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Suluhan D, Yildiz D, Fidanci BE. Triangle technique: An effective tool for improving nursing students' ability to calculate safe pediatric medication dosages. J Child Health Care 2023; 27:160-173. [PMID: 36537754 DOI: 10.1177/13674935221145511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Calculating the correct medication dosage for pediatric patients can be difficult for nurses to determine, as the pediatric dose is typically a small fraction of the adult dosage. This study aims to examine the impact of the Triangle Technique on the ability of nursing students to calculate low and high safe dosage ranges in children. To evaluate how this educational tool could improve a nurse's skill in this area, a quasi-experimental pre-/post-test research design was employed including one hundred fifty-eight third-year nursing students. The Pediatric Medication Administration Form and Pediatric Safe Dosage Calculations Quiz (PSDCQ) were used to measure the effectiveness of the Triangle Technique. While <50% (n < 79) of students gave correct answers to each question in PSDCQ before this intervention, all of the participants (N = 158, 100%) gave a correct answer to one question, and >89.2% (n > 141) of the students correctly answered the other four questions of PSDCQ. The change in scores (pre-PSDCQ median score = 0, IQR = 60; post-PSDCQ median score = 100, IQR = 0) post-intervention was statistically significant (z = 10.633, p ≤ .001), indicating that this teaching technique was effective for improving students' ability to calculate pediatric safe dose ranges. Nursing students (n = 144, 91.1%) were satisfied with using Triangle Technique. Using the Triangle Technique can increase nursing students' understanding of how they calculate safe pediatric medication dosages.
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Affiliation(s)
- Derya Suluhan
- Gülhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Dilek Yildiz
- Gülhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Berna Eren Fidanci
- Gülhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
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2
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Need assessment and development of a mobile-based medication dosage calculation application for ICU nurses. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-022-00720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fuster-Linares P, Alfonso-Arias C, Gallart Fernández-Puebla A, Rodríguez-Higueras E, García-Mayor S, Font-Jimenez I, Llaurado-Serra M. Assessing Nursing Students' Self-Perceptions about Safe Medication Management: Design and Validation of a Tool, the NURSPeM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084663. [PMID: 35457531 PMCID: PMC9028847 DOI: 10.3390/ijerph19084663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
Objective: The objective was to design and validate a tool for assessing nursing students’ self-perceptions about safe medication management. Methods: A descriptive instrumental study was conducted involving construct definition, development of the tool, analysis of the content validity, and psychometric evaluation. Consensus regarding the content was obtained through a two-round Delphi process, and the resulting tool (the NURSPeM) was administered to nursing students to examine its internal consistency, temporal stability, and construct validity, the latter through exploratory factor analysis. Results: Thirteen experts participated in the Delphi process, which yielded a tool comprising two questionnaires: (1) Self-perceptions about safe medication management (27 items) and (2) the frequency and learning of drug-dose calculation (13 items). The tool’s psychometric properties were then examined based on responses from 559 nursing students. This analysis led to the elimination of three items from questionnaire 1, leaving a total of 24 items distributed across seven dimensions. All 13 items in questionnaire 2 were retained. Both questionnaires showed good internal consistency (Cronbach’s alpha = 0.894 and 0.893, respectively) and temporal stability (ICC = 0.894 and 0.846, respectively). Conclusions: The NURSPeM is a valid and reliable tool for assessing nursing students’ self-perceptions about safe medication management. It may be used to identify areas in which their training needs to be enhanced, and to evaluate the subsequent impact of new teaching initiatives.
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Affiliation(s)
- Pilar Fuster-Linares
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
| | - Cristina Alfonso-Arias
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | | | - Encarna Rodríguez-Higueras
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
| | - Silvia García-Mayor
- Nursing Department, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
| | | | - Mireia Llaurado-Serra
- Nursing Department, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (C.A.-A.); (A.G.F.-P.); (E.R.-H.)
- Correspondence: (P.F.-L.); (M.L.-S.); Tel.: +34-93-504-20-00 (ext. 5631) or +34-626-838-951 (P.F.-L.); +34-93-504-20-00 (ext. 5634) or +34-665-033-050 (M.L.-S.)
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Mulac A, Hagesaether E, Granas AG. Medication dose calculation errors and other numeracy mishaps in hospitals: Analysis of the nature and enablers of incident reports. J Adv Nurs 2022; 78:224-238. [PMID: 34632614 DOI: 10.1111/jan.15072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIMS To investigate medication dose calculation errors and other numeracy mishaps in hospitals and examine mechanisms and enablers which lead to such errors. DESIGN A retrospective study using descriptive statistics and thematic analysis of the nature and enablers of reported incidents. METHODS Medication dose calculation errors and other numeracy mishaps were identified from medication-related incidents reported to the Norwegian Incident Reporting System in 2016 and 2017. The main outcome measures were medications and medication classes involved, severity of harm, outcome, and error enablers. RESULTS In total, we identified 100 numeracy errors, of which most involved intravenous administration route (n = 70). Analgesics were the most commonly reported drug class and morphine was the most common individual medication. Overall, 78 incidents described patient harm. Frequent mechanisms were 10- or 100-fold errors, mixing up units, and incorrect strength/rate entered into infusion pumps. The most frequent error enablers were: double check omitted or deviated (n = 40), lack of safety barriers to intercept prescribing errors (n = 25), and emergency/stress (n = 21). CONCLUSION Numeracy errors due to lack of or improper safeguards occurred during all medication management stages. Dose miscalculation after dilution of intravenous solutions, infusion pump programming, and double-checking were identified as unsafe practices. We discuss measures to prevent future calculation and numeracy errors. IMPACT Our analysis of medication dose calculation errors and other numeracy mishaps demonstrates the need for improving safety steps and increase standardization for medication management procedures. We discuss organizational, technological, and educational measures to prevent harm from numeracy errors.
