Nurses Perception on Medication Administration Error (MAE) at Surgical Wards in HUSM Aizatul Shakira, A, S., Norazliah, S.

, & Kasmah Wati, P. School of Health Sciences, Universiti Sains Malaysia, Health Kota (haru, Kelantan, Malaysia am!us, Ku"an# Kerian, $%$&'

BACK !"UN#$ Mortality rate )ue to me)ication error inci)ence in Unite) States *as hi#her than inci)ence of motor vehicle acci)ents, "reast cancer or A+,S. Althou#h many !reventative measures *ere im!lemente) to re)uce the inci)ence, the inci)ence is still alarmin# !articularly relate) to violation of & -i#hts )urin# )ru# a)ministration. As me)ication a)ministration is one of the vital roles of nurses, it *as crucial to )etermine nurses. !erce!tion to*ar)s me)ication a)ministration error /MA01 at the "usiest *ar)s in a teachin# hos!ital. PU!P"SE$ 2his )escri!tive stu)y aime) to )etermine the nurses. !erce!tion on me)ication a)ministration error at various sur#ical *ar)s in Hos!ital Universiti Sains Malaysia /HUSM1. ME%H"#$ Seventy one nurses from various sur#ical *ar)s *ere selecte) for this stu)y "y usin# stratifie) sam!lin# metho). ,ata *as collecte) "y usin# self a)ministere) 3uestionnaire a)a!te) from ,emehin, (a"alola an) 0rhun, /4''51 an) Wilkins an) Shiel)s, /4''51. Usin# SPSS version $5, analysis of )ata *as con)ucte) usin# )escri!tive an) 6ne7Way AN68A. !ESU&%S$ All nurses /$''91 ha) a*areness on MA0. +n a))ition, 4%.5'9 of the nurses !erceive) the estimate) fre3uency of MA0 occurrence *as at $ !er $' )ru# a)ministration. Most of the nurses !erceive) *ron# time /44.&:91, *ron# )ru# /4'.5'91 an) *ron# )oses /4'.5'91 as the most fre3uently occurrin# ty!e of MA0. 2he nurses also !erceive) that )istraction an) interru!tion )urin# me)ication a)ministration !rocess /$;.<491, e=cess *orkloa) /$:.;'91, me)ication name) *as 3uite similar /$:.$;91, an) *ron# la"elin# /e.#. me)icine, !atient name1 as the main factors contri"utin# to MA0. Measures to re)uce MA0 inci)ence *ere encoura#in# self re!ortin# of me)ication a)ministration error /$:.;&91, avoi)ances of all forms )istractions /$:.&<91, im!ortance of continuous !rofessional e)ucation an) re>trainin# of all nurses in the ri#ht *ay of a)ministerin# me)ication /$<.%;91 an) involvement an) coo!eration in me)ication )elivery "y all health care )elivery /e.#. nurses, !harmacists an) !hysicians1/$<.:&91. A 6ne>Way AN68A sho*e) that there *as a si#nificant )ifference in nurses. !erce!tion to*ar)s role overloa) "et*een three sur#ical *ar)s, ?/4, %51 @ :.$'A, !@'.'4$. C"NC&US'"N$ All sur#ical nurses ha) a*areness of MA0 inci)ence *ith the main contri"utin# factor relate) to the !roce)ure )urin# )ru# a)ministration an) nurses. !erce!tion to*ar)s role overloa) in )ifferent sur#ical *ar). 2he information o"taine) from this stu)y "rin#s to li#ht im!ortant to a!!ly measures an) #ui)eline for nurses in re)ucin# the inci)ence of MA0. KE(W"!#SB Me)ication error, nurse, !erce!tion, sur#ical *ar)s 'ntroduction Me)ication a)ministrations are one of nurses. crucial roles in clinical area. +n recent years, issue in me)ication error is alarmin# an) nee)s action in or)er to re)uce the error. Me)ication error is any !reventa"le event that may cause or lea) to ina!!ro!riate me)ications use or !atient harm *hile the me)ication is in the control of the health care !rofessional, !atient or consumer. Me)ication error also i)entifie) as errors in !rescri"in#, )is!ensin#, an) a)ministration errors "y Wakefiel)s, Holemen, (or)ers, (le#en an) 8au#hn, /4''A1. ,es!ite of the action of nurses, )octors an) !harmacist are actually in line *ith this error. 2his issue is kno*n to have hi#her inci)ence in neonatal unit than a)ult /Kaushal, (ate) & Can)ri#an, 4''$1. Amon# all of the re!orte) inDuries in hos!ital, $'9 to $59 is attri"ute) to me)ication a)ministration error /MA01 /Hume, $AAA1. 2hese errors occur )ue to non a)herence of nurses

