Registered nurses play a critical role in the health care system. ANAs Code of Ethics demands nurses take an active role in addressing the environmental system factors and human factors that present increased risk to patients, says Rebecca M. Patton, MSN, RN, CNOR, president of the American Nurses Association. Proper and consistent syringe labeling is one way to reduce risks associated with medication errors.
The 2007 Study of Injectable Medication Errors was developed and co-sponsored by the ANA and Inviro Medical Devices. It was designed to capture opinions, concerns and experiences about challenges related to labeling on syringes, which has been a Joint Commission recommendation since 2006. Results of the study can be downloaded at www.nursingworld.org.
Injectable medication errors
When asked about the point in the process medication errors are most likely to occur, the majority of nurses say either during the preparation and administering of medication to patients (48 percent), or during the transcription of the initial order (47 percent).
To help reduce injectable medication errors, the vast majority of nurses (81 percent) believe their healthcare facility should ensure sufficient staff is available for timely and efficient administration.
Nurses indicate the most common factors contributing to injectable medication errors are:
Too rushed / busy environment (78 percent)
Poor / illegible handwriting (68 percent)
Missed or mistaken physicians orders (62 percent)
Similar drug names or medication appearance (56 percent)
Working with too many medications (60 percent)
Frequency of syringe usage
Nearly half (44 percent) of nurses say they inject medicine via a syringe more than five times per shift, and more than one-third (37 percent) administer injectable medication at least one time per shift.
Labeling injectable medication
Slightly more than one-third (37 percent) of nurses claim injectable medications are always labeled. However, this study identified that as many as 28 percent of nurses nationwide do not label syringes when using them. Of the 72 percent who do, in fact, label syringes, they do so by:
Writing on self-adhesive labels then applying to syringe (54 percent)
Writing on pieces of tape and adhering to syringe (31 percent)
Using Sharpie® and writing directly on syringe (11 percent)
Writing on paper or sticky note and taping to syringe (4 percent)
While 62 percent are aware of The Joint Commissions 2007 National Patient Safety Goals addressing the labeling of all medications and medication containers, only half (51 percent) of respondents are aware that The Joint Commission has determined that the pre-labeling of syringes does not meet labeling goals, since the label should be prepared only at the time the medication or solution is prepared.
Challenges of labeling
Challenges often arise when attempting to label a syringe. Labels covering measurement gradations on the syringe barrel pose the greatest problem (65 percent). Fifty-five percent of nurses consider the absence of a suitable label poses the greatest challenge, while 39 percent think a label impairs their ability to accurately check the dosage when comparing it to the order.
Benefits of a write-on stripe
When nurses were asked their opinions about a write-on stripe manufactured on the syringe, the vast majority (95 percent) believe the greatest benefit is the fact that it would not interfere with visibility of the syringe content or gradations on the syringe barrel. Ninety-three percent believe it will reduce the risk of error, while 92 percent of nurses say a write-on stripe also helps address The Joint Commissions goal for medication labeling.
This research confirms that our healthcare systems need new technology that simply and efficiently improves patient and employee safety, says Gareth Clarke, chief executive officer of Inviro Medical Devices. To help address the challenges associated with injectable medication errors and to comply with The Joint Commissions goal for medication labeling, we are adding the InviroSTRIPE® feature -- an integral write-on stripe that allows for critical information to be recorded directly onto the syringe barrel -- to our full range of InviroSNAP!® safety syringes and our standard luer lock syringes.
Nurses influence on selection of sharps devices
Eighty-one percent of nurses reveal that safety syringes are used in most or all departments within their healthcare facility. Even though the 2000 Needlestick Safety and Prevention Act (NSPA), adopted as public law 106-430 by the 106th Congress, mandates that institutions conduct annual product reviews and that nurses be involved in the decision-making process, the majority of nurses (58 percent) say they do not have an opportunity to influence the selection of sharps safety devices used at their healthcare facility.
Additional health and safety concerns
According to 65 percent of nurses, health and safety concerns play a key role in determining the specific area in which they choose to work, as well as their decision to continue practicing.
The top four health and safety concerns for nurses nationwide are acute / chronic effects of stress and overwork (72 percent), back injuries (67 percent), infection of tuberculosis or other infectious disease (38 percent), and getting HIV or hepatitis from a needlestick injury (35 percent).
The study also reveals that 55 percent of nurses have experienced needlestick injuries from needles contaminated by blood or body fluids.
We are honored to support ANAs goal to continue bringing value to its members by addressing topical workplace issues with this survey, says Jean McDowell, vice president of clinical affairs for Inviro Medical Devices. Inviro Medical will apply the input secured from front-line nurses to further improve our safe medication delivery systems.
This study clearly indicates a need for the right safety equipment -- especially in regard to injectables -- to reduce the risk of medication errors and sharps-related injuries, adds Patton.
Conducted in April, the 2007 Study of Injectable Medication Errors is based on an online, nationwide survey of nurses. The study is sponsored by the American Nurses Association, with support provided by Inviro Medical Devices. The surveys margin of error is plus or minus 3 percent.
Of the 1,039 nurses surveyed:
22 percent have been a nurse for one to five years
12 percent have been nurses for 6 to 10 years
15 percent have been nurses for 11 to 15 years
51 percent have been nurses for more than 15 years
Source: American Nurses Association (ANA) and Inviro Medical Devices