Critical Appraisal of Research
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Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4572
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
CONTRIBUTION OF THE WORK LOAD TO THE OCCURRENCE OF MEDICATION ERRORS IN NURSING
CONTRIBUIÇÃO DA CARGA DE TRABALHO PARA A OCORRÊNCIA DE ERROS DE MEDICAÇÃO NA ENFERMAGEM
CONTRIBUCIÓN DE LA CARGA DE TRABAJO PARA LA OCURRENCIA DE ERRORES DE MEDICACIÓN EN LA ENFERMERÍA
Ketri Fagondes Aires1, Jamila Geri Tomaschewski Barlem2, Catharine Silva de Souza3, Laurelize Pereira
Rocha4, Deciane Pintanela de Carvalho5, Carolina Domingues Hirsch6
ABSTRACT
Objective: to analyze the contribution levels of the workload for the occurrence of medication errors in nursing. Method: this is an exploratory-descriptive study with a quantitative approach, conducted with 49 nurses in a public hospital in the South of Brazil, using an instrument built and validated by the authors of the research. Data were analyzed by descriptive and inferential statistics. Results: most participants had experienced some medication error in their work unit, with dose errors being the most frequent and the number of staff contributing to the occurrence of medication errors. Conclusion: the study facilitated the recognition of elements of the workload that contribute to the occurrence of medication errors in nursing, which may support the construction of strategies necessary to minimize the occurrence of medication errors
and patient safety. Descriptors: Workload; Nursing; Patient Safety; Medication Errors.
RESUMO
Objetivo: analisar os níveis de contribuição da carga de trabalho para a ocorrência de erros de medicação na enfermagem. Método: estudo exploratório-descritivo, de abordagem quantitativa, realizado com 49 enfermeiros em um hospital público do Sul do Brasil, mediante aplicação de um instrumento construído e validado pelos autores da pesquisa. Os dados foram analisados a partir de estatística descritiva e inferencial. Resultados: a maioria dos participantes já vivenciou algum tipo de erro de medicação em sua unidade de trabalho, sendo os erros de dose os mais frequentes e o quantitativo de pessoal o fator que mais contribui para ocorrência de erros de medicação. Conclusão: o estudo oportunizou o reconhecimento de elementos da carga de trabalho que contribuem para a ocorrência de erros de medicação na enfermagem, o que poderá subsidiar a construção das estratégias necessárias para a minimização da ocorrência dos erros de medicação e segurança do paciente. Descritores: Carga de Trabalho; Enfermagem; Segurança do Paciente; Erros de
Medicação.
RESUMEN
Objetivo: analizar los niveles de contribución de la carga de trabajo para la ocurrencia de errores de medicación en la enfermería. Método: estudio exploratorio-descriptivo, de enfoque cuantitativo, realizado con 49 enfermeros en un hospital público de Sur de Brasil, mediante aplicación de un instrumento construido y validado por los autores de la investigación. Los datos fueron analizados a partir de estadística descriptiva e inferencial. Resultados: la mayoría de los participantes ya vivió algún tipo de error de medicación en su unidad de trabajo, siendo los errores de dosis los más frecuentes y el cuantitativo de personal el factor que más contribuyó para ocurrencia de errores de medicación. Conclusión: el estudio mostró el reconocimiento de elementos de la carga de trabajo que contribuyen para la ocurrencia de errores de medicación en la enfermería, lo que podrá subsidiar la construcción de las estrategias necesarias para la minimización de la ocurrencia de los errores de medicación y seguridad del paciente. Descriptores: Carga de Trabajo;
Enfermería; Seguridad del Paciente; Errores de Medicación. 1Nurse (graduated), Nursing School of the Federal University of Rio Grande/FURG. Rio Grande (RS), Brazil. E-mail: [email protected]; 2,4Nurses, Professors, Nursing School of the Federal University of Rio Grande/FURG. Rio Grande (RS), Brazil. E-mail: [email protected]; [email protected]; 3,5Nurses, Master´s, Graduate Program, Federal University of Rio Grande/FURG. Rio Grande (RS), Brazil. E-mails: [email protected]; [email protected]; 6Nurse, Ph.D. students, Graduate Program of the Federal University of Rio Grande/FURG. Rio Grande (RS), Brazil. E-mail: [email protected]
ORIGINAL ARTICLE
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4573
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
The nursing workload is associated with the
time the staff performs their activities, which
are directly influenced by the patients´
needs. These activities may be affected by
the patient´s level of dependence, the
severity of the disease, the institution´s
environment, the characteristics of the work,
the physical space and the profile of the
team's workers.1
The imbalance in professional activities,
motivated by factors of the environment or
intrinsic to the professional can lead to
overwork, characterizing the work overload
that compromises the quality of care and puts
the safety of the patient at risk.2
In this sense, the evaluation of the
variables that make up the nursing workload
becomes an important instrument to improve
the quality of care and, especially, contribute
to patient safety.
