Challenges in Administration of Microinfusion Medication by Critical Care Nurses at Intensive Care Unit Kenyatta National Hospital

Abstract

Background of the study: Most drugs given as Microinfusion require infusion pumps to administer. They are very potent with very narrow therapeutic index and any small changes on the process results in enormous effects to patients. The nursing profession has a duty to advocate for patients rights as well as do no harm. One of the core goals of nurses is medication administration; this puts nurses in the last line of defense against medication administration errors (MAEs). Microinfusion medication studies over the years have focused to improve therapy delivery to patients while reducing chances of errors. This study aimed to look into the roles played by the patient, nurse, system and structure that hamper the efforts to reduce the Microinfusion MAEs on which minimal studies have been done. Objective: This study determined the prevalence of drug errors, competency level, institutional and structural related factors influencing the administration of Microinfusion medication by critical care nurses at Kenyatta National Hospital’s (KNH) Intensive Care Unit (ICU). Significance of study: Local data in the area of Microinfusion MAEs is not available, specifically KNH’s ICU. This study therefore sought to breech this gap and hopes to influence policy on management of critical patients, patient safety, environment, and curriculum development so as to reduce Microinfusion MAEs. Methodology: This study used a descriptive cross-sectional study design, simple random sampling was used pick 64 participants. Quantitative data was analyzed by both descriptive and inferential statistics, which included regression analysis. Descriptive statistics were presented by use of the mean, percentages and standard deviation. Chi-square was used to determine statistical significance of the differences in proportions and logistic regression was used to identify factors that lead to MAEs. Necessary ethical approval was sought. Results: The prevalence of MAEs was at 64.1% in the last six months, 65.6% 0f the respondents reported lack of supportive supervision, 37.5% of the respondents reported not to know mechanisms in place for reporting Microinfusion medication errors, 54.7% of the respondents reported the ICU was well designed for management of supplies and medication. This prevalence was of statistical significance when cross tabulated with critical care nurses competency level (p<0.05) on aspects such as; having prescription checks [95%CI= 0.000-17.9; p=0.008], working experience, type of medication error, checking weight of patients [p=0.019], reporting of the errors [95%CI = 0.1-0.8; p=0.019], documenting drug errors and monitoring patients after drug administration. Structural and institutional factor such as design and supervision were not statistically significant with Microinfusion MAEs (p>0.05) Conclusion and recommendation: The prevalence of Microinfusion administration errors in KNH-ICU is high. There is need to ensure that nurses are always equipped with adequate knowledge and experience in drug administration through trainings and mentorship programs as this will reduce medication errors and increase safety of patient in health facilities