to*ar)s & -i#hts techni3ues of a)ministerin# me)ication /-aDa Co!e, (oo, -ohana & heah, 4''AE Fones & 2rei"er, 4'$'1. (alas, Scott an) -o#ers /4''%1 state) factor such as heavy *orkloa)s, com!le=ity of the !atient.s nee)s interru!tions an) !oor communication amon# health care !rovi)ers *ere contri"ute) to a)ministration error. 2he conse3uences of such errors are increases mor"i)ity, mortality, cost of care an) )elaye) hos!ital )ischar#e) /(ates, ullen & Cair), $AA;E Kohn, orri#an & ,onal)son, $AAAE ,ellemin, 4'':1. Preventive measure to re)uce such error is re>e)ucatin# the nurses a"out the a)herence of the G& -i#hts., im!rovin# nurses. a*areness of the correct ste!s in me)ication a)ministration an) continuin# monitorin# throu#h 3uality assurance stu)ies, re)uce *orkloa) an) increases nursin# staffin# /,emehin, (a"alola & 0rhun, 4''5E -aDa Co!e et al., 4''A1. MA0 inci)ence is hi#h in the other forei#n countries. +n alifornia, over ;'' !atients )ie each year "ecause of this issue /S!eier, 4'''1. +ran.s nurses a)mitte) mean of error in a)ministerin# )ru#s they committe) as 4.4 !er nurses /Mrayyan, Shishani & Al>?aouri, 4'';1. Het in 2ai*an, &;.49 of their nurses ha) e=!erience) of makin# me)ication a)ministration errors / hian#, 4'$'1. +n Malaysia, there are still a fe* stu)ies im!lemente) to*ar)s this issue. 2he violatin# of the &-i#ht !rinci!le in )ru# a)ministration is one of the factors relate) to this issue an) the main error *as *ron# time /-aDa Co!e et al., 4''A1. HUSM status as a teachin# hos!ital an) one of the referral hos!itals in South 0ast Malaysia !lay a maDor factor relates to MA0. (ase) on a stu)y )one "y Mark an) (elyea /4''A1, MA0 in teachin# hos!ital is hi#her )ue to communication an) coor)ination !ro"lems *ith nursin# staff as com!are) to other hos!ital. 2hey i)entifie) the fre3uency of error *as occur in each $ !er $'' )ru# a)ministration an) e=cess *orkloa) as the main factor contri"ute to the MA0 /,emehin et al., 4''A1. Hence, fre3uency an) factor associates *ith MA0 !erceive) "y nurses have to "e i)entifie) in or)er to !revent the inci)ence of me)ication a)ministration error. Conceptual )rame*or+ 2he conce!tual frame*ork of this stu)y is utilize) from 2heory of Ioal Attainment "y Kin#, /$A5$1 an) it centere) on the si= )imensions of nurses. !erce!tion on MA0 a)a!te) "y ,emehin et al. /4''51 an) Wilkins an) Shiel)s /4''51. Si, dimensions o- nurses perception o- medication administration error B Si= )imensions of nurses. !erce!tion on MA0 is a)a!te) from ,emehin et al, /4''51 an) Wilkins an) Shiel)s /4''51 inclu)eB /$1 a*areness to*ar)s MA0, /41 ty!es of MA0, /<1 estimation fre3uency of MA0, /:1 factor of MA0 occurrence, /&1 strate#ies to re)uce MA0 /%1 role overloa). "./ecti0e 2o )etermine nurses. !erce!tion of me)ication a)ministration error /MA01 at sur#ical *ar)s in HUSM. Speci-ic "./ecti0es $. 2o )etermine nurses. !erce!tion of me)ication a)ministration error /MA01 at sur#ical *ar)s in HUSM. 4. 2o )etermine the )ifferences in nurses. !erce!tion to*ar)s role overloa) "et*een sur#ical *ar)s in HUSM. !esearc1 Met1odolog2 2his )escri!tive an) cross sectional stu)y *as to )etermine the nurses. !erce!tion on me)ication a)ministration error /MA01 at sur#ical *ar)s in HUSM. 2he su"Dects *ere recruite) from ei#ht sur#ical *ar)s an) three #rou!s of sur#ical *ar)s *ere create) for the !ur!oses of analysis that is Ieneral sur#ical *ar)s, 6rtho!e)ic sur#ical *ar)s an) 6ther sur#ical *ar)s.