In Brazil, the National Patient Safety
Program (PNSP), instituted by Administrative
Rule MS/GM Nº 529, of April 1, 2013,
recommends the elaboration and
implementation of a set of basic protocols to
minimize errors and adverse events.3 Among
the patient safety priorities, issues related to
drug prescription and administration deserve
to be highlighted, as they are responsible for
the largest number of adverse events in health
facilities.4
Medication errors can be defined as any
preventable event that can lead to improper
or inappropriate use of medication or harm
the patient.5
The nurse together with the nursing team
plays a fundamental role in the medication
system, considering that they act in the last
stage of the system, administering medication
and monitoring the reactions of the client.
Thus, the actions performed by this
professional are decisive in the prevention of
medication errors, being the legal
responsibility of the professional to administer
medication.6
In many health institutions, there is not a
safety culture, but rather a punitive system,
which leads to underreporting, weakening the
identification of factors that contribute to the
event. The variables that compose the nursing
work process can contribute to the occurrence
of medication errors. Thus, to identify the
contribution of these variables in the
occurrence of medication errors is of
fundamental importance for the construction
of strategies that minimize the occurrence of
adverse events and contribute to the safety of
the patient, which justified the
accomplishment of this study.
Thus, the research question of this study
presents is: what are the levels of workload
contribution to the occurrence of medication
errors in nursing? The purpose of this study
was to analyze the levels of contribution of
the workload to the occurrence of medication
errors in nursing.
This is an exploratory-descriptive study
with a quantitative approach, performed at a
University Hospital in the South of Brazil, with
49 nurses selected by non-probabilistic
sampling for convenience. The inclusion
criterion was to be a nurse in one of the care
units of the selected hospital.
A self-administered questionnaire was used
as a collection instrument composed of 25
questions in Likert format, elaborated and
validated by the authors of the research,
using face, content and construct validity.
The nurses were invited to participate in
the study at the place and work shift, and the
instruments were delivered directly to the
informants in a brown paper envelope,
without identification, and the scheduling of
the collection was carried out.
After applying the instrument to the
selected sample, a factorial analysis was
performed to reduce and summarize the data,
aiming the formation of factors and the
validation of the instrument construct. The
formation of the factors obeyed two criteria:
the level of association between the variables
found through the factorial loads (>, 450); and
their level of subjectivity. Cronbach´s alpha
was used to test the reliability of the
instrument by checking the consistency of
different characteristics of each of the
factors, measured through instrument
questions.
The results referring to the studied sample
were obtained through descriptive statistics,
using the means and frequency distribution of
the constructs and their indicators, and
inferential statistics. The data were submitted
to the Kolmogorov-Smirnov normality test,
and a non-parametric distribution was
verified. Thus, the Mann-Whitney test was
used to compare the means in the case of
variables with two nominal categories.
Numerical data analysis was performed using
Spearman's Rho correlation. P <0.05 was
considered statistically significant.
Statistical Package for Social Sciences
(SPSS) software version 22.0 was used to
analyze the data, facilitating the process of
data organization in tables that allowed a
INTRODUCTION
METHOD
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4574
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
better visualization of the results and their
interpretation.
Ethical aspects were respected, by the
recommendations of Resolution 466/12 of the
National Health Council. Thus, the study was
approved by the Local Research Ethics
Committee (Opinion Nº 144/2015).
Regarding the construct validity, five of the 25 questions of the instrument submitted to the exploratory factorial analysis were excluded because they presented low factor loads (less than 0.450), forming blocks with a single question or because they did not express conceptual coherence with the proposed block.