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Affiliation(s)
- Alma Mulac
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ellen Hagesaether
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Gerd Granas
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Bişkin Çetin S, Cebeci F. Perceptions of Clinical Nurses About the Causes of Medication Administration Errors: A Cross-Sectional Study. Florence Nightingale Hemsire Derg 2021; 29:56-64. [PMID: 34263223 PMCID: PMC8137725 DOI: 10.5152/fnjn.2021.19135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/13/2020] [Indexed: 11/25/2022] Open
Abstract
AIM This study was conducted to determine the perceptions of nurses about the causes of medication administration errors and the rates of reporting errors made or witnessed by them. METHOD This methodological, descriptive, multicenter, and cross-sectional study sample of this study included 590 clinical nurses working in an inpatient setting in Turkey. The data were collected using the Medication Administration Error Reporting Survey, which is a self-report questionnaire. RESULTS In the study, it was determined that insufficient number of nurses, heavy workloads, and illegible medication orders of physicians were the most common causes leading to medication errors as stated by the nurses. Moreover, 26.1% of the nurses reported that they had made an medication error, and more than half of the nurses reported that they had witnessed medication errors. It was found that 68.8% of medication errors were not reported. CONCLUSION It is important to determine the nurses’ perceptions about the causes of medication errors to prevent repetition of medication errors and to establish standards for medication safety. Therefore, it may be recommended to reduce workloads of nurses and develop methods to increase the rate of reporting medication errors.
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Affiliation(s)
- Songül Bişkin Çetin
- Department of Nursing, Akdeniz University Faculty of Nursing, Akdeniz University Hospital, Antalya, Turkey
| | - Fatma Cebeci
- Department of Nursing, Akdeniz University Faculty of Nursing, Akdeniz University Hospital, Antalya, Turkey
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Lloyd A. Applied numeracy assessments within the nursing associate curriculum. Nurse Educ Pract 2020; 48:102753. [PMID: 32927337 DOI: 10.1016/j.nepr.2020.102753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/01/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Andy Lloyd
- Nursing, University of Gloucestershire, Oxstalls Campus, Oxstalls Lane, Longlevens, Gloucestershire, GL2 9HW, UK.
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Alomari A, Sheppard-Law S, Lewis J, Wilson V. Effectiveness of Clinical Nurses' interventions in reducing medication errors in a paediatric ward. J Clin Nurs 2020; 29:3403-3413. [PMID: 32531850 DOI: 10.1111/jocn.15374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses' medication administration practice. BACKGROUND Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. DESIGN An Action Research (AR) three-phase quantitative study. METHODS Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. RESULTS Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. CONCLUSION Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empowers them to find solutions that are tailored to their own practice culture and environment.
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Affiliation(s)
- Albara Alomari
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Suzanne Sheppard-Law
- Nursing Research Unit SCHN, University of Technology Sydney, Randwick, Sydney, NSW, Australia
| | - Joanne Lewis
- University of Technology, Sydney, NSW, Australia
| | - Val Wilson
- University of Wollongong and Illawarra Shoalhaven Local Health District & Adjunct University of Technology, Sydney, NSW, Australia
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Senior Nursing Studentsʼ Perceptions of Their Readiness for Oral Medication Administration Prior to Final Year Internship. Dimens Crit Care Nurs 2020; 39:23-32. [DOI: 10.1097/dcc.0000000000000401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Márquez-Hernández VV, Fuentes-Colmenero AL, Cañadas-Núñez F, Di Muzio M, Giannetta N, Gutiérrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PLoS One 2019; 14:e0220001. [PMID: 31339914 PMCID: PMC6655641 DOI: 10.1371/journal.pone.0220001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medication errors have long been associated with low-quality medical care services and significant additional medical costs. OBJECTIVE The aim of this study was to culturally adapt and validate the questionnaire on knowledge, attitudes and behaviors in the administration of intravenous medication, as well as to explore these factors in a hospital setting. METHODS The study was divided into two phases: 1) validation and cross-cultural adaptation, and 2) cross-sectional study. A total of 276 hospital-based nursing professionals participated in the study. RESULTS A Cronbach's alpha value of 0.849 was found, indicating good internal consistency. In the multivariate analysis, statistically significant differences were found between knowledge and attitudes, demonstrating that having greater suitable knowledge correlates with having a more positive attitude. It was also discovered that having a positive attitude as well as the necessary knowledge increases the possibility of engaging in adequate behaviors. CONCLUSIONS The knowledge, attitudes and behavior questionnaire has a satisfactory internal consistency in order to be applied to the Spanish context. Implications for nursing management: Knowledge acquisition and positive attitude are both factors which promote adequate behavior, which in turn seems to have an impact on medication errors prevention. Health institutions must encourage continuous education for their employees.
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Affiliation(s)
- Verónica V. Márquez-Hernández
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
- Research Group for Health Sciences, University of Almería, Almería Spain
| | | | | | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Noemi Giannetta
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Lorena Gutiérrez-Puertas
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Ainscough LP, Ford JL, Morecroft CW, Peak M, Turner MA, Nunn AJ, Roberts M. Accuracy of intravenous and enteral preparations involving small volumes for paediatric use: a review. Eur J Hosp Pharm 2018; 25:66-71. [PMID: 31156991 PMCID: PMC6452381 DOI: 10.1136/ejhpharm-2016-001117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Children often need to be administered very small volumes of medicines that are authorised for use in adults. Neonatal drug delivery is particularly challenging, and doses are often immeasurable with the equipment currently available. AIM To summarise research to date on the accuracy of intravenous and enteral medicine preparation requiring small volumes (<0.1 mL), with a focus on paediatric use and to identify areas for further work. METHOD Twenty-three publications were identified for the narrative review via: Web of Science (1950-2016), Cumulative Index to Nursing and Allied Health Literature (1976-2016), Excerpta Medica Database (1974-2016) and International Pharmaceutical Abstracts (1970-2016) searches. Nine additional papers were identified through backward citation tracking and a further 17 were included from the personal knowledge of the review team. RESULTS Measurement of volumes (<0.1 mL), for enteral and intravenous dosing, accounts for 25% of medicine manipulations within paediatric hospitals. Inaccuracies are described throughout the literature with dose administration errors attributed to technique, calculation, dilution and problems associated with equipment. While standardised concentrations for intravenous infusion and drug concentrations that avoid measurement of small volumes would ameliorate problems, further work is needed to establish accurate methods for handling small volumes during the administration of medicines to children and risk minimisation strategies to support staff involved are also necessary. CONCLUSIONS This review has revealed a paucity of information on the clinical outcomes from problems in measuring small volumes for children and highlighted the need for further work to eliminate this source of inaccurate dosing and potential for medication error.