Sample Seventy one sur#ical nurses *ere recruite) usin# ran)omize) stratifie) sam!lin# from Fanuary> ?e"ruary, 4'$$. 'nstrumentations 2his stu)y *as con)ucte) usin# self> a)ministere) 3uestionnaire com!rise) of three main !arts. Part A *as for )emo#ra!hic )ata, Part ( *as for assessment of nurses. !erce!tion on me)ication a)ministration error /MA01 at sur#ical *ar)s in HUSM an) Part assessment of role overloa). Part A *as for )emo#ra!hic )ata. 2he assessment of )emo#ra!hic )ata consiste) of si= items that i)entifie) su"Dects. a#e, #en)er, marital status, level of e)ucation an) num"er of year !ractices. Part ( *as for assessment of nurses. !erce!tion on MA0 at sur#ical *ar)s in HUSM. 2his 3uestionnaire *as a)a!te) from ,emehin, (a"alola an) 0rhun /4''51 an) consiste) of 3uestions on five )imensions of nurses. !erce!tions to*ar)s MA0. 2he )imensions *ere /$1 a*areness, /41 ty!es of error, /<1 estimation fre3uency, /:1 factor occurrence, /&1 strate#ies to re)uce error. Ans*ers for this !art *ere measure) "y usin# close) en)e) 3uestion. Part *as assessment of role overloa) to*ar)s MA0. 2his 3uestionnaire *as a)a!te) from Wilkins an) Shiel)s /4''51 an) consiste) of si= items an) the ans*ers for this !art *ere measure) "y usin# a &>!oint Cikert Scale. A !ilot stu)y *as )one to analyze the relia"ility of this 3uestionnaire. 2he ron"ach al!ha of this 3uestionnaire *as '.%';. !esults MaDority of the sur#ical nurses *ere 4$ to &: years /M@ <'.<5, S,@;.;:1. Most of them *ere female /A'.$91 an) A.A9 *ere male. 2he maDority *ere Malays /A5.%91. Most of them *ere marrie) /;$.591. 2heir level of e)ucation *as )i!loma /55.;91 an) several ha) "achelor.s )e#ree /:.491. 2heir len#th of *orkin# e=!erience ran#e) from one year to <$ years /M@;.;<, S,@;.'<1. Nurses Perception on Medication Administration Error MaDority of nurses /$''91 ha) a*areness of the occurrence of MA0. Mean*hile, the nurses rate) the fre3uency of MA0 *as at $ !er $' )ru# a)ministration /4%.5'91, $ !er $'' )ru# a)ministration /4&.:'91, $ !er $''' )ru# a)ministration /$%.A'91, + )o not kno* the fre3uency of occurrence /$4.;'91, $ !er $'''' )ru# a)ministration /A.A'91 an) the least $ !er $''''' )ru# a)ministration /5.&'91. 2he most ty!e of MA0 !erceive) "y nurses *as *ron# time a)ministration /44.&:91, *ron# )ru# a)ministration /4'.5'91, *ron# )ose a)ministration /4'.5'91 an) )ru# a)ministere) to the *ron# !atient /$5.&'91. 2he least i)entifie) ty!e of )ru# a)ministration error *as *ron# route of a)ministration /$;.<:91. MaDority of the nurses i)entifie) )istractions an) interru!tions )urin# me)ication a)ministration !rocess /$;.<491 as the hi#hest factor contri"ute) to MA0. 2his *as follo*e) "y e=cess *orkloa) /$:.;'91 as the secon) hi#hest factor lea)s to MA0. Most of the nurses i)entifie) me)ication name) *as 3uite similar /$:.$;91, *ron# la"elin# /e.#. me)icine, !atient name1 /$4.%'91, ine=!erience) staff /$$.'491, ina)e3uately traine) staff to a)minister me)ication /A.:&91, lack of )ata concernin# !atient /e.#. !atient name, a#e, *ei#ht, hei#ht1 /;.5;91 an) slee! )e!rivation /%.5491 as the other factor associate) to MA0. Mean*hile, the least i)entifie) factor contri"ute) to MA0 *as unfamiliarity *ith the nursin# unit /e.#. me)ication trolley1 /%.':91. 2he result also sho*e) four im!ortant su##estions to re)uce MA0 in sur#ical *ar)s. MaDority of nurses a#ree) that self>re!ortin# of me)ication a)ministration errors shoul) "e encoura#e) /$:.;&91 as the main su##estion to re)uce MA0. 2his *as follo*e) "y nurses shoul) concentrate *hen )is!ensin# an) avoi) all forms of )istractions /$:.&<91. (esi)es that, continuous !rofessional e)ucation an) re>trainin# of all nurses in the ri#ht *ay of a)ministerin# me)ication is vital so as to ensure strict o"servance of the G& -i#hts. of )ru# a)ministration

