Decision-making processes used by nurses during intravenous drug preparation and administration

dougherty l., sque m. & crouch r. (2012) Decision-making processes used by nurses during intravenous drug preparation and administration. Journal of Advanced Nursing68(6), 1302–1311.

Abstract

Aim.  The aim of this study was to explore the decision-making processes that nurses use during intravenous drug administration and how this influences risk taking and errors.

Background.  Intravenous drug errors have been estimated to be a third of all drug errors. Previous drug error research has focused on observation of nurses and errors they make but has not attempted to understand the decision-making processes used during the preparation and administration of intravenous drugs.

Method.  A three-phased ethnographic study was carried out in a specialist cancer hospital in 2007 using focus groups, observation and interviews. This article is concerned with the observation and interview phase. Observation took place on two wards, each over a week. Twenty nurses were observed preparing and administering intravenous drugs; then interviewed about their procedure. Data analysis was carried out using a five stage approach.

Findings.  Major themes identified include: interruptions; identification and knowing the patient; routinized behaviour, prevention of errors. These represent the findings of the observation and interviews with the nurses. One key finding was the lack of checking of patient identity prior to IV drug administration, which appeared to be based on nurses feeling they knew the patient well enough, although this was in contrast to how they checked even familiar drugs. This article will focus on identification and knowing the patient.

Conclusion.  Implications for practice included: exploring new and effective methods of education based on behavioural theories; involving staff in updating policies and procedures; formal assessment of staff during intravenous preparation and administration.