What decision making processes do novice and experienced intravenous nurses use during intravenous drug administration and how does this influence risk taking and errors?

Abstract

At least one patient will experience a potentially serious intravenous (IV) drug error every day in an ’average’ hospital. IV 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 IV drugs.

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

A three-phased ethnographic study was carried out in a specialist cancer hospital, using focus groups, observation and interviews. Three focus groups with 14 registered nurses
were used to develop culturally relevant definitions related to error and experience. Observation of the two wards took place over a week each. Twenty nurses were observed preparing and administering IV drugs, and then interviewed about their procedure. Data analysis was carried out using a five stage approach.

Definitions of drug error, IV drug error, novice and experienced IV givers were developed from the focus groups. Four major themes were identified and represent findings from the direct observation and interview of the nurses: interruptions; lack of
identification/knowing the patient; routinised behaviour; prevention of errors. One of the key findings was the lack of checking of patient identity prior to IV drug administration,
which appeared to be based on the nurses feeling they knew the patient well enough although this was in contrast to the checking of drugs even if they were familiar with them. Implications for practice included: exploring new and effective methods of education based on behavioural theories; involving staff in updating and writing policies and procedures; and formal assessment of staff during IV preparation and administration.

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