/$<.%;91. Cast "ut not least, all !rofessionals involve) in me)ication )elivery /e.#. nurses, !harmacists an) !hysicians1 "e more coo!erative *ith one another /$<.:&91. Nurses Perception on !ole "0erload 6verall, maDority of sur#ical nurses ha) hi#h level of role overloa) /&A.4'91. %1e #i--erences in Nurses Perception to*ards !ole "0erload .et*een Surgical Wards3 2he result reveale) a si#nificant )ifference in nurses. !erce!tion to*ar)s role overloa) "et*een three #rou!s of sur#ical *ar)s /!@ '.'4$1. 2he )ifference *as lie "et*een Ieneral sur#ical *ar)s an) 6ther sur#ical *ar)s /Mean ,ifference @ '.:AJ1. 2a"le :.$B ?re3uency, !ercenta#e, mean, S, of the characteristics amon# nurses in sur#ical *ar)s /n@;$1.
#emograp1ic C1aracteristic A#e /years1 /min to ma=@ 4$ to &:1 Se= Male ?emale Marital status Sin#le Marrie) ,ivorce) 6thers -aces Malay hinese +n)ia 6thers Cevel of e)ucation ertificate in nursin# ,i!loma in nursin# (achelor )e#ree 6thers Cen#th of *orkin# e=!erience /years1 /min to ma=@$ to <$1 Mean (S#) <'.:5 /;.;:1 > > > > > > > > > > > > > > ;.;< /;.'<1 )re4uenc2 (5) > ; /A.A1 %: /A'.$1 4' /45.41 &$ /;$.51 ' /'1 ' /'1 ;' /A5.%1 $ /$.:1 ' /'1 ' /'1 & /;.'1 %< /55.;1 < /:.41 ' /'1 >

2a"le 4B ?re3uency an) !ercenta#e of nurses. !erce!tion on me)ication a)ministration error /MA01 /n@;$1.
Nurses Perception on Medication Administration Error (MAE) A*areness of the occurrence of MA0 at sur#ical *ar)s in HUSM Hes No 0stimate) fre3uency of occurrence $ !er $' )ru# a)ministration )re4uenc2 (5) ;$ /$''1 ' /'1 $A /4%.5'1