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Affiliation(s)
- L P Ainscough
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - J L Ford
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - C W Morecroft
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - M Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M A Turner
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - A J Nunn
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Roberts
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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A time management intervention using simulation to improve nursing students’ preparedness for medication administration in the clinical setting: A quasi-experimental study. Collegian 2018. [DOI: 10.1016/j.colegn.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bull ER, Mason C, Junior FD, Santos LV, Scott A, Ademokun D, Simião Z, Oliver WM, Joaquim FF, Cavanagh SM. Developing nurse medication safety training in a health partnership in Mozambique using behavioural science. Global Health 2017; 13:45. [PMID: 28676121 PMCID: PMC5496247 DOI: 10.1186/s12992-017-0265-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background Globally, safe and effective medication administration relies on nurses being able to apply strong drug calculation skills in their real-life practice, in the face of stressors and distractions. These may be especially prevalent for nurses in low-income countries such as Mozambique and Continuing Professional Development post-registration may be important. This study aimed to 1) explore the initial impact of an international health partnership’s work to develop a drug calculation workshop for nurses in Beira, Mozambique and 2) reflect upon the role of health psychologists in helping educators apply behavioural science to the training content and evaluation. Methods In phase one, partners developed a training package, which was delivered to 87 Portuguese-speaking nurses. The partnership’s health psychologists coded the training’s behaviour change content and recommended enhancements to content and delivery. In phase two, the refined training, including an educational game, was delivered to 36 nurses in Mozambique and recoded by the health psychologists. Measures of participant confidence and intentions to make changes to healthcare practice were collected, as well as qualitative data through post-training questions and 12 short follow-up participant interviews. Results In phase one six BCTs were used during the didactic presentation. Most techniques targeted participants’ capability to calculate drug doses accurately; recommendations aimed to increase participants’ motivation and perceived opportunity, two other drivers of practice change. Phase two training included an extra seven BCTs, such as action planning and further skills practice. Participants reported high confidence before and after the training (p = 0.25); intentions to use calculators to check drug calculations significantly increased (p = 0.031). Qualitative data suggested the training was acceptable, enjoyable and led to practice changes, through improved capability, opportunity and motivation. Opportunity barriers to medication safety were highlighted. Conclusions Reporting and measuring medication errors and related outcomes is a complex challenge affecting global efforts to improve medication safety. Through strong partnership working, a multi-disciplinary team of health professionals including health psychologists developed, refined and begin to evaluate a locally-led drug calculation CPD workshop for nurses in a low-resource setting. Applying behavioural science helped to collect feasible evaluation data and hopefully improved impact and sustainability.
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Affiliation(s)
| | | | | | | | - Abigail Scott
- East Anglia Medicines Information Service, Ipswich Hospital NHS Trust, Ipswich, UK
| | | | | | | | | | - Sarah M Cavanagh
- East Anglia Medicines Information Service, Ipswich Hospital NHS Trust, Ipswich, UK.,University of Suffolk, Ipswich, UK
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Effects of Web-Based Instruction on Nursing Students' Arithmetical and Drug Dosage Calculation Skills. ACTA ACUST UNITED AC 2017; 35:262-269. [DOI: 10.1097/cin.0000000000000317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. In this article, the authors discuss important methods in teaching nursing students to administer medications, and include best practices and strategies for student success, with a focus on safety.
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Medication errors as malpractice-a qualitative content analysis of 585 medication errors by nurses in Sweden. BMC Health Serv Res 2016; 16:431. [PMID: 27558024 PMCID: PMC4997761 DOI: 10.1186/s12913-016-1695-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/19/2016] [Indexed: 02/08/2023] Open
Abstract
Background Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses’ work experience in relation to the risk and type for medication errors. Methods All medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses’ work experience and associations within and between the errors and contributory factors, Fisher’s exact test was used, and Cohen’s kappa (k) was performed to estimate the magnitude and direction of the associations. Results There were a total of 613 medication errors in the 585 cases, the most common being “Wrong dose” (41 %), “Wrong patient” (13 %) and “Omission of drug” (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being “Negligence, forgetfulness or lack of attentiveness” (68 %), “Proper protocol not followed” (25 %), “Lack of knowledge” (13 %) and “Practice beyond scope” (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being “Role overload” (36 %), “Unclear communication or orders” (30 %) and “Lack of adequate access to guidelines or unclear organisational routines” (30 %). The errors “Wrong patient due to mix-up of patients” and “Wrong route” and the contributory factors “Lack of knowledge” and “Negligence, forgetfulness or lack of attentiveness” were more common in less experienced nurses. The experienced nurses were more prone to “Practice beyond scope of practice” and to make errors in spite of “Lack of adequate access to guidelines or unclear organisational routines”. Conclusions Medication errors regarded as malpractice in Sweden were of the same character as medication errors worldwide. A complex interplay between individual and system factors often contributed to the errors.
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Abstract
The calculation of dosages in paediatrics is the concern of the whole medical and paramedical team. This activity must generate a minimum of risks in order to prevent care-related adverse events. In this context, the calculation of dosages is a practice which must be understood by everyone.
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Affiliation(s)
- Daniel Benlahouès
- ED 180, Laboratoire Éducation, Discours et apprentissages, Université Paris Descartes, Sorbonne Paris Cité, Faculté des Sciences humaines et sociales, 45 rue des Saints-Pères, 75006 Paris, France.
