Background: Injection is the most common medical procedure in the world today accounting for 16-20 billion injection annually while 50% of them are unsafe (WHO, 2014; MMIS, 2004- 2010) and are associated with transmission of blood-borne pathogens such as HIV, HBV and HCV.

Aim: The aim of this study was to determine the knowledge, perception and influencing nurses on medication safety practice in Cross River state Hospital.

Methods: A descriptive cross-sectional study conducted among108 nurses working in medical, surgical, pediatrics, maternity and gynecology units, casualty and MCH (maternal child health unit) was conducted using self-administered questionnaire and observation checklist but only 97 out of 108 responded back. Convenient sampling method was used to select both the study sites the participants in each study areas. Data was collected using four section structured questionnaire. Along with demographic characteristics details forming the first section of the questionnaire, questions regarding knowledge, perception and factorss of nurses on medication safety practice were included in the subsequent sections. Data were subjected to descriptive analysis (use of percentages and frequency) in addition to Microsoft excell. All ethical considerations were respected by ensuring voluntary participation with written consent and upholding of utmost confidentiality.

Results: More than three quarter (94.85%) of the respondents had not attended training on medication safety practice but generally, the findings showed that their knowledge was average; all new that unsafe injection practices predisposes to blood-borne infections namely HIV, HBV and HCV while only 26.80%(n=26) were able to state WHO/CDC core principles for medication safety practice (one needle, one syringe at one time).Only 22.68%(n=22) believed that medication safety practice does not predispose community to bio-hazards and on average,75.41% of respondents showed positive attitude towards medication safety practice. 69.7%(n-17) did not wash their hands before either preparing or giving injection, 96% never scrub the rubber septum with approved antiseptic swab while injection preparation not done at bedside accounted for 63.35%. Less than half(44%) recap the needle. Syringes and needles places on the surface or carried a distance prior to disposal was 21.76%.97.86% used touched technique when opening vials while 43.89% never located sharp container at the point of use where needed.30.11% of respondents believed that multiple dose vials should be used for more than one patient.

Conclusion: Nurses in this facility had high rates of unsafe injection practice. Majority of them had positive attitude towards medication safety practice and a good level of knowledge about medication safety practice. Training concentrating on medication safety practice, guidelines to dispose biomedical waste and monitoring of the activity is needed.

1.1 Background to the study
Safe injection is a vital component of infection prevention process without which many patients are at risk of being exposed to several non curable and curable infectious diseases. Patients’ seek healthcare for either curatives purpose, preventive (Immunization) or for rehabilitative purpose. Healthcare providers use diverse measures to meet the need of patients including but not restricted to nursing care and pharmacological care. Pharmacological care involves drug administration of injectable medications that may go through different routes including intramuscular, intradermal route, intravenous and subcutaneous among others. Despite the advantages of these routes of drug administration, Canadian Needle Stick Surveillance Network (CNSSN) reports that intramuscular injection seems to be the most frequents route of infection transmission (CNSSN, 2000).

Injections are the most common medical procedure worldwide and 50% of them are said to be unnecessary (WHO/CDC, 2010; MMIS, 2010) and oral medication could have work better in some scenarios(conditions) where injection was the route of drug administration prescribed. Therefore, injections when medical indicated should be administered safely (Adejumo et al., 2013) to avoid risking patients of any avoidable morbidity and mortalities. WHO defines medication safety practice as a medical procedure that neither causes harm to the patient nor exposes the health- care worker to any avoidable risk and also not result in waste that is hazardous to the community (WHO, 2010).

Nurses and patients are at risk of getting infected and sustaining injuries in the process of delivering nursing care. Measures that help in preventing theses incidences resulting from unsafe injection practices (positive attitude, knowledge about medication safety practice and safe practices) are vital elements of nursing care, Amado & Saka, (2012).Unsafe injections causes’ serious health burden in many health facilities in developing and develop countries including Nigeria. Reuse of syringes and needles, non-aseptic technique, and injection at incorrect anatomical sites are some of the unsafe practices that harm nurses and patients including needle-stick injuries and infections (MOH, Nigeria, 2010).

Studies have also shown that South East Asia records the highest degree of unsafe use injection (75%) including Nepal (Gyawali et al., 2013). Unsafe injections results to beyond tolerated burdens to either individuals, country or to the whole word.

The global burden of unsafe injection estimated by WHO (2008) include 0.34 million HIV infections, 15 million HBV infections, 1million HCV infections, 3million bacterial infections and 850,000 injection site infections. All these are assumed to have been contributed by use of unsafe injectables despite decreasing spread through sexual and vertical means (Riaz H. & Kamal W., 2012).