$ !er $'' )ru# a)ministration $ !er $''' )ru# a)ministration $ !er $'''' )ru# a)ministration $ !er $''''' )ru# a)ministration + )o not kno* the fre3uency of occurrence 2y!es of )ru# a)ministration error i)entifie) Wron# )ru# a)ministration Wron# )ose a)ministere) Wron# time of a)ministration Wron# route of a)ministration ,ru# a)ministere) to the *ron# !atient ?actor occurrence of MA0 0=cess *orkloa) +ne=!erience) staff +na)e3uately traine) staff Slee! )e!rivation Unfamiliarity *ith a nursin# unit /e.# me)ication trolley1 ,istraction an) interru!tion )urin# me)ication a)ministration !rocess. Me)ication name is 3uite similar Cack of )ata concernin# !atient /e.# !atient name, a#e, *ei#ht, hei#ht1 Wron# la"elin# /e.# me)ication, !atient name1 Strate#ies to re)uce MA0 More nurses shoul) take !art in a)ministerin# me)ications A su!erior or more e=!erience) nurse shoul) )ou"le check )is!ense) me)icines "efore )ru# are a)ministere). 2here shoul) "e a)e3uate orientation an) familiarization *ith a ne* nursin# unit /e.# me)ication trolley, !atient "e)1 Nurses shoul) concentrate *hen )is!ensin# an) avoi) all forms of )istractions All !rofessional involve) in me)ication )elivery /e.# nurses, !harmacist an) !hysician1 are more coo!erative *ith one another. ontinuous !rofessional e)ucation an) re>trainin# of all nurses in the ri#ht *ay of a)ministerin# me)ication is vital to ensure strict o"servance of the G& -i#hts. of )ru# a)ministration Self re!ortin# of me)ication a)ministration error shoul) "e encoura#e)

$5 /4&.:'1 $4 /$%.A'1 ;/A.A'1 % /5.&'1 A /$4.;'1 <% /4'.5'1 <% /4'.5'1 <A /44.&:1 <' /;.<:1 <4 /$5.&'1 &% /$:.;'1 :4 /$$.'41 <% /A.:&1 4% /%.541 4< /%.':1 %% /$;.<41 &: /$:.$;1 <' /;.5;1 :5 /4.%'1 :$ /5.5A1 &$ /$$.'%1 &5 /$4.&51 %; /$:.&<1 %4 /$<.:&1

%< /$<.%;1

%5 /$:.;&1 2here shoul) "e a)e3uate commen)ation an) re*ar) for nurses *ith no recor) of me)ication a)ministration error. &$ /$$.'%1

2a"le <B ?re3uency, !ercenta#e, mean an) stan)ar) )eviation of role overloa) amon# nurses in sur#ical *ar)s /n@;$1.
!ole "0erload Hi#h /K:.''1 Co* /L:.''1 No3 o- nurses (n) :4 4A Percentage (5) &A.4 :'.5 Mean (S#) :.$; /$.A:1

2a"le :B Mean nurses. !erce!tion to*ar)s role overloa) "et*een sur#ical *ar)s /n@;$1.
Surgical *ards Ieneral 6rtho!e)ic 6thers
a. ". 6ne>Way AN68A test JSi#nificant at !L'.'&

n << 4& $<

Mean (S#) <.;4 /'.:51 <.:< /'.%%1 <.4< /'.&<1

)6statistic (d-) :.$'A / 4E %5 1

p6 0alue J'.'4$

2a"le & B Mean nurses. !erce!tion to*ar)s role overloa) *ithin sur#ical *ar)s /n@;$1.
)actor Ieneral 6rtho!e)ic 6thers
c.

Mean <.;4 <.:< <.4<

Mean di--erence eneral >.4A >.:A

"rt1opedic '.4A >.4'

"t1ers '.:AJ '.4'

J2he mean )ifference is si#nificant at the '.'& level.