Thus, in its final version, the instrument,
consisting of 20 items, presented five
constructs: patient conditions; infrastructure;
conflicts and dissatisfactions; the number of
staff; and work organization. The five
dimensions of the instrument explain 71.77%
of the variation of the original questions,
which represents an adequate degree of
synthesizing the data, facilitating its handling
and interpretation.
The reliability of the five constructs of the
instrument was tested by calculating the
Cronbach´s alpha. The Cronbach´s alpha of
the instrument presented a value of 0.89,
while the coefficients of the five constructs
were between 0.78 and 0.90, values
considered high for exploratory studies,
evidencing the reliability of the instrument in
the selected sample. Table 1 presents the
factorial loads of each construct according to
their formation in the factors, the explained
variance, as well as the Cronbach´s alpha
values.
Regarding the characteristics of the sample
studied, it was verified that the 49 nurses had
an average of 37 years old (37.23) and most of
them were female (93.9%). The average time
of professional training was 12 years (12.33),
ranging from three months to 34 years of
training. The time of professional
performance varied between one month and
35 years, being 12 years (12,24) the average
time of professional performance.
Regarding the units of action of the 49
nurses, it was verified that five of them
worked in surgical units, seven in a prompt
care unit and risk classification, six in the unit
of medical clinic and hospital day, 12 in
General Intensive Care Unit and Neonatal, five
in obstetric units, five in the pediatric unit
and nine were spare substitutes, working in all
care units. Nine Of the 49 nurses had
graduation, 24 had a residency or
specialization degree, 11 were masters, and
three had a Ph.D. course.
When questioned about participation in
continuing education activities, 63.3% of the
nurses affirmed participating in the proposed
activities. When questioned about the
performing meetings in the work unit, 64.60%
of the participants stated that they
participated in meetings.
Considering the experience of medication
errors, 85.7% of the nurses said they had
experienced some medication error in their
work unit. Among the types of error, 49% were
dose errors, 36.7% medication errors, 30.6%
patient errors, 18.4% time errors and 16.3%
route errors. On the frequency of the errors,
39.5% of the nurses stated that the errors
occur once every six months and 39.5%
mentioned that they occur once every year.
When questioned about reporting the
occurrence of errors, 61.5% answered that
they report medication errors that occurred in
their work unit.
The descriptive analysis (Table 2) allowed
verifying the contribution levels of each
construct for the occurrence of medication
errors by nursing. The construct conditions of
the patient presented the lowest mean (3.42)
among the factors that contribute to the
occurrence of medication errors in nursing. It
was observed that the level of patient
dependence, work in units that provide care
to patients in critical conditions or terminally
ill patients and constant work with human
suffering are indifferent in the occurrence of
medication errors. In this construct, the issue
“Working in units that provide care to patients
in critical conditions” had the highest mean
(3.53).
The infrastructure construct presented an average of 3.78, evidencing that, according to the nurses surveyed, the absence of computerized systems for drug prescriptions, poor infrastructure and the quality of materials and equipment, including those for individual protection, are also indifferent to the occurrence of medication errors. The issue of “precarious infrastructure” presented the highest mean in this construct (3.94).
Also, in the construct conflicts and
dissatisfactions, the average of 3.98 was
obtained, noting that professional
dissatisfaction, patients that exceed the
complexity of care unit, the amount of
medication used by the patient and the
conflicts in interpersonal relationships are
indifferent to the occurrence of medication
errors. However, in this construct, the issue of
“ineffective communication among health
professionals” presented an average of 4.37,
showing that the lack of communication or
inadequate communication between the
RESULTS
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4575
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
health team contributes to the occurrence of
medication errors.
The construct of quantitative of personnel
presented the highest mean of the instrument
(4.41), noting that nurses believe that the
quantitative of nursing workers, the
quantitative/qualitative dimensioning of
inadequate nursing personnel and working in
more than one health institution or having
other professional occupations contribute to
the occurrence of medication errors. In this
context, the issue “quantitative of nursing
workers” presented the highest average
(4.49).
The construct of work organization
presented a mean of 3.82, noting that nurses
believe that the absence of
continuous/continuing education training,
nursing care prescriptions and norms and
routines manuals are indifferent to the
contribution of the occurrence of medication
errors. However, nurses believe that the
absence/lack of knowledge of protocols for
safe practices in medication administration
(4.06) contributes to the occurrence of errors.
