Úvod: Podání léčiv hospitalizovanému pacientovi představuje kritické místo při poskytování zdravotních služeb a je spojené s výskytem různých kategorií pochybení s reálným dopadem na zdraví pacienta a náklady zdravotní péči. Cíl: Cílem práce bylo analyzovat vliv intervencí a jejich udržitelnost na prevalenci pochybení spojených s podáním léčiv sestrou hospitalizovaným pacientům. Metodika: Data pochází z observačně intervenční studie probíhající v letech 2020 až 2023 a analyzující podání léčiv sestrou v jedné z českých nemocnic. Sběr dat proběhl formou přímého pasivního pozorování týmem tvořeným sestrou a farmaceutem na interním a chirurgickém oddělení a oddělení následné péče, a to vždy tři po sobě jdoucí dny v době ranních, poledních a večerních podání léčiv. Zaznamenána byla všechna léčiva podaná v době pozorování, údaje o pacientovi, sestře podávající léčiva, vlastním podání léčiva a správném způsobu podání a zacházení s jednotlivými lékovými formami. Všechna data včetně údajů o sestrách byla anonymizovaná a standardním způsobem ochráněna. Po prvním sběru dat byly na základě získaných dat vytvořeny a implementovány komplexní intervence. Pochybení byla rozdělena na léková a procesní a pomocí statistických metod byl zhodnocen dopad a udržitelnost navržených intervencí. Výsledky: Celkem bylo pozorováno podání 3 826 léčiv podávaných 55 sestrami 222 pacientům průměrně starším 75 let. Ve více než 80 % se jednalo o pevné perorální lékové formy. Nejvyšší prevalence pochybení byla zaznamenána u těchto kategorií: nesprávný časový odstup od potravy, chybějící identifikace pacienta, absence dezinfekce rukou sestry před podáním léčiva, neprovedené kontroly užití léčiva pacientem a nepoužití čistých pomůcek pro přípravu léčiva. Ve všech těchto případech se ukázaly navržené intervence jako účinné a bylo zaznamenáno statisticky významné zlepšení v průběhu studie. Závěr: Pozitivní dopad intervencí na snížení výskytu lékových pochybení při podání léčiv sestrou ukazuje, že udržení a další posílení kultury bezpečí při poskytování zdravotní péče v nemocnici vyžaduje opakovanou edukaci zdravotnických pracovníků.
Introduction: The medication administration to hospitalized patients is critical in the delivery of healthcare services and is associated with the occurrence of various categories of errors with real impact on patient health and healthcare costs. Aim: The aim of this study was to analyse the impact of interventions and their sustainability on the prevalence of errors associated with medication administration by nurses to hospitalized patients. Methods: Data were obtained from an observational intervention study conducted from 2020 to 2023 and analysing medication administration by nurses in one of the Czech hospitals. Data collection was done by direct passive observation by a team including a nurse and a pharmacist in the internal medicine, surgery, and long-term wards on three consecutive days during morning, midday, and evening administrations. All drugs administered at the time of observation, details of the patient, the nurse administering the medicine, the actual administration of the medicine, and the correct method of administration and handling of each dosage form were recorded. All data, including nurse data, were anonymised, and protected. After initial data collection, complex interventions were developed and implemented based on the data collected. Errors were divided into medication and process errors and the impact and sustainability of the proposed interventions were assessed using statistical methods. Results: A total of 3 826 drugs administered by 55 nurses to 222 patients with a mean age over 75 years were observed. More than 80 % were solid oral dosage forms. The highest prevalence of errors was incorrect timing in relation to food, lack of patient identification, lack of nurse hand disinfection prior to medication administration, failure to check if patient used administered drug, failure to use clean equipment for medication administration. In all these cases, the proposed interventions proved to be effective, and a statistically significant improvement was observed over the course of the study. Conclusion: The positive impact of the interventions on reducing the occurrence of medication errors in the administration of medicines by nurses shows that maintaining and further strengthening a safety culture in the delivery of healthcare in the hospital requires repeated education of healthcare workers.
