The current discussion covered the following sections, First finding related to demographic characteristics, Second findings related nurse's practices regarding medication errors. And finally correlation and additional findings pertinent to the study. Concerning frequency distribution of nurses practices' errors regarding medication administration in different critical care settings at a teaching Hospital in Upper Egypt. The present result showed that only more than one-third of nurses had satisfactory practices level in the preparation of medication and during medication administration. On the other hand, the majority of them had satisfactory level of practice after drug administration and only one third of them had total satisfactory performance about drug administration. So the nurse obtained low mean practice scores in preparation of medications and , during administration when compared to post administration. This happening may due to lack of training, inaccessible guidelines for medication administration, interruption while administering medication, limited communication with another nurse when they encountered a problem, and inability to adhere to rights of medication administration
This result come in the line with{ 23 } who studied the knowledge, attitude and practice of nurses in administering medications at Mansoura University Hospitals who revealed greater than three quarters of the nurses have got unsatisfactory practice score with respect to drug preparation as well as nurse's had got unsatisfactory practice level regarding medication administration. Besides, { 24 } who studied in North West Ethiopia knowledge, attitude and practice of patients' medication counseling among drug dispensers who reported that post medicine practice requires improvement. This finding might be ascribed to the persistent workload that makes the nurses practice described by low-level of performance.
Regarding the nurses' done/not practices during preparation of medication, the current study revealed that almost three fourth of critical care nurses didn’t check instructions regarding administration of drugs. This may have relevant to absence of monitoring and follow up of nurses' action steps during administration of medication. The present finding contradicted with {25 } who studied nursing perceptions of medication administration practices, reasons for errors and reporting of errors in a tertiary care hospital in Bangalore and reported that the majority of nurses consistently checked the composition of the medication before administration. This outcome is confirmed by{26 } who detailed that most of the contemplated nurses didn’t aware of drug protocol.
Concerning the nurses' checking the prescribed route and form of each medication, the current study showed that the greater part of nurses checked the prescribed route and form of each medication for validity and clarity of each drug, as well as checked the prescribed dosage, time and administered dose accurately. This finding is consistent with{27-28 } who studied nurses' adherence to guidelines on safe medication preparation and administration in long‐term elderly care and revealed that most nurses guaranteed to consistently prepared medications as indicated by the relevant guidelines. As well , our finding is matched similar study done by{29} who studied nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting and showed that most of the contemplated nurses checking patient identification, the drug name, the dosage, the route and the scheduled time prior to giving drug.
Regarding the observation of critical care nurses practices during administration of medications , the current study showed that two thirds nurses didn't communicate information sensitively to the their patients before and during administration of medication . This finding is inconsistent with { 29} who found that the most of the contemplated nurses provided patient with required education about delivered medication .
On the other hand, most of nurses confirmed the patient's identity before administering medication, and they disposed non administered and squandered drugs or sharps appropriately . This finding is congruent with{ 27} who stated that over half the participants administered medication to their patients in accordance with the provided guidelines. Also this result come in accordance with{ 29} who revealed that the majority of the considered nurse checking patient identification prior to giving drugs.
The present study showed that greater than half of critical care nurses didn't records monitoring data related to administered medication. On the other hand, all nurses reported the abnormal findings to physician. This finding may may be related to the nurses work overload as well as the lack of policy that guide medication administration. The current finding is agreed with{26} who found that the studied nurses ignored following medication rules in recording the observations pertinent to the administered drug. On the contrary , the current finding is not agreed with{30}who examined knowledge and practice of intensive care unit nurses on intravenous drug administration and reported the majority of the contemplated nurses were adherent to nursing practice of the medication administration protocol.
Regarding comparison of the studied nurses practices by their educational level, The current study showed that there was no significant differences were found in practice mean score regarding drug administration. This finding is agreed partially with {31 } who studied effect of maternity nurses knowledge and Practices regarding the medication errors on women safety in labor unit and found no statistically significant differences between the maternity nurses level of practices, their qualification and source of information regarding the drugs used in labor unit and precautions of drugs administrating.
Regarding the correlation between age, years of experience, patient number, and total practices among critical care nurses, the current study indicated that there were strong positive correlations between the age of the staff nurses with their total practices, and moderate positive correlations between years of experience with their total practices. This finding may due to that nurses acquired experience from their work area . But there was a negative fair association between patient number and nurses practices. This result was supported by{32 } who stated that there were true positive correlations between nurses' demographic characteristics and total observational performance. Likewise, this finding is agreed with {31 } who revealed that there was a significant correlation between the level of practice in medication administration among nurses and their age and span of experience. Moreover , our finding is consistent with {31 } who revealed that there was a high significant correlation between the nurses' practices in drug administration and their age, total years of experience, while, found no correlation between the maternity nurses’ practices level and their educational level. On the other side , our findings are contradicted with{33 }who studied effectiveness of planned teaching program on knowledge and practice regarding safe medication administration among staff nurses and revealed that all demographic variables are not significantly associated with their pretest score of practice level. Regarding the nurse-patients ratio in the present study, it showed that greater than one third of nurses were caring for three patients followed by 40% who caring for two patients. This may be due to available number of nursing in critical units was few. This result come in the line with {34 } who studied the correlation between medication errors with job satisfaction and fatigue of nurses and reported that the nurse in ICU or CCU are responsible for two to three patients. As well, this finding is supported by{35 } who stated that nurse –patient ratio is identified by patients' condition status and the accessible number of nurses.
Limitation of the study:
The current design used in this study does not confirm the presence of a definitive cause and effect relationship. The sample size was relatively small .As a result, the number of critical care nurses enrolled in this study might have provided the absence of a significant association between some of the contributing factors and MAEs, as well as to the generalizability of the present findings