Table 1. Average workload contribution levels for medication errors. Rio Grande (RS), Brazil, 2015.
Factors n Average
Patient conditions 49 (3.42) Q9 Working in units that provide care to patients in critical conditions 49 3.53 Q10 Working in units that provide care to terminal patients 49 3.43 Q11 Dealing constantly with human suffering 49 3.35 Q12 Level of dependence of the patient Infrastructure
49 49
3.37 (3.78)
Q19 Lack of computerized systems for drug prescriptions 49 3.59 Q20 Quality of materials and equipment 49 3.45 Q21 Precarious infrastructure 49 3.94 Q22 Quality of personal protective equipment 49 3.43 Conflicts and dissatisfaction 49 (3.98) Q8 Professional dissatisfaction 49 4.06 Q13 Patients who exceed the complexity of the care unit 49 4.02 Q14 Number of medications used by the patient 49 3.86 Q24 Ineffective communication among health professionals 49 4.37 Q25 Conflicts in interpersonal relationships 49 3.59 Quantitative of personnel 49 (4.41) Q1 Quantitative nursing workers 49 4.49 Q2 Quantitative/qualitative dimensioning of inadequate nursing staff 49 4.47 Q5 Work in more than one health institution or have another occupation 49 4.27 Organization of work 49 (3.82) Q15 Lack of Continuous/Continuing Education Training 49 3.86 Q16 Absence of nursing care prescriptions 49 3.61 Q17 Absence/misunderstanding of standards and routines manuals Q18 Absence/lack of knowledge of protocols for safe practices in drug administration
49 49
3.76 4.06
Regarding the tests to verify significant
differences between the samples, the Mann-
Whitney test (Table 2) allowed to analyze the
existence of possible differences in the
average of the factors that contribute to the
occurrence of medication errors, considering
the characteristics of the sample. Nurses who
participate in continuing education activities
believe that the infrastructure factor
contributes more to the occurrence of
medication errors than those who do not
participate. Also, nurses who work in units
where meetings occur, believe that the
patient´s condition factor contributes more to
the occurrence of medication errors than
those who work in units where meetings do
not occur.
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4576
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
Table 2. Relationship between the characteristics of the sample and the identified constructs. Rio Grande (RS), Brazil, 2015.
Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
Works in another institution No Yes
N 38 11
m p m P m p m p m p
24.24 27.64
.485 26.34 20.36
.218 24.30 27.41
.523 26.36 20.32
.203 25.45 23.45
.681
Permanent education No Yes
N 17 31
22.94 25.35
.566 19.12 27.45
.047*
22.26 25.73
.410 23.00 25.32
.571 19.65 27.16
.073
Experience of errors No Yes
N 7 42
26.57 24.74
.769 28.57 24.40
.492 22.29 25.45
.605 30.43 24.10
.291 21.43 25.60
.492
Meetings No Yes
N 17 31
16.79 28.73
.005* 24.32 24.60
.948 22.12 25.81
.380 20,00 26.97
.089 26.74 23.27
.409
Error notification No Yes
N 15 24
19.83 20.10
.942 18.00 21.25
.382
20.93 19.42
.684 22.87 18.21
.201 21.17 19.27
.610
* Significance at the level of 5
The Rho-Spearman test demonstrated that
there were no significant differences in the
“training time” and “professional
performance time” and the constructs patient
conditions, infrastructure, conflicts and
dissatisfactions, personnel quantitative and
work organization.