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Mackie JE, Bruce CD. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach. NURSE EDUCATION TODAY 2016; 40:146-153. [PMID: 27125165 DOI: 10.1016/j.nedt.2016.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/10/2016] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accurate calculation of medication dosages can be challenging for nursing students. Specific interventions related to types of errors made by nursing students may improve the learning of this important skill. OBJECTIVE The objective of this study was to determine areas of challenge for students in performing medication dosage calculations in order to design interventions to improve this skill. DESIGN Strengths and weaknesses in the teaching and learning of medication dosage calculations were assessed. These data were used to create online interventions which were then measured for the impact on student ability to perform medication dosage calculations. SETTING The setting of the study is one university in Canada. PARTICIPANTS The qualitative research participants were 8 nursing students from years 1-3 and 8 faculty members. Quantitative results are based on test data from the same second year clinical course during the academic years 2012 and 2013. METHODS Students and faculty participated in one-to-one interviews; responses were recorded and coded for themes. Tests were implemented and scored, then data were assessed to classify the types and number of errors. RESULTS Students identified conceptual understanding deficits, anxiety, low self-efficacy, and numeracy skills as primary challenges in medication dosage calculations. Faculty identified long division as a particular content challenge, and a lack of online resources for students to practice calculations. Lessons and online resources designed as an intervention to target mathematical and concepts and skills led to improved results and increases in overall pass rates for second year students for medication dosage calculation tests. CONCLUSION This study suggests that with concerted effort and a multi-modal approach to supporting nursing students, their abilities to calculate dosages can be improved. The positive results in this study also point to the promise of cross-discipline collaborations between nursing and education.
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Affiliation(s)
- Jane E Mackie
- Trent Fleming School of Nursing, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2, Canada.
| | - Catherine D Bruce
- School of Education, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2, Canada.
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Van Lancker A, Baldewijns K, Verhaeghe R, Robays H, Buyle F, Colman R, Van Hecke A. The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study. J Adv Nurs 2016; 72:2054-64. [PMID: 27060466 DOI: 10.1111/jan.12967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effectiveness of an e-learning course compared with a face-to-face lecture on medication calculation. BACKGROUND The current knowledge on medication calculation of nursing students and nurses is insufficient to provide safe care. DESIGN A stratified-clustered quasi-experimental study. METHODS A random selection of nursing schools were allocated to the e-learning course (intervention group) (seven schools; 189 students) or face-to-face lecture (control group) (six schools, 222 students). Students in both groups completed a validated medication calculation test (maximum score: 16) prior to the course (T0), immediately after the course (T1) and 3 months later (T2). A linear mixed model was used for data analysis. RESULTS Medication calculation skills improved significantly more by the face-to-face lecture than e-learning course. Students in both groups significantly improved in medication calculation skills immediately after the course (T1) and 3 months later. The results flattened at T2 with a significant decline in the intervention group between T1 and T2 and a non-significant decline in the control group. Based on a subgroup analysis, improvement in medication calculation skills at T2 could only be observed in vocational-level (sub degree) nursing students receiving a face-to-face course. CONCLUSIONS Both medication calculation courses had a positive effect on medication calculation skills. Students receiving traditional face-to-face lecture improved significantly more than the students receiving the e-learning course.
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Affiliation(s)
- Aurélie Van Lancker
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Katleen Baldewijns
- Technical Institute of Higher Professional Education, Department Nurse Education, Hasselt, Belgium
| | - Rik Verhaeghe
- Nursing Department, Ghent University Hospital, Belgium
| | - Hugo Robays
- Department of Pharmacy, Ghent University Hospital, Belgium
| | - Franky Buyle
- Department of Pharmacy, Ghent University Hospital, Belgium
| | - Roos Colman
- Medical Informatics, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Nursing Department, Ghent University Hospital, Belgium
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Bagnasco A, Galaverna L, Aleo G, Grugnetti AM, Rosa F, Sasso L. Mathematical calculation skills required for drug administration in undergraduate nursing students to ensure patient safety: A descriptive study. Nurse Educ Pract 2016; 16:33-9. [DOI: 10.1016/j.nepr.2015.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 03/10/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Sneck S, Saarnio R, Isola A, Boigu R. Medication competency of nurses according to theoretical and drug calculation online exams: A descriptive correlational study. NURSE EDUCATION TODAY 2016; 36:195-201. [PMID: 26521035 DOI: 10.1016/j.nedt.2015.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/03/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Medication administration is an important task of registered nurses. According to previous studies, nurses lack theoretical knowledge and drug calculation skills and knowledge-based mistakes do occur in clinical practice. Finnish health care organizations started to develop a systematic verification processes for medication competence at the end of the last decade. No studies have yet been made of nurses' theoretical knowledge and drug calculation skills according to these online exams. OBJECTIVES The aim of this study was to describe the medication competence of Finnish nurses according to theoretical and drug calculation exams. DESIGN A descriptive correlation design was adopted. Participants and settings All nurses who participated in the online exam in three Finnish hospitals between 1.1.2009 and 31.05.2014 were selected to the study (n=2479). METHODS Quantitative methods like Pearson's chi-squared tests, analysis of variance (ANOVA) with post hoc Tukey tests and Pearson's correlation coefficient were used to test the existence of relationships between dependent and independent variables. RESULTS The majority of nurses mastered the theoretical knowledge needed in medication administration, but 5% of the nurses struggled with passing the drug calculation exam. Theoretical knowledge and drug calculation skills were better in acute care units than in the other units and younger nurses achieved better results in both exams than their older colleagues. CONCLUSION The differences found in this study were statistically significant, but not high. Nevertheless, even the tiniest deficiency in theoretical knowledge and drug calculation skills should be focused on. It is important to identify the nurses who struggle in the exams and to plan targeted educational interventions for supporting them. The next step is to study if verification of medication competence has an effect on patient safety.
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Affiliation(s)
- Sami Sneck
- Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Administration Center, Oulu University Hospital, Oulu, Finland.
| | - Reetta Saarnio
- Metropolia University of Applied Sciences, Helsinki, Finland.
| | - Arja Isola
- Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
| | - Risto Boigu
- Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland.
