Background 
Patient safety has become a global priority, with medication safety one of its key components. Therefore, within the multidisciplinary team, pharmacists are seen as pivotal in researching medication errors and delivering safer healthcare.

Medicines are routinely manipulated from their constituent ingredients into a ready to administer form in ward and departments. Recent UK observational research has highlighted concern with intravenous (IV) medicines doses prepared in clinical areas; errors are common, preventable and pose a substantial risk to patients¹. Identifying issues contributing to these errors is the next step to identify practical solutions to improve patient safety.

The aim of the exploratory study was to gather detailed information on steps nurses take when assembling and preparing IV medicines in real-life situations, what problems they meet and how they resolve these problems.

Methods 
Following ethical approval, nurses involved in IV medicines preparation at an acute teaching hospital were recruited, by opportunistic sampling for in-depth audio recorded interviews. The face-to-face interview schedule was pre-piloted and checked for face validity. Sampling continued until theme saturation (n=16). Using an ethnographic approach, detailed information on the steps, practical problems and solutions encountered during IV medicines assembly and preparations were gathered². Responses were transcribed into QSR Nud*ist, version 6 software for qualitative coding. Common and recurrent themes have been identified using an iterative approach. Further analysis using grounded theory techniques will be undertaken. 

Results 
The sixteen nurses recruited ranged from D grade to I grade, from a wide range of adult medical and surgical areas. Preliminary analysis suggests a common process for IV medicines assembly and preparation. There were numerous problems and concerns identified with current practice, as well as potential solutions. Examples of these are shown below.

Table 1. Common themes identified from in-depth interviews

Conclusions 
The study findings will facilitate prioritisation of manpower and resources to target workable solutions to safeguard patients. Whilst IV preparation continues to be routinely undertaken in clinical areas it is vital to consider the views and concerns of nursing staff.

References

1. Crowley C et al., Describing the frequency of IV medication preparation and administration errors. Hospital Pharmacist 2004;11:330-336.
2. Spradley JP. The ethnographic interview. Belmont: Wadsworth Group, 1979.