It was possible to verify that most nurses
participating in this study had experienced
some medication error during their
professional career in nursing, and the dose
errors were evidenced as those that occur
more frequently and the route errors as those
less occurring. These results agree with the
findings of the literature, which point out that
dose-related errors in medication are the
most prevalent in health institutions,
including absence of dose and inadequate
dose, and mistakes of wrong-way
administration are the infrequent ones.7
It is worth noting that the frequency and
the most prevalent type of medication errors
contribute to reducing the number of errors in
different health institutions.8 Currently, based
on actions directed at patient safety, a new
culture has been implemented in health
institutions since, culturally, the idea that
health professionals do not make mistakes or
cannot make mistakes is widespread in
society.3
Thus, to implant a culture of safety in
health institutions, individual guilt for errors
has been replaced by the reorganization of
care processes to notify and anticipate the
errors and correct them before injury or harm
to the patient. Thus, error reporting aims to
generate error-prevention alerts, enabling the
construction of strategies that contribute to
the reduction of adverse events in the context
of health.4
In this sense, it was verified that most of
the nurses participating in this study stated
that they report medication errors when they
occur in their work units. However, there are
still hospitals that do not notify their errors,
preventing the opportunity to improve the
service and implementation of safe practices
to minimize similar errors.10
Regarding the evaluation of the levels of
contribution of the workload to the
occurrence of medication errors in nursing, it
was possible to perceive that the quantitative
of personnel is the factor that contributes
most to the occurrence of such errors. Similar
results have been found in other studies,
which have shown that the adequate number
of nursing professionals is directly related to
the safety of the patient and health workers,
so hospitals that do not demonstrate
initiatives that contribute to good working
conditions and can contribute to the existence
of a greater number of adverse events.9
In general, health institutions show
insufficient and inadequate numbers of
nursing workers to meet the routine and needs
of the unit, which can compromise the health
and safety of the worker and the patient,
generating a risk of errors.11 In this sense, the
personnel dimensioning is a system that must
be used to plan and evaluate the quantitative
necessary for institution, as well as the
qualitative of the nursing professional
adjusted to offer the assistance in the way
that the health service needs, guaranteeing
the safety of patients and professionals and
avoiding adverse events.12
DISCUSSION
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4577
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
It should also be noted that, besides the
number of personnel, other factors can cause
work overload in nursing, for example, the
institution´s precarious infrastructure,
including lack of materials, lack of
professionals in other areas in the institution,
absence of individual protective equipment,
lack of continuous and continuing education
capacities.13 However, in this study, the
infrastructure, including the different
elements that compose it, was evidenced by
nurses as indifferent to the occurrence of
medication errors.
Concerning the contribution of conflicts
and dissatisfactions to the occurrence of
medication errors, especially professional
dissatisfaction, patients that exceed the
complexity of unit care, the number of
medications used by the patient and conflicts
in interpersonal relationships, it was possible
to verify that these were also considered
indifferent by nurses for the occurrence of
such errors. It should be stressed that
overload is one of the major reasons for
professional dissatisfaction, which can
increase job rotation and abstention, harming
the multi-professional team, patient care, and
the institution.14
The workload varies according to the
inpatient complexity, clinical status,
procedures and therapy used so that the more
critical the patient´s condition or, the greater
the number of adverse events, the greater the
burden. The use of a system that assesses the
workload is extremely important for nursing
professionals, providing safety for patients
and employees and alerting the institution to
the recruitment of an adequate number of
professionals.16
Regarding the contribution of conflicts and
dissatisfaction to the occurrence of
medication errors, it was verified that the
lack of communication or ineffective
communication contributes to the occurrence
of errors in nurses´ vision. This result is in line
with a study that analyzed the strategies to
promote patient safety from the perspective
of care nurses, in which it was verified that
errors in the medication administration
process begin with ineffective communication
between the pharmacy professional who the
dispensing physician, the prescribing
physician, and the nursing team administering
the medication.17
Thus, communication failure is evidenced
as one of the main causes of errors, of
medication errors in health institutions, which
also end up not being properly notified and
analyzed by those involved, causing, again,
communication errors in the team and new
adverse events.12 One of the main goals of the
National Patient Safety Program (PNSP) is to
improve communication among health
professionals to create strategies to solve this
problem.3
The nurses in this study also showed that
the patient´s conditions are indifferent to the
occurrence of errors. However, the workload
varies according to the complexity of the
hospitalized patient, clinical status, necessary
procedures and therapeutics used, so that the
more critical the patient´s condition or, the
greater the number of adverse events, the
greater will be the burden.15 Thus, some
specificities of nursing care deserve special
attention, for example, care for patients in
the terminal state, which in addition to
physical exhaustion also causes emotional
exhaustion, which may contribute to the
occurrence of medication errors.13
Regarding the contribution of work
organization to the occurrence of medication
errors, the nurses of this research also
evidenced this factor with indifferent to the
occurrence of medication errors. However,
they showed that the absence/ignorance of
protocols for safe practices in drug
administration contributes to the occurrence
of medication errors.