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Sulosaari V, Huupponen R, Hupli M, Puukka P, Torniainen K, Leino-Kilpi H. Factors associated with nursing students' medication competence at the beginning and end of their education. BMC MEDICAL EDUCATION 2015; 15:223. [PMID: 26683623 PMCID: PMC4683869 DOI: 10.1186/s12909-015-0513-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/12/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND In previous studies, deficiencies in nursing students' medication competence have been highlighted. However, the focus of research has been limited especially to medication calculation competence and factors associated with it. In order to develop undergraduate nursing education and research, an understanding of the individual and learning environmental factors associated with medication competence from a broader approach is warranted. Our aim was therefore to evaluate the theoretical, practical and decision-making competence of nursing students and to identify factors associated with their medication competence at the beginning and end of their education. METHODS We used a descriptive, correlational study design with a structured instrument including a set of potential associated factors, knowledge test, medication calculation test and patient vignettes. The participants were nursing students at the beginning (n = 328) and at the end of their education (n = 338). Data were analyzed statistically. RESULTS In the evaluation of theoretical medication competence, the students' mean score over the semesters was 72 % correct answers in a knowledge test. In the evaluation of practical medication competence, the mean score was 74 % correct answers in a medication calculation test. In the evaluation of decision-making competence, the mean score was 57 % correct answers on deciding the best action in the situation given in patient vignettes. At the end of their education, students were able to solve patient vignettes significantly better. Individual factors were most evidently associated with medication competence. At the beginning of their education, students' previous academic success had a stronger association with medication competence. However, at the end of the education students' abilities in self-regulated learning and study motivation were more significant factors. CONCLUSION The core elements of medication competence are significantly interrelated, highlighting the need to provide integrated and comprehensive medication education throughout the undergraduate education. Students' learning style is associated with medication competence. There is a need for methods to identify and support students having difficulties to self-regulate their learning. To increase the safety of medication care of patients, research focusing on the development of effective teaching methods is needed. This study produced information for future nursing education research in this field, especially for interventional studies.
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Affiliation(s)
- Virpi Sulosaari
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Risto Huupponen
- Clinical Pharmacology Unit, Department of Pharmacology, Drug Development and Therapeutics, University of Turku, FI-20014, Turku, Finland.
| | - Maija Hupli
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Pauli Puukka
- National Institute for Health and Welfare, PL 57, FI-20521, Turku, Finland.
| | - Kirsti Torniainen
- Hospital Pharmacy Hospital Pharmacy, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
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Pignard J, Cosserant S, Traore O, Souweine B, Sautou V. [Security of hospital infusion practices: From an a priori risk analysis to an improvement action plan]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:154-64. [PMID: 26294272 DOI: 10.1016/j.pharma.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/01/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Infusion in care units, and all the more in intensive care units, is a complex process which can be the source of many risks for the patient. Under cover of an institutional approach for the improvement of the quality and safety of patient healthcare, a risk mapping infusion practices was performed. METHODS The analysis was focused on intravenous infusion situations in adults, the a priori risk assessment methodology was applied and a multidisciplinary work group established. RESULTS Forty-three risks were identified for the infusion process (prescription, preparation and administration). The risks' assessment and the existing means of control showed that 48% of them would have a highly critical patient security impact. Recommendations were developed for 20 risks considered to be most critical, to limit their occurrence and severity, and improve their control level. An institutional action plan was developed and validated in the Drug and Sterile Medical Devices Commission. CONCLUSION This mapping allowed the realization of an exhaustive inventory of potential risks associated with the infusion. At the end of this work, multidisciplinary groups were set up to work on different themes and regular quarterly meetings were established to follow the progress of various projects. Risk mapping will be performed in pediatric and oncology unit where the risks associated with the handling of toxic products is omnipresent.
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Affiliation(s)
- J Pignard
- Pôle pharmacie, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - S Cosserant
- Service de réanimation médicale polyvalente, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - O Traore
- Service d'hygiène, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France; Direction qualité, gestion des risques et droits des usagers, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Souweine
- Service de réanimation médicale polyvalente, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France
| | - V Sautou
- Pôle pharmacie, CHU de Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France; EA 4676 C-BIOSENSS, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France
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Del Rio Crespo EA. Experiencia con la implementación del uso de soluciones estandarizadas de cloruro de potasio. AVANCES EN ENFERMERÍA 2015. [DOI: 10.15446/av.enferm.v33n1.48648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>El cloruro de potasio es un medicamento de alto riesgo que se utiliza frecuentemente en los hospitales. En el Hospital Pablo Tobón Uribe se conformó un grupo para liderar la implementación de una práctica segura para el uso de este medicamento. Inicialmente, se realizó un diagnóstico y con sus resultados se definió el retiro de las ampollas de cloruro de potasio de las unidades asistenciales, la prescripción de mezclas estandarizadas con este electrolito para pacientes pediátricos y adultos y su preparación centralizada por el Servicio Farmacéutico. Se hizo un seguimiento para evaluar la adherencia a la práctica implementada, en el que se encontró<br />un cumplimiento del 91,2%, sin presencia de viales almacenados en las unidades donde se restringió; además, se encontró la no influencia en las tasas de flebitis en comparación con meses previos al uso de estas mezclas y el reconocimiento de los riesgos inherentes al uso de un medicamento como el cloruro de potasio dentro del personal asistencial. En el momento actual, esta práctica continúa ejerciéndose en la institución, aunque se han tenido<br />mejoras de acuerdo a los hallazgos en los seguimientos realizados. Por lo tanto, es modelo a seguir para la implementación de otras medicaciones y mezclas que contienen electrolitos.</p>
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Lapkin S, Levett-Jones T, Gilligan C. Using the Theory of Planned Behaviour to examine health professional students' behavioural intentions in relation to medication safety and collaborative practice. NURSE EDUCATION TODAY 2015; 35:935-940. [PMID: 25935666 DOI: 10.1016/j.nedt.2015.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 03/13/2015] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Safe medication practices depend upon, not only on individual responsibilities, but also effective communication and collaboration between members of the medication team. However, measurement of these skills is fraught with conceptual and practical difficulties. AIMS The aims of this study were to explore the utility of a Theory of Planned Behaviour-based questionnaire to predict health professional students' behavioural intentions in relation to medication safety and collaborative practice; and to determine the contribution of attitudes, subjective norms, and perceived control to behavioural intentions. DESIGN A descriptive cross-sectional survey based upon the Theory of Planned Behaviour was designed and tested. PARTICIPANTS A convenience sample of 65 undergraduate pharmacy, nursing and medicine students from one semi-metropolitan Australian university were recruited for the study. METHODS Participants' behavioural intentions, attitudes, subjective norms, and perceived control to behavioural intentions in relation to medication safety were measured using an online version of the Theory of Planned Behaviour Medication Safety Questionnaire. RESULTS The Questionnaire had good internal consistency with a Cronbach's alpha of 0.844. The three predictor variables of attitudes, subjective norms, and perceived control accounted for between 30 and 46% of the variance in behavioural intention; this is a strong prediction in comparison to previous studies using the Theory of Planned Behaviour. Data analysis also indicated that attitude was the most significant predictor of participants' intention to collaborate with other team members to improve medication safety. CONCLUSION The results from this study provide preliminary support for the Theory of Planned Behaviour-Medication Safety Questionnaire as a valid instrument for examining health professional students' behavioural intentions in relation to medication safety and collaborative practice.
