الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Medications are of a great benefit to patient’s lives for relieving pain or curing illness. Medications may be very dangerous if improperly used, moreover medication safety is one of the highest priorities of nursing practice, a matter of considerable concern for all health team members. Medication errors produce a variety of problems for patients ranging from minor discomfort to substantial morbidity that may prolong hospitalization or lead to death and risk of litigation Rosen, Galili, Kott, Goodman & Freedman, (2018).
Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually. Errors can occur at different stages of the medication use process. Medication errors occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death Thomas et al. (2019).
Aim of the study:
This study aimed to assess the effect of medication safety guidelines on prevention/ decreasing the medication errors frequency rate among the nurses in the intensive care unit.
Through the following:
1. Assessing the nurses’ level of knowledge regarding medication safety overview and medication safety guidelines’ components.
2. Assessing the nurses’ level of practice pre application of the training program regarding medication safety guidelines’ components.
3. Assessing types and frequency rate of medication errors in the ICU; pre application of medication safety guidelines’ components.
4. Applying the training program regarding medication safety guidelines’ components for the nurses based on their needs assessment.
5. Evaluating the nurses’ level of knowledge post application of the training program regarding medication safety guidelines’ components.
6. Evaluating the nurses’ level of practice post application of the training program regarding medication safety guidelines’ components.
7. Assessing types and frequency rate of medication errors in the ICU; post application of the training program regarding medication safety guidelines’ components.
Research Hypothesis
The current study hypothesized that:
H1: The medication safety guidelines application will have a significant positive effect on prevention/ decreasing the medication errors frequency rate among the nurses in Intensive Care Unit.
Study design:
A quasi experimental design used to achieve the aim of the current study.
Setting:
This study was conducted at the three intensive care units (MICU, SICU & CCU), affiliated to Kafr elsheikh University.
Subjects:
A convenient sample included all available nurses at the time of the study (n=59), who are working in the mentioned setting and accepted to participate in the study, from both gender, with bachelor degree qualification, different age groups, and years of experiences were recruited to this study.
Study tools:
1- Self-administered questionnaire; consisted of two parts
A. Demographic data
It was concerned with the demographic data (years of experience, Gender, qualifications, job title, and unit of specialty).
B. Nurses’ knowledge assessment:
It was developed by the researcher after reviewing the recent literature review, Mullner & Chung, the American Hospital Association & Institute for safe medication practice, (2002) & Zayed, (2012). It used to assess the nurses’ level of knowledge regarding medication safety guidelines’ pre and post its application.
Part a: Concerning medication safety overview, which included (5 questions) about patient safety, medication safety, medication errors, medication errors’ types and medication errors’ reasons.
Part b: Concerning medication safety guidelines which included 10 components distributed as the following; drug labeling, packaging, and nomenclature (8 items), drug storage, stock and standardization (8 items), environmental factors (7 items), patient information (8 items), drug information (7 items), communication of drug information (11 items), staff competency and education (10 items), patient education (6 items), quality process and risk management (9 items) & drug device acquisition, usage and monitoring (10 items). So the total items of the guidelines components were 89 items.
2- Nurses practice observational checklist:
This tool was developed by the researcher after reviewing the related literature WHO (2017), Adrienne (2014) & Cheragi, Manoocheri, Mohammadnejad & Ehsani, (2013). It was designed to assess the nurses’ practice; regarding medication safety guidelines’ 10 components and estimate the frequency of medication errors types which included (13) types, pre and post guidelines’ application.
Results:
The important findings obtained from the study can be summarized as following:
• 52.54% of the studied nurses were in the age category (25 < 30 years), 79.66% of them were females & 100% had a bachelor degree. In relation to the ICU type 40.68% were in medical ICU, (79.66%, 15.25%, and 5.08%) were staff nurses, charge nurses and head nurses respectively. Regarding nurse patient ratio; it was found that 100% of them were assigned to only 2 patients).
• 91.98% of the studied nurses had a proper knowledge regarding medication safety guidelines’ components post application than pre 73.68% with a highly significant difference at (P≤ 0.001).
• 88.26% of the studied nurses had proper practice regarding medication safety guidelines’ components application post than pre 42.06% with a highly significant difference at (P≤ 0.001).
• The frequency rate of all types of medication errors’ was decreased among the ICU nurses post medication safety guidelines’ components application 0.9% than pre 4.46% with a highly significant difference at (P≤ 0.001).
• There was a significant positive correlation between the studied nurses’ total knowledge and total practice pre and post guidelines application (r =0.702, p=0.002).
• There was a significant negative correlation between total practice and total frequency rate of medication errors pre and post guidelines application at (r: -0.711, p: 0.003 & r: - 0.568, P: 0.009 respectively).
Conclusion
Based on findings of the present study, it can be concluded that:
The application of the medication safety guidelines had a highly statistically significant positive effect on the studied nurses’ knowledge and practice, and consequently decreased the frequency rate of medication errors; which support the stated research hypothesis.
Recommendations
The important recommendations inferred from the study results were:
1. Continuous in-service training programs for all ICU nurses at different hospitals regarding the suggested medication safety guidelines for decreasing the frequency rate of medication errors.
2. Arabic booklet about medication safety guidelines should be available for all ICU nurses at all settings.
3. Further researches are recommended to study the impact of the program regarding medication safety guidelines & medication errors on nurses’ performance on the long run.
4. Further researches are recommended to study the factors affecting nurses’ compliance regarding following medication safety guidelines components.
5. Using the study findings as a basis for construction of training endeavors based on identified knowledge and practice gaps to respond to their unmet needs.
6. Building a safety culture in the health care setting which provides a comforting environment for the ICU staff nurses regarding the improvement of reporting medication errors.
7. Further researches are needed to study the impact of medication safety guidelines & medication errors frequency rate on patient progress and length of stay.
8. Collaboration between pharmacists and nurses is paramount to improve the quality of drug supply chain and decrease the risk of medication errors.
9. Publishing posters containing medication safety guidelines in all ICUs in different health care setting.
10. Periodical assessment of the ICU nurses knowledge and practice to detect the areas to be covered in training education courses to improve their practice regarding medication management and medication errors.
11. Replication of the research study on a large probability sample is recommended to achieve more generalization.