Medication administration safety assessment tool: Construction and validation

To build and validate the Patient Safety Assessment in Medication Administration (ASPAM - Avaliação da Segurança do Paciente na Administração de Medicamentos) tool.

Method:

Methodological study in which the construction, Content Validation Index (CVI), construct validation (factorial analysis) and reliability were performed in terms of homogeneity (Cronbach’s Alpha).

Results:

The ASPAM reached CVI of 0.77 for simplicity, 0.76 for clarity and 0.93 for relevance. The exploratory factorial analysis was adequate for the tool (Kaiser-Meyer-Olkim of 0.66 and Bartlett’s sphericity with p <0.001). The Cronbach’s Alpha end of the scale with 28 items was 0.85.

Conclusion:

The ASPAM tool was valid and reliable for the identification of risk-generating conditions for the occurrence of Adverse Drug Events.

Descriptors:
Patient Safety; Drug Utilization; Validation Studies; Medication Errors; Nursing Care

Items of the 1^st version of the tool	Content Validity Coefficient			Items of the 2^nd version of the tool
Items of the 1^st version of the tool	S^* * Simplicity;	C^§ § Clarity;	R^£ £ Relevance.	Items of the 2^nd version of the tool
1. Uses at least two identifiers to confirm the right patient before administering medications.	0.85	0.57	1	1. Uses at least two identifiers (full name and medical record number) to confirm the patient before administering the medication.
2. Verifies the name of the prescription medication before administering it.	1	0.85	1	2. Verifies the name of the prescription medication before administering it.
3. Brings to the bed only what is prescribed to a single patient, not using a tray containing several medications for different patients.	0.71	0.71	1	3. Brings to the bed only the medications prescribed to a single patient.
4. Administers medication by verbal order only in case of emergency, with written record of the verbal order.	0.57	0.57	0.85	4. Administers medication by verbal order only in case of emergency.
5. Checks if patient is allergic to the prescribed medication, identifying the allergic patient in a differentiated way, with a bracelet and a warning on the chart, alerting the whole team.	0.57	0.71	1	5. Checks if patient is allergic to the prescribed medication.
	0.57	0.71	1	6. Identifies the allergic patient in a differentiated way with a bracelet and a medical record, alerting the whole team.
6. Identifies the prescribed route of administration, verifying if it is the technically recommended route of administration for a given medication.	0.71	0.71	1	7. Identifies the route of administration prescribed for the medication.
	0.71	0.71	1	8. Checks if the prescribed route is technically recommended for administering the medication.
7. Washes hands before preparation and administration of medications.	1	1	1	9. Washes hands before preparation and administration of medications.
8. Uses aseptic materials and techniques to administer medications intravenously and to other routes requiring this type of technique.	0.71	0.71	0.85	10. Uses aseptic materials and techniques to administer medications.
9. Prepares the medication immediately prior to its administration, obeying the schedule of the prescription.	0.71	0.71	1	11. Prepares the medication immediately prior to its administration.
10. Administers the medication at the right time.	0.71	0.85	1	12. Administers the medication at the right time.
11. In cases of patient preparation for exams or fasting, do not administer or postpone the administration of doses without discussing conduct with the prescriber.	0.71	0.57	0.85	Excluded
12. Adjusts the administration times of the medications to the routine of use already established before the hospitalization.	1	1	1	13. Adjusts the administration times of the medications to the routine of use already established before the hospitalization.
13. Discusses the prevention of medication-medication and medication-food interactions with the multiprofessional team.	0.71	0.71	1	Excluded
14. Carefully checks the dose prescribed for the medication.	1	1	1	14. Carefully checks the dose prescribed for the medication.
15. Makes sure that the scheduled infusion is the one prescribed for that patient.	0.85	0.71	0.71	Excluded
16. Confers the drip speed, programming and operation of continuous infusion pumps with the prescription.	0.85	1	1	15. Checks the drip speed, programming and operation of continuous infusion pumps with the prescription.
17. Performs double check of calculations for preparation and for administration of potentially dangerous or high vigilance medications.	1	1	1	16. Performs double check of calculations for preparation and for administration of potentially dangerous or high vigilance medications.
18. Uses standard measuring tools to prepare medications to measure doses accurately (e.g., millimeter syringes).	1	1	1	17. Uses standard measuring tools to prepare medications to measure doses accurately (e.g., millimeter syringes).
19. Returns leftover unadministered medications to the pharmacy.	0.85	0.85	1	18. Returns leftover unadministered medications to the pharmacy.
20. Checks the timing of administration of the medication immediately after each dose.	0.57	0.57	1	19. Records the time of administration of the medication immediately after each dose.
21. Records all medication-related occurrences (delays, cancellations, discontinuation, patient refusal and adverse events) and the different effects (in intensity and form) expected from the medication described by the patient/companion or observed for the team.	0.57	0.57	1	20. Records all medication-related events (e.g., postponements, cancellations, shortages, patient refusals, side effects, and adverse events).
	0.57	0.57	1	28. Informs the prescriber of all effects other than expected (in intensity and shape) for the medication.
22. Guides the patient and the caregiver about the medication administered (name), aspect (color and shape), justification of the indication, frequency with which it will be administered, expected effects, possible incidents related to the medication therapy, registering them in medical records and notifying them to the Risk Management and/or the Patient Safety Center.	0.57	0.57	0.71	21. Notifies the Risk Management and/or Patient Safety Center of any incidents related to medication therapy.
	0.57	0.57	0.71	25. Guides the patient and the companion about the name of the medication administered, aspect (color and shape), justification of the indication, frequency with which it will be administered and expected effects.
23. Checks whether the medication to be administered has the pharmaceutical form and route of administration prescribed.	0.42	0.42	0.71	26. Checks if the medication to be administered is in a pharmaceutical form (e.g., Ampoule, vial, tablet) compatible with the prescribed route of administration.
24. Observes the patient to identify, if possible, whether the medication had the desired effect.	0.71	0.85	1	27. Evaluates the patient to identify, if possible, whether the medication has the desired effect.
25. Clarifies doubts about the readability of the prescription, the indication of the medication, its dosage, vacuous prescription ("do if necessary", "at medical discretion"), unit of measures used, pharmaceutical form, route of administration and dose directly with the prescriber.	0.85	0.85	0.85	24. Clarifies doubts about prescribing before the prescriber before administering the medication (e.g., Ineligibility of prescription, indication of the medication, dosage, "if necessary", "at medical discretion", unit of measures used, pharmaceutical form, route of administration and dose).
26. Only administers the medication if the doubts are cleared.	0.71	0.71	1	Excluded
27. Keeps standardization regarding adequate storage and complete and clear identification (with date and time of the manipulation, concentration of the medication, name of the person responsible for the preparation and validity) of all medications that are under the care of the nursing team.	0.85	0.85	0.85	22. Keeps adequate records of prepared medications to be stored (date and time of the manipulation, concentration of the medication, name of the person responsible for the preparation and validity).
28. Monitors the temperature of the medication packaging refrigerator, recording the maximum and minimum values daily.	1	1	1	23. Monitors the temperature of the medication packaging refrigerator, recording the maximum and minimum values daily.
Total Criterion Content Validity Coefficient	0.77	0.76	0.94