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Affiliation(s)
- Samuel Lapkin
- Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, Australia.
| | - Tracy Levett-Jones
- School of Nursing and Midwifery, Faculty of Health, Richardson Wing University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Conor Gilligan
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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Aggar C, Dawson S. Evaluation of student nurses' perception of preparedness for oral medication administration in clinical practice: a collaborative study. NURSE EDUCATION TODAY 2014; 34:899-903. [PMID: 24582895 DOI: 10.1016/j.nedt.2014.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/19/2014] [Accepted: 01/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Attainment of oral medication administration skills and competency for student nurses is challenging and medication errors are common. The ability of nurses to master a clinical skill is dependent upon educational instruction and practice. OBJECTIVES The aim of this study was to evaluate nursing students' perception of preparedness for oral medication administration in two practice environments and determine possible relationship between student demographics and their perceived preparedness for oral medication administration. DESIGN This was a cross sectional, exploratory study. PARTICIPANTS Eighty-eight second year students from a baccalaureate nursing course from two metropolitan Australian tertiary institutions participated. METHODS Student nurses' perception of preparedness for oral medication administration was measured via a self-administered, adapted, and validated questionnaire. RESULTS The overall mean Total Preparedness Score was 86.2 (range 71-102). There was no significant difference for perceived total preparedness to administer oral medications between the two facilities. Whilst there was no significant relationship established between student demographics and their perceived preparedness to administer oral medications, four single questions related to clinical practice were shown to be significant. CONCLUSION Low fidelity simulated teaching environments that incorporate time management and post medication situations, may improve student nurses' perceived preparedness for oral medication administration.
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Affiliation(s)
- Christina Aggar
- Sydney Nursing School, University of Sydney, Room A5.04, MO2, NSW 2006, Australia.
| | - Sonja Dawson
- Faculty of Nursing and Health, Avondale College of Higher Education, 185 Fox Valley Rd, Wahroonga, NSW 2076, Australia.
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Grugnetti AM, Bagnasco A, Rosa F, Sasso L. Effectiveness of a Clinical Skills Workshop for drug-dosage calculation in a nursing program. NURSE EDUCATION TODAY 2014; 34:619-624. [PMID: 23810339 DOI: 10.1016/j.nedt.2013.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/20/2013] [Accepted: 05/31/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mathematical and calculation skills are widely acknowledged as being key nursing competences if patients are to receive care that is both effective and safe. Indeed, weaknesses in mathematical competence may lead to the administration of miscalculated drug doses, which in turn may harm or endanger patients' lives. However, little attention has been given to identifying appropriate teaching and learning strategies that will effectively facilitate the development of these skills in nurses. One such approach may be simulation. OBJECTIVES To evaluate the effectiveness of a Clinical Skills Workshop on drug administration that focused on improving the drug-dosage calculation skills of second-year nursing students, with a view to promoting safety in drugs administration. DESIGN A descriptive pre-post test design. SETTINGS Educational. Simulation center. PARTICIPANTS The sample population included 77 nursing students from a Northern Italian University who attended a 30-hour Clinical Skills Workshop over a period of two weeks. METHODS The workshop covered integrated teaching strategies and innovative drug-calculation methodologies which have been described to improve psychomotor skills and build cognitive abilities through a greater understanding of mathematics linked to clinical practice. RESULTS Study results showed a significant improvement between the pre- and the post-test phases, after the intervention. Pre-test scores ranged between 0 and 25 out of a maximum of 30 points, with a mean score of 15.96 (SD 4.85), and a median score of 17. Post-test scores ranged between 15 and 30 out of 30, with a mean score of 25.2 (SD 3.63) and a median score of 26 (p<0.001). CONCLUSIONS Our study shows that Clinical Skills Workshops may be tailored to include teaching techniques that encourage the development of drug-dosage calculation skills, and that training strategies implemented during a Clinical skills Workshop can enhance students' comprehension of mathematical calculations.
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Affiliation(s)
- Anna Maria Grugnetti
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Francesca Rosa
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
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Ramjan LM, Stewart L, Salamonson Y, Morris MM, Armstrong L, Sanchez P, Flannery L. Identifying strategies to assist final semester nursing students to develop numeracy skills: a mixed methods study. NURSE EDUCATION TODAY 2014; 34:405-412. [PMID: 23623279 DOI: 10.1016/j.nedt.2013.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND It remains a grave concern that many nursing students within tertiary institutions continue to experience difficulties with achieving medication calculation competency. In addition, universities have a moral responsibility to prepare proficient clinicians for graduate practice. This requires risk management strategies to reduce adverse medication errors post registration. AIM To identify strategies and potential predictors that may assist nurse academics to tailor their drug calculation teaching and assessment methods. This project builds on previous experience and explores students' perceptions of newly implemented interventions designed to increase confidence and competence in medication calculation. METHODS This mixed method study surveyed students (n=405) enrolled in their final semester of study at a large, metropolitan university in Sydney, Australia. Tailored, contextualised interventions included online practice quizzes, simulated medication calculation scenarios developed for clinical practice classes, contextualised 'pen and paper' tests, visually enhanced didactic remediation and 'hands-on' contextualised workshops. Surveys were administered to students to determine their perceptions of interventions and to identify whether these interventions assisted with calculation competence. Test scores were analysed using SPSS v. 20 for correlations between students' perceptions and actual performance. Qualitative open-ended survey questions were analysed manually and thematically. RESULTS The study reinforced that nursing students preferred a 'hands-on,' contextualised approach to learning that was 'authentic' and aligned with clinical practice. Our interventions assisted with supporting students' learning and improvement of calculation confidence. Qualitative data provided further insight into students' awareness of their calculation errors and preferred learning styles. Some of the strongest predictors for numeracy skill performance included (1) being an international student, (2) completion of an online practice quiz, scoring 59% or above and (3) students' self-reported confidence. CONCLUSION A paradigm shift from traditional testing methods to the implementation of intensive, contextualised numeracy teaching and assessment within tertiary institutions will enhance learning and promote best teaching practices.