In this sense, one of the current initiatives
of the National Patient Safety Program in
Brazil refers to the implementation of safe
practices in health institutions, based on basic
protocols.3 Nursing has a great responsibility
for patient safety and care that medication
administration requires, as the “right nine,”
patient-centered, medication, route, dose,
time, registration, form, orientation and right
response, recommended by the Protocol of
Safety in Prescribing, Use and Administration
of Medications.4
Regarding adverse drug administration
events, the role of nursing is directly
associated with the reduction of errors, since
the last stage of drug therapy is under the
responsibility of the nursing team, so that
when there is an error in the previous
processes, it may be Identified and
interrupted, avoiding failures in patient
safety.18 Thus, a protocol-based care plan, as
well as the use of technologies,
computerization in nursing, electronic medical
prescriptions, systems for calculating doses,
dilution and reconstitution volumes,
interactions, records for patients to see
contraindications and drug allergies, bar codes
for medication and modern infusion pumps
generate more safety for the professional and
the patient, minimizing the occurrence of
errors.19
Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4578
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
In this study, it was also possible to verify
that nurses participating in continuing
education activities believe that the
infrastructure factor contributes more to the
occurrence of medication errors than those
who do not participate. Thus, it is possible to
affirm that the nurses who participate in the
permanent education know better the
materials and equipment that can be used in
their work and are updated on their use to
minimize medication errors. As already
identified in the literature, active
participation in continuing education activities
contributes to the construction of collective
strategies to promote harm minimization,
adverse events, and reduce risk of incidents.20
Finally, it was found that nurses who work
in units in which meetings take place believe
that the factor conditions of the patient
contribute more to the occurrence of
medication errors than those who work in
units where meetings do not occur. It is
possible to infer that nurses who hold
meetings with their teams better visualize the
conditions of their inpatients, discuss
situations, expose and share more their
difficulties in the care they provide, which
allows a better visualization of the
contribution of the patient´s conditions to the
occurrence of medication errors.21
Given this research, it can be verified that
most of the participating nurses have
experienced some medication error in their
work unit, with dose errors being the most
frequent and the route errors the less
frequent. There was a predominance of nurses
who reported reporting the occurrence of
medication errors occurring in their work unit,
which allows affirming that the nurses of the
research institution have already been seeking
to implement a safety culture and to carry out
joint preventive measures to reduce the
occurrence of errors.
Regarding the levels of contribution of the
workload, it can be identified that the
number of nursing staff is the factor that
contributes most to the occurrence of
medication errors in the nurses´ view. Also, it
was verified that the factors patient's
conditions, infrastructure, conflicts and
dissatisfaction and work organization were
evidenced by nurses as indifferent to the
occurrence of medication errors in nursing.
However, some issues present in such
factors have been pointed out as important
elements that contribute to the occurrence of
medication errors in nursing, such as lack of
communication or ineffective communication
among health professionals, and absence/lack
of knowledge of protocols for safe practices in
nursing in the administration of medicines. In
this sense, it is highlighted that both the
improvement of communication among health
professionals and the adoption of protocols for
safe practices in medication administration
have been widely encouraged by the National
Patient Safety Program as strategies to
minimize medication errors and avoid adverse
events.
It is expected that this study will
contribute to the construction of the
necessary strategies to minimize the
occurrence of medication errors and patient
safety, from the recognition of workload
variables that contribute to the occurrence of
such errors. Such strategies may focus on the
adequate design of nursing personnel in health
institutions, actions aimed at improving
communication among health professionals
and adopting protocols for safe practices in
drug administration.
As a limitation of the study, it is
emphasized that it was done with a specific
sample of nurses from a hospital in the south
of Brazil due to the short time possible for its
execution, which does not allow the
generalization of its results. It is also possible
to highlight the difficulty of the nurses in
collaborating and in participating in the
research.
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Aires KF, Barlem JGT, Souza CS de et al. Contribuição da carga de trabalho para a ocorrência...
English/Portuguese
J Nurs UFPE on line., Recife, 10(12):4572-80, Dec., 2016 4580
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.9978-88449-6-ED1012201619
http://www.scielo.br/pdf/reeusp/v42n4/en_
v42n4a08.pdf.
Submission: 2016/06/09 Accepted: 2016/11/04 Publishing: 2016/12/01
Corresponding Address
Carolina Domingues Hirsch Rua Visconde de Paranaguá, 102
CEP 96203-900 Rio Grande (RS), Brazil
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