Despite most injection being given worldwide are provided following safe clinical procedure, viral hepatitis and other infectious disease transmission through unsafe practices, are still on large scale (WHO, 2000). Appropriate and effective measures must be taken to curb this route of transmission of diseases (N.A. Ismail et al., 2007).

Knowledge and adherence to medication safety practice in developing country is still suboptimal (CDC, 2011), resulting to the use of injection beyond the rational medical use. 50% risk rate to injuries in National Hospital (Anthony M. 2013).

A quantitative rapid assessment on medication safety practice practices in 25 health facilities in three provinces in Nigeria report some vital information on how nurses are divergent in their perception and practices regarding medication safety practice (Eastern province, western province and north eastern province) (Judy M., 2015). Safe practices both at individual and institution level are influenced by the healthcare facility lack of adequate implementation and follow up of safety standard and policies.

According to Nigeria Aids Indicator Survey (NAIS, 2012), poor leadership and lack of experience among the nurses in public hospital contribute to unsafe injections, evidenced by a study carried out in Meru level five hospitals (Judy M., 2015).

Thus, medication safety practice practice is significantly vital and a breach in this practice (unsafe injection) may cause major harms and contributes to increased infections among the nurses and the patients (Anita Shankar, 2014).

1.2 Problem statement
Safe and appropriate use of injection as recommended by WHO/CDC offer the best infection control and is the key element for medication safety practice improvement. Annually, unsafe injection account for 30% and 40% new hepatitis B and hepatitis C respectively and also cost government 3-5 times the cost of auto-disposable syringes (Missionpharma, 2015).

Although several studies have pointed out the prevalent of unsafe injection existing in the whole world and our country, recent reports still shows the alarming and increase incidences of unsafe injections practices. 77% of the nurses practices unsafe injection in Gujarat state, India, (Mateo, 2010).

In Nigeria, several quantitative rapid assessments on medication safety practice practices in 25 health facilities in three provinces, reveals significant information on how nurses are divergent in their perception and practices regarding medication safety practice. The finding reveals that safe practices both at individual and institution level are influenced by the healthcare facility lack of adequate implementation and follow up of safety standard and policies and negligence and unsafe practices among nurses and other healthcare providers (Judy M., 2015).

Approximately 50% risk rate to injuries and infections in Nigerian National Hospital (Anthony

M. 2013).To improve nurses knowledge and attitude towards medication safety practice practices, injection modules in nursing schools is vital and needed (MMIS PEPFAR, 2004; Ndegwa, John SnowInc, 2016). There is limited documentation on the level of knowledge of nurses regarding medication safety practice, their attitudes and nature of practice regarding medication safety practice in Calabar.

1.3 justification of the study
Safe injection practices in the health care institutions are a reflection of the level of knowledge of nurses on injection, positive attitude toward injection practices and provision of the necessary support needed. It also determines the patient health outcome or time of stay in the healthcare facilities. There has been much effort to reduce the adverse effects of unsafe handling of injections and the resulting biomedical wastes, however, there have been little studies to determine and assess how knowledge, perception and influencing nurses affect the provision of medication safety practice to patients.

Majority of the injection given are unsafe and are unnecessary. Whereby 70% of injection given are unsafe (MMIS, 2010) while 58% of the healthcare providers are at risk of injuries (needle- sticks) and blood bone infections (MOH, 2007a) due to this practice. Despite the existing policy and institutional measures, unsafe injection in Nigerian health facilities has not been adequately addressed.

In Calabar, no research has been done addressing nursing practice towards medication safety practice. Factors such as human (attitude, level of training and knowledge) and institutional factors, which are considered in this study, would be useful in finding a lasting solution the identified gaps in Cross River state Hospital.

1.4 Research questions
1. What is the nurses’ level of knowledge towards medication safety practice at the hospital?

2. What is the nature of injection practices among nurses at the hospital?

3. What is the attitude of nurses towards medication safety practice at the hospital?

1.6 General objectives
The general objective of the study was to determine level of knowledge, attitude, and practice of nurses on medication safety practice at Cross River state Hospital.

1.6.1 Specific objective
The specific objectives were:
1. To determine the level knowledge among nurses on medication safety practice at the hospital;

2. To identify the nature of injection practices among nurses at the hospital;

3. To explore nurses attitudes towards medication safety practice practices at the hospital

1.7 Scope of the study
Curative or preventive injections can be prescribed and administered by different healthcare providers including doctors and clinical officers (C.Os).This study was limited to the qualified nurses working in NCRH as their knowledge level, attitude and the nature of practice being the independent variables and medication safety practice as the dependent variable. Injection rooms in the wards and casualty unit and MCH immunization room were the main point of interest for the study.

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Item Type: Project Material  |  Size: 52 pages  |  Chapters: 1-5
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