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Affiliation(s)
- Lucie M Ramjan
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
| | - Lyn Stewart
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
| | - Yenna Salamonson
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
| | - Maureen M Morris
- Student Learning Unit, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
| | - Lyn Armstrong
- Student Learning Unit, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
| | - Paula Sanchez
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751; Centre for Applied Nursing Research (CANR), South Western Sydney Local Health Network Services, Locked Bag 7103, Liverpool BC NSW 1871.
| | - Liz Flannery
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751.
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An evaluation of the drug calculation skills of registered nurses. Nurse Educ Pract 2014; 14:55-61. [DOI: 10.1016/j.nepr.2013.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 04/17/2013] [Accepted: 06/05/2013] [Indexed: 11/20/2022]
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Safety in numbers 6: Tracking pre-registration nursing students' cognitive and functional competence development in medication dosage calculation problem-solving: The role of authentic learning and diagnostic assessment environments. Nurse Educ Pract 2013; 13:e66-77. [DOI: 10.1016/j.nepr.2012.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
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Safety in numbers 4: The relationship between exposure to authentic and didactic environments and Nursing Students' learning of medication dosage calculation problem solving knowledge and skills. Nurse Educ Pract 2013; 13:e43-54. [DOI: 10.1016/j.nepr.2012.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/17/2022]
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Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and Nature of Medication Administration Errors in Health Care Settings: A Systematic Review of Direct Observational Evidence. Ann Pharmacother 2013; 47:237-56. [DOI: 10.1345/aph.1r147] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To systematically review empirical evidence on the prevalence and nature of medication administration errors (MAEs) in health care settings. DATA SOURCES: Ten electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, Scopus, Applied Social Sciences Index and Abstracts, PsycINFO, Cochrane Reviews and Trials, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, and Health Management Information Consortium) were searched (1985-May 2012). STUDY SELECTION AND DATA EXTRACTION: English-language publications reporting MAE data using the direct observation method were included, providing an error rate could be determined. Reference lists of all included articles were screened for additional studies. DATA SYNTHESIS: In all, 91 unique studies were included. The median error rate (interquartile range) was 19.6% (8.6–28.3%) of total opportunities for error including wrong-time errors and 8.0% (5.1–10.9%) without timing errors, when each dose could be considered only correct or incorrect. The median rate of error when more than 1 error could be counted per dose was 25.6% (20.8–41.7%) and 20.7% (9.7–30.3%), excluding wrong-time errors. A higher median MAE rate was observed for the intravenous route (53.3% excluding timing errors (IQR 26.6–57.9%)) compared to when all administration routes were studied (20.1%; 9.0–24.6%), where each dose could accumulate more than one error. Studies consistently reported wrong time, omission, and wrong dosage among the 3 most common MAE subtypes. Common medication groups associated with MAEs were those affecting nutrition and blood, gastrointestinal system, cardiovascular system, central nervous system, and antiinfectives. Medication administration error rates varied greatly as a product of differing medication error definitions, data collection methods, and settings of included studies. Although MAEs remained a common occurrence in health care settings throughout the time covered by this review, potential targets for intervention to minimize MAEs were identified. CONCLUSIONS: Future research should attend to the wide methodological inconsistencies between studies to gain a greater measure of comparability to help guide any forthcoming interventions.
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Affiliation(s)
- Richard N Keers
- Richard N Keers MPharm, Postgraduate Research Student, Centre for Pharmacoepidemiology and Drug Safety Research, School of Pharmacy and Pharmaceutical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, England
| | - Steven D Williams
- Steven D Williams MPhil, Consultant Pharmacist and Honorary Clinical Lecturer, School of Pharmacy and Pharmaceutical Sciences, University of Manchester
| | - Jonathan Cooke
- Jonathan Cooke PhD, Honorary Professor, School of Pharmacy and Pharmaceutical Sciences, University of Manchester
| | - Darren M Ashcroft
- Darren M Ashcroft PhD, Professor of Pharmacoepidemiology, Centre for Pharmacoepidemiology and Drug Safety Research, School of Pharmacy and Pharmaceutical Sciences, Manchester Academic Health Sciences Centre, University of Manchester
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Sulosaari V, Kajander S, Hupli M, Huupponen R, Leino-Kilpi H. Nurse students' medication competence--an integrative review of the associated factors. NURSE EDUCATION TODAY 2012; 32:399-405. [PMID: 21652125 DOI: 10.1016/j.nedt.2011.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 04/30/2011] [Accepted: 05/16/2011] [Indexed: 05/30/2023]
Abstract
AIM The aim of this review was to identify factors associated with nurse students' medication competence. BACKGROUND Registered nurses play an important role in safe and effective medication management. Previous nursing literature has highlighted deficiencies in nurse students' medication competence, yet little is known about specific factors which are associated with their medication competence. METHOD Integrative literature review. RESULTS Nineteen articles met the selection criteria for this review. The main competence area the reviewed articles focused on was medication calculation skills of nurse students. However, a total of twelve factors were identified to be associated with nurse students' medication competence. They constitute three main categories: factors associated with individual nurse students' particular circumstances, the clinical learning environment, and the educational institution. Individual factors such as students' attitudes towards mathematics and their self-confidence seem to be associated most strongly with medication competence. CONCLUSION First, based on this review, the focus in medication competence research has been strongly on nurse students' medication calculation skills. Therefore, in future research and practice, attention needs to be paid to other competency areas as well, such as medication administration and patient medication education skills. Second, overall, only a limited amount of research exists that explores what factors are associated with medication competence.
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Affiliation(s)
- Virpi Sulosaari
- University of Turku, Faculty of Medicine, Department of Nursing Science, Finland.
