Payne, 2004), ensuring authentic behavior. The use of a single, trained observer (a clinical pharmacist) and a standardized error recording form enhanced result reliability (Parahoo, 2014; Salmon, 2015).

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