- MeSH
- bezpečnost pacientů MeSH
- hospitalizace MeSH
- lidé MeSH
- medikační omyly * prevence a kontrola MeSH
- snížení rizika poškození MeSH
- zdravotní sestry v klinické praxi výchova MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Aim: The study aimed to describe nurses' roles, map their views, knowledge, and experiences, and clarify the factors influencing their work and personal life during the Covid-19 pandemic in the Czech Republic. Design: A descriptive and cross-sectional design was used for the study. Methods: A representative sociological survey was conducted. A non-standardized questionnaire was used to collect data; the primary objective was to survey nurses' views, knowledge, and experiences gained during the Covid-19 pandemic and identify essential issues that must be addressed before the next pandemic. The questionnaire contained a total of 57 questions. The sample was constructed by quota sampling; the criteria for inclusion in the sample were the respondents' gender, age, and region. These characteristics were established as representative. The sample consisted of 1,197 nurses. Results: The most commonly reported factor influencing the work of nurses during the Covid-19 pandemic was fear of transmitting the infection (63.6%). Fear of the unknown (59%) and increased workload (54.7%) were also frequently reported to be strong influencers. The responses of nurses were statistically significantly influenced by the type of medical facility in which they worked (p < 0.05) and where they worked during the Covid-19 pandemic (p < 0.001). Most respondents (89.6%) said Covid-19 represented increased physical and mental burdens. Almost the same proportion of respondents (88.4%) felt Covid-19 affected their social lives, and 76.7% reported that it also affected their personal lives. Conclusion: Healthcare facility management should ensure sufficient personal protective equipment (PPE) is available before pandemics and pay close attention to the needs of staff regarding psychological counselling and crisis intervention during pandemics.
Introduction: Administering medication is one of the riskiest operations in healthcare. This research aims to map the reasons and context for disrupting nurses while administering medicines in selected inpatient wards of 4 hospitals in South Bohemia. Methods: We used the method of directly observing general and practical nurses while administering drugs – in selected internal and surgical wards and long-term care and rehabilitation wards. The data was collected in 2021, 2022, and 2023. Results: 18,370 inpatient medicine administrations were observed during the morning, midday, and evening administrations. 58 nurses from 4 hospitals, with an average age of 37.4, participated in the research. We recorded 791 interruptions. The most common reasons were patient questions and work communication, but we also recorded interruptions unrelated to nursing care. Conclusion: Due to the lack of strategies, we recommend introducing preventive measures and educational interventions in the monitored hospitals to reduce disruption while nurses are administering medicinal products, and thus improve the quality and safety of the nursing care provided.
BACKGROUND: Medication administration errors (MAE) are a worldwide issue affecting the safety of hospitalized patients. Through the early identification of potential causes, it is possible to increase the safety of medication administration (MA) in clinical nursing. The study aimed to identify potential risk factors affecting drug administration in inpatient wards in the Czech Republic. MATERIAL AND METHODS: A descriptive correlation study through a non-standardized questionnaire was used. Data were collected from September 29 to October 15, 2021, from nurses in the Czech Republic. For statistical analysis, the authors used SPSS vers. 28 (IBM Corp., Armonk, NY, USA). RESULTS: The research sample consisted of 1205 nurses. The authors found that there was a statistically significant relationship between nurse education (p = 0.05), interruptions, preparation of medicines outside the patient rooms (p < 0.001), inadequate patient identification (p < 0.01), large numbers of patients assigned per nurse (p < 0.001), use of team nursing care and administration of generic substitution and an MAE. CONCLUSIONS: The results of the study point to the weaknesses of medication administration in selected clinical departments in hospitals. The authors found that several factors, such as high patient ratio per nurse, lack of patient identification, and interruption during medication preparation of nurses, can increase the prevalence of MAE. Nurses who have completed MSc and PhD education have a lower incidence of MAE. More research is needed to identify other causes of medication administration errors. Improving the safety culture is the most critical challenge for today's healthcare industry. Education for nurses can be an effective way to reduce MAEs by enhancing their knowledge and skills, mainly focusing on increasing adherence to safe medication preparation and administration and a better understanding of medication pharmacodynamics. Med Pr. 2023;74(2):85-92.