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A systematic approach to improving medication safety in a pediatric intensive care unit. Crit Care Nurs Q 2012; 35:15-26. [PMID: 22157489 DOI: 10.1097/cnq.0b013e31823c25dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Safety and quality improvement are major issues in children's hospitals. Improving pediatric medication safety often takes on a larger role in pediatric units than in adult units due to the larger size differences and dose ranges found in a pediatric intensive care unit. This article reviews the literature and our own experience at the CS Mott Children's Hospital, University of Michigan, to improve medication safety. The issues identified include (1) an effective pediatric medication safety governance structure within a larger hospital, (2) practice standardization strategies for physicians, nurses, and pharmacists, (3) use of pharmacy technicians as unit medication managers, which reduces medication costs and decreases nursing time spent hunting for medications, and (4) methods to improve the safety culture in a pediatric intensive care unit.
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Pons JMV. El déficit de comprensión numérica. Las matemáticas como problema. Med Clin (Barc) 2012; 138:15-7. [DOI: 10.1016/j.medcli.2011.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 09/08/2011] [Indexed: 11/29/2022]
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Sherriff K, Burston S, Wallis M. Effectiveness of a computer based medication calculation education and testing programme for nurses. NURSE EDUCATION TODAY 2012; 32:46-51. [PMID: 21345550 DOI: 10.1016/j.nedt.2011.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/25/2011] [Accepted: 01/28/2011] [Indexed: 05/30/2023]
Abstract
The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety.
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Affiliation(s)
- Karen Sherriff
- Gold Coast Health Service District, QLD, Nursing Education and Research Unit, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
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Simonsen BO, Johansson I, Daehlin GK, Osvik LM, Farup PG. Medication knowledge, certainty, and risk of errors in health care: a cross-sectional study. BMC Health Serv Res 2011; 11:175. [PMID: 21791106 PMCID: PMC3162500 DOI: 10.1186/1472-6963-11-175] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 07/26/2011] [Indexed: 11/10/2022] Open
Abstract
Background Medication errors are often involved in reported adverse events. Drug therapy, prescribed by physicians, is mostly carried out by nurses, who are expected to master all aspects of medication. Research has revealed the need for improved knowledge in drug dose calculation, and medication knowledge as a whole is poorly investigated. The purpose of this survey was to study registered nurses' medication knowledge, certainty and estimated risk of errors, and to explore factors associated with good results. Methods Nurses from hospitals and primary health care establishments were invited to carry out a multiple-choice test in pharmacology, drug management and drug dose calculations (score range 0-14). Self-estimated certainty in each answer was recorded, graded from 0 = very uncertain to 3 = very certain. Background characteristics and sense of coping were recorded. Risk of error was estimated by combining knowledge and certainty scores. The results are presented as mean (±SD). Results Two-hundred and three registered nurses participated (including 16 males), aged 42.0 (9.3) years with a working experience of 12.4 (9.2) years. Knowledge scores in pharmacology, drug management and drug dose calculations were 10.3 (1.6), 7.5 (1.6), and 11.2 (2.0), respectively, and certainty scores were 1.8 (0.4), 1.9 (0.5), and 2.0 (0.6), respectively. Fifteen percent of the total answers showed a high risk of error, with 25% in drug management. Independent factors associated with high medication knowledge were working in hospitals (p < 0.001), postgraduate specialization (p = 0.01) and completion of courses in drug management (p < 0.01). Conclusions Medication knowledge was found to be unsatisfactory among practicing nurses, with a significant risk for medication errors. The study revealed a need to improve the nurses' basic knowledge, especially when referring to drug management.
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Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011; 20:1027-34. [PMID: 21690248 PMCID: PMC3228265 DOI: 10.1136/bmjqs-2011-000089] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Intravenous medication administrations have a high incidence of error but there is limited evidence of associated factors or error severity. Objective To measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience. Methods Prospective observational study of 107 nurses preparing and administering 568 intravenous medications on six wards across two teaching hospitals. Procedural failures (eg, checking patient identification) and clinical intravenous errors (eg, wrong intravenous administration rate) were identified and categorised by severity. Results Of 568 intravenous administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and 25.5% (95% CI 21.2 to 29.8) of these were serious. Four error types (wrong intravenous rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors. Wrong rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and severity decreased with clinical experience. Each year of experience, up to 6 years, reduced the risk of error by 10.9% and serious error by 18.5%. Administration by bolus was associated with a 312% increased risk of error. Patient identification was only checked in 47.9% of administrations but was associated with a 56% reduction in intravenous error risk. Conclusions Intravenous administrations have a higher risk and severity of error than other medication administrations. A significant proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases. A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both areas suggest specific targets for intervention.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 1 AGSM Building, University of New South Wales, Kensington 2052, Sydney, Australia.
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Dyjur L, Rankin J, Lane A. Maths for medications: an analytical exemplar of the social organization of nurses' knowledge. Nurs Philos 2011; 12:200-13. [DOI: 10.1111/j.1466-769x.2011.00493.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The aim of this article is to review the preparation and administration of intravenous (IV) therapy and to outline safe standards of practice. This article reviews the preparation for the procedure and then outlines actions for preparing--the patient, the practitioner, the environment and equipment, and then the medication--before describing the administration of any IV medication, whether via a bolus, intermittent or continuous route. A review of errors in IV therapy indicated calculation skill and a wide knowledge is required, while the National Patient Safety Agency (NPSA) (2010) highlighted omited and delayed medications as the second largest cause of medication incidents. Therefore the Royal College of Nursing (RCN) (2010) suggested each practitioner must have knowledge of the principles of reconstituting, including aseptic technique, compatibility (physical, chemical, and therapeutic), stability, storage, labelling, interactions, dosage, calculations and the use of appropriate equipment. Furthermore, Finlay (2004) advocated that training must also include the management of anaphylaxis. The necessity for safe and consistent IV practice is endosed and explored through Crimlisk et al's (2009) nine rights of IV medications, and Billings and Kowalski's (2005) mnemonic (CATS:PRRR).
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Parslow GR. Commentary: Decaying numerical skills. "I can't divide by 60 in my head!". BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2010; 38:46-47. [PMID: 21567791 DOI: 10.1002/bmb.20374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Graham R Parslow
- Department of Biochemistry and Molecular Biology, The University of Melbourne, Victoria 3010, Australia.
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