The nurse's role in drug handling within municipal health and medical care

In Sweden, elderly care has been transferred from the county councils to the municipalities, resulting in changes in the work tasks of nurses. Today, nurses within municipal health and medical care carry sole responsibility for large groups of care receivers, especially during evenings and weekends. A consequence of this heavy work load is that the nurses have to delegate a number of tasks to subordinate staff. Drug administration is a task which is often delegated. Cases of malpractice involving drug administration, reported from the municipal health and medical service to the regional supervisory units of the National Board of Health and Welfare during a 3-year period, have been analysed in order to gain a deeper understanding of the underlying causes of malpractice. In addition, interviews were conducted with eight nurses, the objective being to find out how they rate their knowledge within this area. The analysis showed that the majority of errors occurred in nursing homes and that the most common errors were administration of the wrong drug, and levels of drugs administered exceeding the prescribed ones. These errors were also common among subordinate staff who had been delegated responsibility for drug administration. Of the nurses interviewed, six out of eight had been close to making errors or had noticed a colleague making an error in conjunction with drug handling. Not all nurses reported errors made to the physician in charge immediately on discovery. It is concluded that through the transformation of elderly care, nurses working within municipal health and medical care have been given a new professional role. This places new demands on their competence, requiring them to make independent judgements and to take their own initiatives.