الفهرس 
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Abstract
Nursing has been challenged to do more with less for years! We are caring for more patients, using fewer resources, trying to work faster, better, and more efficiently than ever before, while striving to maintain customer satisfaction and high-quality care. With endless increases in technology and complexity of patient care, safety has been a priority of nurses for years.
Six sigma is a method and management philosophy that attempt to improve processes and customer satisfaction to near perfection, reduce defects, reduce variation and ensure continual improvement. Competition in healthcare sector is forcing healthcare organizations to look for new ways and means for improving their processes especially medication administration because of medication administration process can result in low patient satisfaction, also medication errors is a high risk for patient.
The current study is aiming to assess medication administration errors among nursing staff through:
1. Assess nurse’s level of knowledge and performance regarding medication administration errors.
2. Using six sigma methodology to evaluate medication errors among nursing
Research Question: did six Sigma methodology is effective in measuring medication errors among nursing staff?
To achieve these goals the study was conducted in inpatient units’ at As-Salam international hospital, the sample of the study was including hundred nurse who are working at medical surgical floors the sample included both males and females regardless of their qualification.
Data were collected using:
Three types of tools were used for data collection:
Questionnaire sheet used as to assess nurse’s level of knowledge regarding medication errors.
Observational check list used to assess the skill practice before, during and after administration.
Six sigma tools which was used by researcher, incident reports, Pareto chart, cause and effect diagram (fish bone) and process map.
The study reveals that:
The main study finding were as the following: majority of the study sample were male young adults 32%at medical floors their age between 20<30 while at surgical floors 60% their age between 20<30. As regard the years of experience the majority of studied sample their experience less than five years, 52% of the study sample holding technical institute degree while the minority was holding Bachelor degree.
As regard previous training the result revealed that more than half of the study sample in both medical and surgical floor had obtained previous training on medication administration the number of training courses attend related to medication administration 20%in surgical floors attended four courses while 16%from medical floors attended four courses, as regard reading of medications administration manuals 76% in medical floors didn’t read vs. To 36% didn’t read at surgical floors, the study revealed that adequate total nurse’s knowledge in both setting medical satisfactory knowledge ranged between 24%-100%at surgical floors and ranged between 4%-100%at medical floors, there was significant difference related to drug calculation P-value <0.05* and highly significant in both setting medical and surgical floors regarding documentation the P-value <0.01**.
As regard nurses performance the study revealed that, the percentage of satisfactory performance at surgical floors ranged between 7.7%-30% and unsatisfactory performance ranged between 70%-93.3% and the percentage of satisfactory performance at medical floors ranged between 14%-24% and unsatisfactory performance ranged between 82%-100%.
The vital few of the problem was, missed dose (extra medication found in the patient medication box and reflects that the dose is not given at its time and/or although it’s have been signed in medication sheet as given. Final root causes of medication administration errors (missed dose) revealed that the problem was in the process itself as well as human errors, it was explained as follows:
Poorly designed process (type of distribution system), delay of the process, and overload during the porter transport the drug from the pharmacy. Errors (receiving &checking) the drug from pharmacy. Delivery during rush hours No control over the medication room. Lack of bachelor degree nurses Incompetent medication nurse (years of experience).Training deficit (incomplete number of training courses). Nurse’s patient ratios. No double check mechanism. Noisy environment and the over confident feeling of the nurses after the hospital got the JCI first accreditation as they are not complied with the double check policy. The number of training courses required, and poor Supervision level.
The study recommended that:
For Education:
Raising awareness of Six Sigma concept and methodology for all organizational wide.
Conduct a training courses related to medication administration to all levels of care providers.
For Practice:
Suitable work environments should exist for the preparation of drug products. Potential error sources within the work environment, such as frequent interruptions, should be identified and minimize.
Develop systematic program of quality improvement and peer review to assist in identifying and eliminating causes of errors (system breakdowns) and preventing their recurrence
Double check mechanism by involved care giver.
Standard drug administration times should be established for the hospital by the pharmacy &therapeutic committee (or its equivalent), with input from the departments of nursing and pharmacy. Policies and procedures should allow for deviations from the standard times when necessary. Further, standard drug concentrations and dosage charts should be develop to minimize the need for dosage calculations by staff.
High-risk drug products in the nursing units when possible, should be checked by a second individual (preferably, another registered nurse).
All drug orders should verify before medication administration. Nurses should carefully review original medication orders before administration of the first dose and compare them with medications dispensed.
Nurses should check the identity and integrity (e.g., expiration date and general appearance) of the medications dispensed before administering them. When there are discrepancies, the nurse should contact the pharmacy department and determine the appropriate action.
Patient identity should verify before the administration of each prescribed dose. When appropriate, the patient should observe after administration of the drug product to the patient should observe after administration of the drug product to ensure that the doses were administer as prescribed and have the intended effect.
All doses should be administered at scheduled times unless there are questions or problems to be resolved. Medication doses should not remove from packaging or labeling until immediately before administration. The administration of medication should document as soon as it is completed.
The Further Study:
Apply the similar study in other hospital, (government and privet hospitals), but it is recommended to continue in the same hospital which the study is conducted.