#iscussion Nurses Perception on Medication Administration Error (MAE) 2he fin)in#s sho*e) that maDority of nurses /$''91 !erceive) a*areness on MA0 issue. Most nurses !erceive) fre3uency of MA0 is at $ !er $' )ru# a)ministrations /4%.591. 2his fin)in# in)icates that there is hi#h fre3uency of MA0 !erceive) "y nurses )ue to the com!le=ity of treatment, )ia#nosis, an) variety of me)ication in sur#ical *ar)s. As a teachin# hos!ital, it also contri"utes to hi#her inci)ence of MA0. 2his is mi#ht "e )ue to )istraction an) )istur"ance from !hysician, co*orkers, stu)ents an) !atients face) "y nurses )aily. Mark an) (elyea /4''A1 in their stu)y i)entifie) that MA0 inci)ence in teachin# hos!ital is hi#her than the other hos!ital. 2his fin)in# *as inline *ith the !revious stu)y )one "y ,emehin, (a"alola an) 0rhun /4''51. -esearchers claime) that the fre3uency of me)ication a)ministration error /MA01 in a teachin# hos!ital in Ni#eria as in $ !er $'' )ru# a)ministration, *hich *as lo*er than the fin)in# in this stu)y. Most of HUSM.s sur#ical nurses !erceive) *ron# time of )ru# a)ministration /44.&:91, a)ministration of *ron# )ose /4'.5'91 an) a)ministration of *ron# )ru# /4'.5'91 *ere the to! three ty!es of MA0 occurre). 2he most im!ortant ty!e of error *as *ron# time of )ru# a)ministration an) it in)icates that nurses *ere una"le to a)minister me)ication at the ri#ht time. 2his is mi#ht "e )ue to heavy *orkloa) face) "y nurses "ecause of ina!!ro!riate nurses to !atient ratio. MA0 *as more likely to ha!!en "ecause lack of staff an) fail to a!!reciate im!ortance of !recise timin# in a)ministerin# me)ication /-aDa Co!e, (oo, -ohana & heah, 4''AE ,eans, 4''&1. 2hese fin)in# #enerally in line *ith !revious stu)y, in)icatin# that *ron# time is the most fre3uent error ty!es /-aDa Co!e et al., 4''AE Cis"y, 4''&E ,eans, 4''&1. 2he fin)in# is inconsistent *ith ,emehin et al. /4''51 *here a)ministration of *ron# )ru# an) *ron# )ose *ere the most ty!e of error occurs. A)ministration of *ron# )ose mi#ht ha!!en "ecause

