Compliance of Nurses with Medication Administration Protocols and its Effect on Adverse Drug Events in Children Hospital, Multan
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Abstract
Background: Medication administration errors remain a major threat to pediatric patient safety because children require weight-based dosing, age-specific adjustments, and close monitoring for medication-related harm. Nurses serve as the final safety checkpoint before medication reaches the patient, making compliance with medication administration protocols essential in pediatric care. Objective: To assess nurse compliance with medication administration protocols and examine its association with medication administration errors and adverse drug events in a pediatric hospital in Multan, Pakistan. Methods: A descriptive correlational observational study was conducted among 78 registered nurses working in pediatric medical, surgical, and intensive care units. Compliance was assessed through 234 observed medication administration episodes using a structured checklist covering patient identification, dose verification, right-time administration, documentation, and independent double-checking of high-alert medications. Medication-related events were classified by type and severity. Descriptive statistics, correlation analysis, regression analysis, and training-based compliance comparison were performed. Results: Overall protocol compliance was 67.4% ± 8.2%. Compliance was highest for patient identification (82.1%) and lowest for high-alert medication double-checking (43.6%). A total of 124 medication-related events were documented, most commonly dosing errors (34.7%), omitted doses (22.6%), and wrong-time administration (17.7%). Overall compliance showed a strong inverse association with medication-related event rates (r = -0.72, p < 0.001), and trained nurses demonstrated significantly higher compliance than untrained nurses (73.8% vs. 63.5%, p < 0.001). Conclusion: Nurse compliance with medication administration protocols was suboptimal and was strongly associated with medication-related event rates. Targeted interventions focusing on high-alert medication double-checking, documentation, dose verification, and regular safety training are recommended
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