CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Medications are therapeutic interventions envisioned to reduce patient suffering, promote healing and improve health and quality of life; however, all medications have potential adverse effects (Metsala et al., 2014). The use of medicines to address the health challenges of patients in the world has increased considerably (Avian et al., 2016). However, the increase in the use of medication is accompanied by medication dosage errors, timing and ineffective monitoring practices. Medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer (Williams, 2014). Drug dosage errors is particularly common in hospitalized patients, especially elderly people, critically ill, pediatric patients and those that require multiple forms of pharmacological therapies (Mirkuzie et al., 2015).

Medication errors may occur in any phase of the medication use process (Mrayyan et al., 2013). The medication use process extends from procuring the medication by the procurement officers; selecting, transcribing and ordering of the medication by the doctors, preparing, dispensing and educating on the medication regimen by the pharmacy attendants; administering and monitoring on the effect of the medication by the nurse and the patient or the consumer who is receiving the medication. Some stages of errors comprise manufacturing, prescribing, transcribing, dispensing, administration of a medication and monitoring of its effects (Dabaghzadeha et al., 2016).

Globally, empirical evidence shows that researchers are concerned by the increased rate of medication error particularly time lapse rate on drug administration, dosage errors and inefficient monitoring practices (Newell et al., 2015). A report from the IOM, (2014) stated that 7,000 deaths could be associated with medication errors annually in the United States. Similarly, (Ammenwerth et al., 2015) estimated that nearly 100,000 individuals per year in the United States (US) die of preventable medication errors especially dosage errors. Aside from death, poor patient safety practices are responsible for the increasing hospital admissions and cost, prolonged hospital stays, use of additional resources, extra cost of litigation, lowering patient satisfaction and undue discomfort (Montesi et al, 2012). It is therefore important to promote safety in the medication process because of the significant consequences associated with medication error.

In Africa, a study by Clifton-Koppel (2018) in Uganda showed that nurses can reduce drug administration errors and improve patient safety by implementing important changes to their individual practice. These changes include reporting medication errors, reducing distractions, independent implementation of safe medication double checks before medication administration, and promoting a safety culture. A prospective observational study carried out in Ethiopia revealed that a total of 196 (89.9 %) administration errors were identified from 218 observations made over a period of 13 days (Feleke et al., 2010). This indicated that at least 15 administrative errors were committed each day in the hospital.

In Cameroon, a study conducted by Sulami et al. (2013) on medication errors in the Yaounde referral Hospital in Nsimbock revealed that the most frequent types of reported medication incidents errors were drug administration related errors. A recent systematic review of drug administration error prevalence in healthcare settings in the East Region of Cameroon found that nursing administration error is the most common type of medication error in health facilities, reporting an estimated median of 19.1 % of total opportunities for error in hospitals (Keers et al., 2013). There is potential for a drug administration error to occur with each dose of medication due to the complex nature of the medication administration process. It is therefore imperative that drug administration errors are detected and reported by nurses

1.2 Problem Statement

The increase in the use of drugs has also brought about an increase in associated medication errors (Avian, 2014). Most of these drug administration timing, dosage errors and monitoring practices are responsible for one-third of medication errors leading to poor patient recovery, death, decreased client satisfaction, and other forms of harm to patients (Westbrook et al., 2012). Failure to administer medications at the right time is the error that occurs most frequently in the medication administration process. Healthcare professionals do not intentionally commit errors; however, inadequate systems predispose individuals to committing errors. In one analysis, 78% of errors were caused by seven system failures, with the leading problem (28%) attributed to failure to disseminate drug information. Elements such as missing patient information, patient education, inadequate drug information, impaired communication, staffing inadequacies, product labeling and nomenclature, staff education, and competency may interrupt the medication use process and contribute to time lapses, dosage errors and limited monitoring practices. During our internship at the Regional Hospital Buea, the investigator noticed that patients who are admitted into hospitals experience approximately one medication error per day of their stay in the hospital. Sometimes nurses and midwives forget to chart, transcribe and monitor infusions.  For the past decades, no study has been conducted at the Regional Hospital Buea in this domain. It is based on this the researcher seeks to assess the time lapses, dosage errors and monitoring practices among nurses at the Regional Hospital Buea.

1.3 Research Questions

1. What is the time lapses in administration of drugs among nurses and midwives at Buea Regional hospital?
2. What are the dosage errors on drug administration among nurses at the Buea Regional Hospital?
3. What are the monitoring practices on drug administration among nurses at the Buea Regional Hospital?

1.4 Research Objectives

1.4.1 General Objective

To assess drug administration timing, dispensing and monitoring practices among nurses at the Buea Regional Hospital.

1.4.2 Specific Objectives

1. To evaluate the time lapses in administration of drugs among nurses and midwives at Buea Regional hospital.
2. To identify dosage errors on drug administration among nurses and midwives at the Buea Regional Hospital
3. To assess the monitoring practices of drug administration among nurses and midwives at the Buea Regional Hospital.