lackin# of )ata concernin# !atient /a#e, *ei#ht, hei#ht1 an) lea) to incorrect )ru# )ose #iven to !atient. Cack of )ata concernin# a !atient *as amon# the to! three factors contri"ute to MA0 /,emehin et al., 4''51. While, *ron# )ru#s a)ministration ha!!en )ue to nurses "ehavior that )i) not u!)ate their kno*le)#e on the current me)ication an) #et confuse) *ith the names. 2hree factors contri"ute to MA0 !erceive) "y nurses *ere )istractions an) interru!tions )urin# me)ication a)ministration !rocess /$;.<491, e=cess *orkloa) /$:.;'91 an) me)ication name is 3uite similar /$:.$;91. (usy *ar)s environment full *ith !atients, )octors, co*orkers an) stu)ents nee) to "e face) "y nurses. every)ay. Nurses nee) to a)minister )ru#s in a Grush. *ith too many )istractions /Fones & 2rei"er, 4'$'1.When in .rush., some of the & -i#hts techni3ues *oul) "e ski!!e) /-aDa Co!e et al., 4''A1. ,istraction an) interru!tion )urin# )ru# a)ministration *ere the secon) hi#hest factor of MA0 in a teachin# hos!ital in Ni#eria /,emehin et al., 4''51. Ho*ever, this fin)in# is inconsistent *ith Scholz /$AA' ite) in 6.Shea, $AAA1. -esearcher i)entifie) no connection "et*een task interru!tion an) MA0. 2he com!le=ity of sur#ical *ar) rather than the other clinical area alon# *ith ina!!ro!riate nurses to !atient ratio create e=cess *orkloa) amon# nurses. With un!re)icta"le *orkin# area, lon# term hos!italization, )iversity of )ia#nosis an) treatment an) variety of me)ication in sur#ical *ar) ma)e MA0 are !rone to "e ma)e as state) "y Man#ol), Martin, Michaels, -a!ley, Seitz & Sim!son /4''51. 0=cess *orkloa)s *ere the main factor associate *ith MA0 in a teachin# hos!ital in Ni#eria /,emehin et al., 4''51. Nurses not u!)ate) their kno*le)#e on current )ru#s an) lack of e=!osure of recent names an) ty!es of )ru#s use) "y !harmacist *ere the other factor lea)s to MA0. 2his issue creates confusion amon# nurses an) a lot of time )evote) !otentially lea) to *ron# time )ru# a)ministration an) *ron# )ru# a)ministration. MaDority of nurses rate) self re!ortin# of MA0 shoul) "e encoura#e) /$:.;&91 as the main su##estion to re)uce MA0. 2his in)icates those nurses ha) a*areness to re!ort an) share the error they have ma)e. 2his fin)in# is consistent *ith Fones an) 2rei"er /4'$'1 in their stu)y, i)entifie) most nurses a#ree that MA0 shoul) "e re!orte). +t is therefore com!ulsory to i)entify *hat MA0 is, *hen an) *hom to re!ort /,eans, 4''&1.Nurses shoul) concentrate *hen )is!ensin# an) avoi) all forms of )istractions /$:.&<91 *as the other strate#ies to re)uce MA0 !erceive) "y nurses. Presence of stu)ents, )octors an) !rofessionals involve) *ith clinical an) researches in the *ar)s *ere amon# )istraction face) "y nurses. every)ay. Poor communication "et*een nurseM)octors, un)erstaffin#, an) *orkin# *ith ine=!erience) nurse, ina)e3uate li#htin#, ina)e3uate trainin# an) noises *ere amon# )istur"ances #et "y nurses in their unit eventually lea)in# to MA0 /,eans, 4''&1. 2his result is in line *ith the !revious stu)y "y ,avis /$AA:1 as cite) in 6.Shea /$AAA1, i)entifie) that, "ein# a"le to concentrate *hile !re!arin# an) a)ministerin# me)ication *ill #reatly assist in !reventin# errors. 2he other strate#ies i)entifie) "y nurses *as continuous !rofessional e)ucation an) re> trainin# of all nurses in the ri#ht *ay of a)ministerin# me)ication is vital so as to ensure strict o"servance of the G& -i#hts. of )ru# a)ministration /$<.%;91. 2his fin)in# sho*e) that nurses are rea)y to "e re>e)ucate) an) a#ree to #o for further trainin#. Nurses shoul) !erio)ically involve in re>trainin# an) re>e)ucation a"out im!ortance to a)here to the & -i#hts an) the !ossi"le si)e effect that coul) ha!!en if they violate) the techni3ues. 2his is su!!orte) "y -aDa Co!e, (oo, -ohana an) heah, /4''A1 *ho stu)ie) the effect of re>e)ucation the nurses on the & -i#hts techni3ues an) it is successfully re)uce) the me)ication a)ministration error /MA01 !ro"lem. ?rom the fin)in#, most nurses a#ree) that all !rofessionals involve) in me)ication )elivery /e.#. nurse, !harmacist an) !hysicians1 are more coo!erative *ith one another /$<.:&91 as the other su##estion to re)uce MA0 inci)ence. 2his in)icates that nurses. no*)ays *ere rea)y to colla"orate *ith the other health !rofessional as to re)uce MA0. 2his fin)in# is consistent *ith ,emehin, (a"alola an) 0rhun, /4''51 in their stu)y. 2hey i)entifie) that multi)isci!linary a!!roach is necessary to re)uce MA0 an) o!timize the effectiveness of me)ication a)ministration !rocess.

