Survey of nursing perceptions of medication administration practices, perceived sources of errors and reporting behaviours.

In January 2003, St. Mary's Hospital Center in Montreal, Quebec, established an interdisciplinary Committee on the Systematic Approach to Medication Error Control to review the whole process of medication administration within the hospital and to develop a systematic approach to medication error control. A cross-sectional survey on medication administration practices, perceived sources of errors and medication error reporting of nurses, adapted from a nursing practice survey and medication variance report (Sim and Joyner 2002), was conducted over a two-week period in February 2004. The results were analyzed by years of experience (greater or less than five years) and patient care unit of practice. The perceived source of error most often cited was transcription (processing), and the second most frequently cited source was the legibility of handwritten medication orders (prescribing). The results demonstrate no significant difference in medication safety practices or in perceptions of errors by years of experience. Nurses appear to adapt to the safety culture of the unit rather quickly, certainly within their first five years on the unit. Good medication error reporting behaviour was noted, with no differences between all comparative groups within both years of experience and unit of practice. Quality improvement initiatives to improve the safety of medication administration practices have included the development of a nursing medication administration handbook, the revision of policies and procedures related to medication administration safety, the standardization of solutions and limited variety of high-risk medication dosages and the reduction of handwritten reorders. The need for ongoing education and information sessions on policies and procedures specific to safe medication practices for all nurses, regardless of years of experience, was identified.