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. 2024 Feb 1;10(4):e25637.
doi: 10.1016/j.heliyon.2024.e25637. eCollection 2024 Feb 29.

Evaluating deviations and considerations in daily practice when double-checking high-risk medication administration: A qualitative study using the FRAM

Sharon A van Stralen  1 , Linda van Eikenhorst  1 , Astrid S Vonk  1 , Bernadette C F M Schutijser  2 , Cordula Wagner  1   2
Affiliations

Evaluating deviations and considerations in daily practice when double-checking high-risk medication administration: A qualitative study using the FRAM

Sharon A van Stralen et al. Heliyon. .

Abstract

Background: Double-check protocol compliance during administration is low. Regardless, most high-risk medication administrations are performed without incidents. The present study investigated the process of preparing and administrating high-risk medication and examined which variations occur in daily practice. Additionally, we investigated which considerations were taken into account when deviating from the guidelines.

Methods: Ten Dutch hospital wards participated. The Functional Resonance Analysis Method was applied to construct a model depicting the Dutch guidelines and a ward-overarching model visualizing daily practice. To create the ward-overarching model, eight semi-structured interviews were conducted per ward discussing the preparation and administration of high-risk medication. Work related Efficiency-Thoroughness Trade-Off rules were used to structure subconscious considerations.

Results: In total, 77 nurses were interviewed. Six model deviations were found between the guideline model and ward-overarching model. Notably, four variations in double-check procedures were found. Here, time pressure was an important factor. Nurses made a risk-assessment, considering for patient stability, and difficulty of calculations, to determine whether the double-check would be executed. Additionally, subconscious reasonings, such as trusting their own or colleagues expertise, weighed on the decision.

Conclusion: Time pressure is the most important factor that withholds nurses from performing the double-check. Nurses instead conduct a risk-assessment to decide if the double-check will be executed. The double-check can thus become habitual or unnecessary for certain medications. In future research, insights of the FRAM could be used to make ward-specific alterations for the double-check procedure of medications, that focus on feasibility in daily practice, while maintaining patient safety.

Keywords: Double check; Patient safety; Work-As-Done; Work-As-Imagined.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Example of a FRAM hexagon with the corresponding aspects.
Fig. 2
Fig. 2
The WAI-model based on the Dutch guidelines.
Fig. 3
Fig. 3
The ward overarching WAD-model.
See this image and copyright information in PMC

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