Nurses percei0ed role o0erload in surgical *ard MaDority of the sur#ical nurses !erceive) hi#h level of role overloa) /&A.4'91. With in a!!ro!riate nurse to !atient ratio, heavy emer#ency an) ur#ent *orkloa) occurre) in sur#ical unit, it *oul) lea) to me)ication error inci)ence / o"", (ai#rie, Smith & ?a"er, $A5A1. 2his is relevant *ith the result, "ecause each sur#ical unit in all countries o!!ose) hi#h role overloa) in their area. 2he com!le=ity of the treatment, )ia#nosis, sur#ery, technolo#y an) variety of me)ication are the challen#es that nee) to "e overcome "y nurses. every)ay. ?or overall, hi#h role overloa) is one of the three main factors in this stu)y that contri"ute to me)ication a)ministration error. %1e #i--erence in Nurses Perception to*ards !ole "0erload .et*een Surgical Wards3 2here *as a si#nificant )ifference in role overloa) amon# nurses "et*een Ieneral sur#ical *ar)s, 6rtho!e)ic *ar)s an) 6ther sur#ical *ar)s /!@ '.'4$1 in this stu)y. +t is o"viously "ecause of the com!le=ity an) the varieties of the sur#ical settin#s. 2his fin)in# is consistent *ith Man#ol), Martin, Michaels, -a!ley, Seitz an) Sim!son /4'';1 in their stu)y. 2hey revie*e) that sur#ical nursin# involve) *ith variation in ty!es of !atient, )ia#nosis, level of )e!en)ency, e=!ecte) outcome, so!histicate) e3ui!ment an) technolo#y use) an) these factors contri"ute to me)ication a)ministration error inci)ences. Conclusion and !ecommendation +n conclusion, most of nurses /$''91 !erceive) a*areness on MA0. 2he fre3uency of MA0 rate) *as one !er $' )ru# a)ministration /4%.591. 2he to! three ty!es of MA0 *ere *ron# time of )ru# a)ministration /44.&:91, a)ministration of *ron# )ose /4'.5'91 an) a)ministration of *ron# )ru# /4'.5'91. ?our im!ortant strate#ies to re)uce MA0 *ere self>re!ortin# of MA0 shoul) "e encoura#e) /$:.;&91, nurses shoul) concentrate *hen )is!ensin# an) avoi) all forms of )istractions /$:.&<91, continuous !rofessional e)ucation an) re>trainin# of all nurses in the ri#ht *ay of a)ministerin# me)ication is vital so as to ensure strict o"servance of the G& ri#hts. of )ru# a)ministration /$<.%;91 an) all !rofessionals involve) in me)ication )elivery /e.#. Nurses, !harmacists an) !hysicians1 "e more coo!erative *ith one another /$<.:&91. 2here *as a si#nificant )ifference in role overloa) amon# nurses "et*een Ieneral sur#ical *ar)s, 6rtho!e)ic *ar)s an) 6ther sur#ical *ar)s /!@ '.'4$1 in this stu)y. 2his stu)y is valua"le in that it !rovi)e a "aseline )ata that *ill "e useful for future intervention measures to re)uce MA0. Nurses nee) to esta"lish voluntary re!ortin# system *ithout !reDu)ice an) the )ata *ill "e useful for future recommen)ation to !lan for further action to re)uce MA0. 2he mana#ement unit shoul) sen) nurses for continuous e)ucation an) re> trainin# on the im!ortance of a)herence to the &-i#hts techni3ue an) increase nurses to !atient ratio. Suita"le *ork environment for safe an) effective )ru# !re!aration shoul) "e !rovi)e). Nurses nee) a 3uite !lace to !re!are me)ication /treatment room1. 2ask oriente) is not suita"le to "e !ractice) *hen a)minister )ru# instea) nurses in char#e) for each cu"icle shoul) #ive the me)ication. Pharmacist )e!artment is encoura#e) to !lay their role to !rovi)e a)e3uate e=!osure of current )ru# use) to nurses. &imitations 2he maDor limitation in this stu)y is the res!onse rate. Many of the res!on)ents not return "ack their 3uestionnaire alon# an) it su"se3uently re)uces the si#nificant of this stu)y. Ac+no*ledgement 2he author #ratefully ackno*le)#es ik Norazliah HD Samsu)in for *isely su!ervision in *ritin# the thesis an) for a)vice in *ritin# this manuscri!t. 2he author also *ishes to ackno*le)#e ik Kasmah Wati (t. Par)i *holehearte)ly for e)itin# the manuscri!t.

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-aDa Co!e, -. F., (oo N. H., -ohana, .F. & heah ?. . .4''A/. A 3uality assurance stu)y on the a)ministration of me)ication "y nurses in a neonatal intensive care unit. $inga)ore Med J, 01.1/, 28-32. S!eier, F. /4'''1. S!eier "ill aime) at eliminatin# me)ication errors. -etrieve) $: Au#ust, 4'$', from ***,sen.ca.#ovMs!eier. Wakefiel), ,. S., Wakefiel), (. F., Holmen, 2. U., (or)ers, 2., (le#en, M. & 8au#hn, 2. /$AAA1. Un)erstan)in# *hy me)ication a)ministration error may not "e re!orte). A%erican Journal of Medical &ualit', $:/41. -etrieve) Fanuari 4$, 4'$$, from htt!EMMaDm.sa#e!u".com. Wilkins, K. & Shiel)s, M. /4''51. $A/41. ;>$;. orrelates of me)ication error in hos!itals. !ealth Re)orts,