Nurse Safety During Medication Administration 

Administering medication is a cornerstone of nursing, which requires adherence to the '5 rights of medical administration'—the right patient, the right drug, the right dose, the right route, and the right time—all taken to increase patient safety and ensure the efficacy of treatments. Whilst these principles are stringently applied to protect those under care, the safety of the nurses conducting the task can sometimes be overshadowed. The protection of nurses during this crucial task is especially relevant as administrating medication can be a major influencing factor in patient aggression and violence.  

 
Medication Administration as a Leading Precipitant of Aggression and Violence

A study published in November 2023 in the Joint Commission Journal on Quality and Patient Safety investigated aggression and violence from patients and visitors within a community hospital and an academic hospital in the United States. The research highlighted administering medication as the leading precipitant to aggressive incidents, with 18.5% of such events precipitated by this. Waiting for care (17.2%) and delivering food and drinks (15.9%) were identified as the next most common factors precipitating aggression. This same study found that nurses were the most common target of aggression and violence and were the target of 41.8% of aggression and violence recorded in the study. 
 

A Recent Incident of a US Nurse Injured Whilst Administering Medication

In November 2023, at Kaua'i Veterans Memorial Hospital in Hawaii, a 22-year-old man bit a nurse whilst she was trying to administer medication. The man had been brought to the hospital after being found unconscious, and when he later became responsive, he became extremely aggressive, threatening healthcare staff and biting the nurse. The nurse received a severe bite injury that required antibiotics and she said that she would be out of work for ten weeks, according to an interview she did with the news channel KHON2. The nurse is calling for stronger measures to prevent this type of injury from happening again.  

Strategies for Enhancing Safety Specifically for Medication Administration

Many states across the US have put, or are in the process of putting, legislation in place to protect healthcare workers from violence better. There are two main approaches that these states are taking to do this, with some states doing both: 

• Establishing laws to increase the criminal penalties for violence committed or threatened against healthcare workers. For example, in December, the Michigan Governor signed into law a bill that notably increases the maximum imprisonment duration and fines for assaults on healthcare professionals, effectively doubling the penalties compared to those for similar offenses not involving healthcare workers. 

• Establishing laws that require healthcare facilities to strengthen worker protection. For example, Texas' SB240 bill requires Texan healthcare facilities to adopt Workplace Violence Prevention Plans by September 1, 2024. 

In the case of aggression during medicine administration, increasing punishments may not have the desired impact of better protecting healthcare workers. Much of the aggression and violence during medicine administration is rooted in factors such as cognitive impairment, confusion, and underlying psychiatric or neurological conditions. It is, therefore, important that all healthcare organizations across the US recognize the risk to healthcare workers from violence and aggression and take initiative-taking measures to protect their staff. 

To mitigate the risks of administering medication, healthcare organizations can adopt several strategies: 

• De-escalation Training: The research study in the Joint Commission Journal on Quality and Patient Safety found that 58.2% of the workers in their study did not have any aggressive behavior management education. Equipping nurses with these skills to calm agitated patients before situations escalate can significantly reduce the risk of violence.  

• Supportive Organizational Policies: Even if not mandated by law, establishing clear protocols for responding to aggression, including immediate support for the nurse involved, is vital. Policies should encourage reporting of all incidents, regardless of severity, to understand patterns and better assess the risks to staff members. 

• Specialized Protective Clothing: Comfortable and dependable protective clothing designed to prevent injury from biting or scratching offers a layer of defence for nurses when conducting close-contact tasks such as administering medication. 

About the Author  

Robert Kaiser is an expert in the prevention of workplace violence related injuries. His written work has been published in several international security and safety focused publications. He is also the Founder and CEO of BitePRO®, the world's first specialised brand of protective clothing, offering dependable scratch and bite protection for those working with individuals displaying challenging behaviour.