Domain	Patient Safety Assessment in Medication Administration	Frequency
		Never	Almost never	Sometimes	Almost always	Always
		1	2	3	4	5
Right patient	1. Uses at least two identifiers (full name and medical record number) to confirm the patient before administering the medication.
Right medication	2. Verifies the name of the prescription medication before administering it.
	3. Brings to the bed only the medications prescribed to a single patient.
	4. Administers medication by verbal order only in case of emergency.
	5. Checks if patient is allergic to the prescribed medication.
	6. Identifies the allergic patient in a differentiated way with a bracelet and a medical record, alerting the whole team.
Right Route	7. Identifies the route of administration prescribed for the medication.
	8. Checks if the prescribed route is technically recommended for administering the medication.
	9. Washes hands before preparation and administration of medications.
	10. Uses aseptic materials and techniques to administer medications.
Right Time	11. Prepares the medication immediately prior to its administration.
	12. Administers the medication at the right time.
	13. Adjusts the administration times of the medications to the routine of use already established before the hospitalization.
Right dose	14. Carefully checks the dose prescribed for the medication.
	15. Checks the drip speed, programming and operation of continuous infusion pumps with the prescription.
	16. Performs double check of calculations for preparation and for administration of potentially dangerous or high vigilance medications.
	17. Uses standard measuring tools to prepare medications to measure doses accurately (e.g., millimeter syringes).
	18. Returns leftover unadministered medications to the pharmacy.
Right Record Of the Administration	19. Records the time of administration of the medication immediately after each dose.
	20. Records all medication-related events (e.g., postponements, cancellations, shortages, patient refusals, side effects, and adverse events).
	21. Notifies the Risk Management and/or Patient Safety Center of any incidents related to medication therapy.
Right Record Of the Administration	22. Keeps adequate records of prepared medications to be stored (date and time of the manipulation, concentration of the medication, name of the person responsible for the preparation and validity).
Right Record Of the Administration	23. Keeps adequate records of prepared medications to be stored (date and time of the manipulation, concentration of the medication, name of the person responsible for the preparation and validity).
Right Guidance	24. Clarifies doubts about prescribing before the prescriber before administering the medication (ex: Ineligibility of prescription, indication of the medication, dosage, "if necessary", "at medical discretion", unit of measures used, pharmaceutical form, route of administration and dose).
Right Guidance	25. Guides the patient and the companion about the name of the medication administered, aspect (color and shape), justification of the indication, frequency with which it will be administered and expected effects.
Right way	26. Checks if the medication to be administered is in a pharmaceutical form (e.g., Ampoule, vial, tablet) compatible with the prescribed route of administration.
Right answer	27. Evaluates the patient to identify, if possible, whether the medication has the desired effect.
Right answer	28. Informs the prescriber of all effects other than expected (in intensity and shape) for the medication.

Component	Total Variance	% of variance	% cumulative
1	6.897	24.633	24.633
2	2.676	9.557	34.190
3	2.492	8.900	43.090
4	1.985	7.090	50.179
5	1.568	5.601	55.780
6	1.327	4.738	60.519
7	1.143	4.082	64.600
8	1.138	4.063	68.663
9	0.956	3.413	72.076

Item	Cronbach's Alpha if the item is excluded
1	0.843
2	0.850
3	0.848
4	0.849
5	0.846
6	0.853
7	0.847
8	0.844
9	0.850
10	0.845
11	0.845
12	0.846
13	0.843
14	0.849
15	0.851
16	0.844
17	0.842
18	0.844
19	0.848
20	0.842
21	0.836
22	0.846
23	0.855
24	0.845
25	0.842
26	0.848
27	0.842
28	0.841

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Patrícia Rebouças Araújo E-mail: enfapatriciaaraujo@yahoo.com.br