Factors affecting the implementation of best practice in medication administration by nurses in a UK NHS trust

Background: Despite numerous studies that review nursing practice and patient safety, barriers exist that ultimately impact on the delivery of best practice. Best practice is defined as ‘more than evidence-based care as it represents ‘quality care’ which, is deemed optimal based on a prevailing standard or point of view’ (Nelson 2014 P.1507). Evidence suggests that to ensure implementation of best practice into the clinical environment it is important to identify methods of staff development and reduce organisational and professional conflicts in the NHS. Research Aim: The research aim in this study is to explore the experiences of registered nurses in medication management within a Local District General NHS hospital to identify the factors which can affect the implementation of ‘best practice’ into clinical practice. Research methodology This research was informed by Grounded Theory. Thirteen participants, all registered nurses involved in medication administration, were first purposively and then theoretically sampled and recruited. Data was collected through in-depth, semi-structured, recorded interviews. Data analysis was completed using the constant comparison method. Ethical approval was obtained prior to the study. Key findings and recommendations This study supports earlier research which suggested lack of staffing, skill mix, time, attitudes and behaviours all impact on the implementation of best practice. However, this study suggests there may be other factors involved. This study suggests implementing best practice is a complex situation based on the nurse’s decision-making processes, their perception of risk and potential outcome to themselves, patients and colleagues. These decisions are also complicated by the nurses’ personal and professional values, levels of trust between themselves and their team and perceptions of their power to influence change. If nurses feel powerless to act in relation to their own values base and professional identity, they may experience cognitive dissonance, potentially resulting in challenge avoidance, moral distress, burnout, sabotage or rebellion, increasing risks and affecting patient safety. The factors involved in implementing best practice are complex. Therefore, it is essential that evaluation is undertaken to identify the threats affecting these and strategies are implemented to improve the nurse’s decisionmaking skills while in challenging environments.