Abstract
Most drugs administered in hospital are given by mouth. An important part of the nurses' work is to ensure that the drugs prescribed by the doctor and provided by the pharmacist, are administered to the patient safely and accurately. Safe, therapeutically effective drug administration is dependent on the nurses' knowledge of medications and a careful monitoring of their effects on his/her patients. This aspect of care requires appropriate decision making and adherence to the UKCC Standards for the Administration of Medicines (1992). This study is concerned with oral drugs which have special recommendations in relation to food. Previous unpublished pilot studies in this area Carr (1984), Hayden (1990) and Dronfield (1993) have shown that special recommendations which are important to the bioavailability of these drugs, are not always indicated on drug charts nor followed during their administration. Research questions were developed concerning current practices regarding drug administration, nurses' knowledge regarding these specific drugs and questions relating to some of the key concepts necessary for optimum nursing behaviour. A representative sample (n=107) was drawn from the population of qualified nurses in an acute NHS Trust. Triangulation, involving various methodologies was used but the major approach was qualitative. Current practices were explored using an observation study. The administration by nurses of drugs with special recommendations for food was examined as well as the additional instructions needed from doctors and additional information required from pharmacists. Nurses' knowledge regarding these specific drugs was examined using a questionnaire survey. Nursing practice itself was investigated using a concept modelling method, Dynamic Concept Analysis (Kontiainen 1991). Five concepts, skill, knowledge, experience, preparation and power were used to create a general information structure from which 107 individual models were created. The findings showed that from the observation study there was a 50/50 chance of the patients taking these oral drugs accurately. Nursing knowledge was found to be variable across Grades (C to G). The most senior nurses were not always the most knowledgeable. DCA showed that from the nurses who took part in the study, only 23, 21.5% could demonstrate practice which was closest to the optimum model. None were demonstrating optimum practice. When specific nursing specialities were analysed, oncology nurses were seen to be administering the drugs in the most appropriate way. Nurses working in surgery medicine and orthopaedics were administering drugs safely but not always accurately according to food intake. In order to improve the situation, educational implications were explored with an urgent recommendation for additional applied pharmacology to be included in pre and post registration curriculums. Reflection was also explored both as an educational learning activity and as a method for developing creative/experiential practice. There is an urgent need to review hospital policies and procedures regarding drug rounds. Most wards still use drug trolleys which appear to be a major contributing factor to these findings. Contemporary practice involving risk assessment, standard setting, and the development of clinical research-based guidelines must be implemented in order to prevent the therapeutic effect of these oral drugs being diminished.