The examination of nurses' adherence to the ‘five rights’ of antibiotic administration and factors influencing their practices: a mixed methods case study at a tertiary hospital, Malawi

BACKGROUND: Adherence to ‘Five Rights’ of medication administration guidelines namely the right drug, the right patient, the right dose, the right time and the right route is the basic nursing standard and a crucial component in medication safety. Specifically for antibiotics, this helps to minimize resistance and reduce hospital costs. There is a dearth in literature on how nurses apply this standard when administering antibiotics to inpatients. This study explored nurses' adherence to the ‘Five Rights’ of antibiotic administration and factors influencing their practices. METHODS: This was a cross sectional case study using prospective observation of 23 nurses and 49 patients with pneumonia and follow up interviews with 13 nurses. Participants were selected between November 2015 and February 2016. The study setting was two medical wards of a tertiary hospital. Observations were guided using a checklist to collect quantitative data. This was followed by semi-structured in-depth interviews with nurses. RESULTS: From the quantitative data, untimely administration of antibiotics was common, with only 10.1% of patients given antibiotics at the right time. Nurses gave the right (prescribed) antibiotics in 67.3% of the patients and 59.2% of the patients received the required doses. 69.4% of the patients received the antibiotics using the right route. The right documentation of dose initiation and continuation occurred in 38.5% and 24.5% respectively. From follow up interview data, two main themes were identified: Competency gap with subthemes namely inconsistent undestanding of three/four times a day dosing schedules and knowledge translation gap; Conflict between medication administration times and ward routines. CONCLUSIONS: We found poor compliance with the ‘Five Rights’ of antibiotic administration. This has been attributed to both a competency gap and challenges within the hospital system.