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Author Stacey Sadler, Eva-Maria Carman & Selina Rizwan Ladak |
| Abstract Double-checking medication, particularly in the paediatric and neonatal setting, is a widely used intervention for the reduction of medication administration errors and is standard practice in most UK hospitals. A systems analysis was undertaken with paediatric and neonatal nurses at a large NHS teaching hospital to understand the key challenges influencing the drug administration and the second checker process, and to support work system recommendation development. A qualitative explorative approach using the SEIPS 2.0 model was adopted for three focus groups and eight semi-structured interviews. In addition, a process map was generated and a Hierarchical Task Analysis conducted, identifying barriers and enablers specifically for the second-checker task and nurse involvement. To further validate the qualitative results, a review of reported drug administration incidences within the Family Health division was conducted. A variety of sociotechnical barriers were identified that currently hinder both the primary nurse and second nurse checker in this process. The task analysis identified differences that occur in practice when compared with the local standard operating procedure. An example of a barrier unique to the second nurse checker centred on the second nurse not challenging the primary nurse if there was a discrepancy in calculations. This work provided an enhanced understanding of the issues nurses’ face and how these interact and affect their day-to day role. Recommendations arising from this work were wide ranging, highlighting that to try to resolve issues within a process, it is imperative that multiple areas are focused on. |