- MeSH
- korelace dat MeSH
- léčivé přípravky MeSH
- lidé MeSH
- medikační omyly * prevence a kontrola MeSH
- průzkumy a dotazníky MeSH
- zpráva o sobě MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Téma očkování zdravotníků proti covid-19 je předmětem diskusí především v případě zdravotních sester. Primární otázkou pro tento literární přehled bylo: “Jaké jsou postoje sester vůči očkování proti covid-19 ve srovnání s ostatními typy zdravotnických profesí?” Druhou otázkou bylo, jaký je podíl sester, které se chystají nechat se očkovat a dále co sestrám v očkování brání, a naopak co jim pomůže při rozhodování nechat se očkovat. Metody: Pro přehledovou práci byl použit formát PRISMA-ScR pro přehledy typu scoping review s ohledem na novou oblast vakcín proti covid-19. V databázích (PubMed/MEDLINE, PROquest and EBSCO) byly vyhledány původní studie ze všech zemí světa, publikované v anglickém jazyce před 20. březnem 2022. Ochota nechat se očkovat byla hodnocena v jedné kategorii společně pro zdravotní sestry a studenty ošetřovatelství, zatímco ve druhé kategorii byli ostatní zdravotničtí pracovníci. Vývoj postojů sester k očkování v čase ve vztahu k postoji ostatních zdravotníků byl vyhodnocen post hoc. Faktory spojené s ochotou nechat se očkovat proti covid-19 byly rozděleny podle kategorií WHO (kontextuální vlivy, individuální/ skupinové vlivy a otázky specifické pro očkování/danou vakcínu) a jsou shrnuty v narativním přehledu. Výsledky: Celkem bylo do přehledu zařazeno 58 studií, které všechny měly průřezové dotazníkové uspořádání, a kterých se zúčastnilo 95 418 zdravotníků (včetně 33 130 sester a 7 391 studentů ošetřovatelství) v 44 zemích Evropy, Ameriky, Afriky a Asie. Hlavní kontextuální faktory, které v hodnocených studiích zvyšovaly ochotu nechat se očkovat, byly důvěra ve vědu, důvěra v lékaře, v odborníky a ve vládní instituce, zatímco altruismus a kolektivní ochrana nebo ochrana ohrožených osob v domácnosti dotazovaných zdravotníků byly zmíněny pouze v malém počtu studií. V počátečních obdobích očkování, tedy před uvedením vakcín do praxe, uváděly sestry nižší ochotu nechat se očkovat než lékaři a ostatní zdravotníci a tento rozdíl mezi zdravotnickými profesemi v čase klesal (p = 0,022). Ochota nechat se očkovat se zvyšovala s rostoucím věkem (n = 25 studií), vyšším stupněm dosaženého vzdělání (n = 7), vyšším počtem let v klinické praxi (n = 4) a byla vyšší u mužů než u žen (n = 23). Pouze v malém poštu studií uváděli zdravotníci jako důvod pro očkování pociťované vysoké osobní riziko těžkého průběhu infekce covid-19 (n = 14) nebo práci na covidových jednotkách (n = 5). Mezi hlavní faktory spojené s vakcinací či vakcínou, které zvyšovaly ochotu nechat se očkovat, patřily důvěra ve vakcínu a v její účinnost a bezpečnost, celkový pozitivní vztah k očkování a především absolvované očkování proti chřipce v předchozích letech (n = 21 studií). Významným faktorem spojeným s vyšší ochotou nechat se očkovat patřila “vakcinační gramotnost”, “pochopení vakcinace”, “znalosti o vakcinaci” případně “pochopení výhod a nevýhod očkování” (n = 17 studií). Závěry: Zdravotní sestry byly zpočátku méně ochotné nechat se očkovat proti covid-19 než ostatní zdravotníci, ale tento rozdíl postupem času vymizel. Podobně váhavý vyčkávací postoj sester k očkování se projevuje i v údajích realizovaného očkování zdravotníků proti covid-19, které registruje Ústav zdravotnických informací a statistiky ČR. Důvěra ve vědecké instituce a výrobce vakcín zvyšuje ochotu nechat se očkovat. Tato ochota také roste s rostoucím věkem, vyšším stupněm vzdělání, delší dobou klinické praxe a také je vyšší u mužů. Mezi nezávislé, zevní intervencí potenciálně ovlivnitelné faktory spojené s vyšší ochotou nechat se očkovat patří vakcinační gramotnost a účast v jiném očkovacím programu, především v případě očkování proti sezonní chřipce.
Aim: There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: “What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?” The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. Methods: The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. Results: Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high “vaccine knowledge”, “vaccine literacy”, „understanding the vaccine” or “understanding benefits and barriers of vaccination” (n = 17 studies). Conclusions: Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.
UNLABELLED: The aim of the study was to identify the reasons for medication administration errors, describe the barriers in their reporting and estimate the number of reported medication administration errors. BACKGROUND: Providing quality and safe healthcare is a key priority for all health systems. Medication administration error belongs to the more common mistakes committed in nursing practice. Prevention of medication administration errors must therefore be an integral part of nursing education. DESIGN: A descriptive and cross-sectional design was used for this study. METHODS: Sociological representative research was carried out using the standardized Medication Administration Error Survey. The research study involved 1205 nurses working in hospitals in the Czech Republic. Field surveys were carried out in September and October 2021. Descriptive statistics, Pearson's and Chi-square automatic interaction detection were used to analyze the data. The STROBE guideline was used. RESULTS: Among the most frequent causes of medication administration errors belong name (4.1 ± 1.4) and packaging similarity between different drugs (3.7 ± 1.4), the substitution of brand drugs by cheaper generics (3.6 ± 1.5), frequent interruptions during the preparation and administration of drugs (3.6 ± 1.5) and illegible medical records (3.5 ± 1.5). Not all medication administration errors are reported by nurses. The reasons for non-reporting of such errors include fear of being blamed for a decline in patient health (3.5 ± 1.5), fear of negative feelings from patients or family towards the nurse or legal liability (3.5 ± 1.6) and repressive responses by hospital management (3.3 ± 1.5). Most nurses (two-thirds) stated that less than 20 % of medication administration errors were reported. Older nurses reported statistically significantly fewer medication administration errors concerning non-intravenous drugs than younger nurses (p < 0.001). At the same time, nurses with more clinical experience (≥ 21 years) give significantly lower estimates of medication administration errors than nurses with less clinical practice (p < 0.001). CONCLUSION: Patient safety training should take place at all levels of nursing education. The standardized Medication Administration Error survey is useful for clinical practice managers. It allows for the identification of medication administration error causes and offers preventive and corrective measures that can be implemented. Measures to reduce medication administration errors include developing a non-punitive adverse event reporting system, introducing electronic prescriptions of medicines, involving clinical pharmacists in the pharmacotherapy process and providing nurses with regular comprehensive training.
Aim: The aim of the research was to ascertain the feelings of frontline nurses during the Covid-19 pandemic. Design: Qualitative research using a phenomenological approach. Methods: Qualitative research using a phenomenological approach was carried out with eight nurses working with Covid-19 patients in a hospital and in a seniors home in Kladno, in the Central Bohemia region of the Czech Republic. Two diagrams, which show ties between identified categories, were generated based on results. Results: External stresses during the first wave were: lack of information, lack of protective equipment, different attitudes towards the pandemic management. During the third wave, they were: lack of nurses and other medical personnel, overwhelming of the healthcare system, too much administrative work, and long working hours spent in protective gear. The stress-reducing factors revealed after the first wave were: solidarity and gratitude expressed by society. During the third wave, nurses noted greater self-confidence and pride, better interpersonal relationships. Conclusion: The effective management of stressors in the pandemic period can contribute to better healthcare. Therefore, we should pay more attention to describe of them in future.
- MeSH
- COVID-19 * psychologie MeSH
- domovy pro seniory MeSH
- duševní zdraví * MeSH
- emoce MeSH
- kvalitativní výzkum MeSH
- lidé MeSH
- nemocnice MeSH
- ochranné faktory MeSH
- psychický stres etiologie MeSH
- statistika jako téma MeSH
- zdravotní sestry psychologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Správné podání léčiva s ohledem na potravu nebo nápoje je jedním ze základních nástrojů pro dosahování cílů farmakoterapie. Není známo, zda je toto zohledněno i při péči o hospitalizované pacienty. Cílem této práce bylo popsat a analyzovat současnou praxi při podávání léčiv ve vztahu k potravě a nápojům pacientům hospitalizovaným ve čtyřech nemocnicích České republiky. Práce vychází z výsledků první fáze prospektivní observační studie zabývající se bezpečností podání léčiv pacientům sestrami. Veškerá data, včetně rozestupu podání léčiv od potravy a údajů o použitém nápoji, byla získána metodou tzv. přímého pozorování, kdy tým pozorovatelů doprovázel sestru během podání léčiv. Správný způsob podání ve vztahu kpotravě/nápoji byl posouzen dle souhrnu údajů o léčivém přípravku a na základě dalších publikovaných dat. Celkem bylo analyzováno podání 5718 perorálních léčiv a 198 insulinů. Nesprávný rozestup od potravy byl pozorován u 15,7 % podání perorálních léčiv a 26,8 % inzulinů. Nejvíce pochybení stran vztahu k potravě se vyskytovalo u léčiv ze skupiny inhibitorů protonové pumpy, antihypertenziv a prokinetik. Nejčastěji použitým nápojem na zapití byl čaj (63,4 %). U některých skupin léčiv byla pozorována pochybení s klinicky závažným dopadem. Práce ukázala na nutnostsystémového přístupu při řešení diskutované problematiky s nutností mezioborové spolupráce.
Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.
