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Garrod M, Fox A, Rutter P. Automated search methods for identifying wrong patient order entry-a scoping review. JAMIA Open 2023; 6:ooad057. [PMID: 37545981 PMCID: PMC10397536 DOI: 10.1093/jamiaopen/ooad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate: (1) what automated search methods are used to identify wrong-patient order entry (WPOE), (2) what data are being captured and how they are being used, (3) the causes of WPOE, and (4) how providers identify their own errors. Materials and Methods A systematic scoping review of the empirical literature was performed using the databases CINAHL, Embase, and MEDLINE, covering the period from database inception until 2021. Search terms were related to the use of automated searches for WPOE when using an electronic prescribing system. Data were extracted and thematic analysis was performed to identify patterns or themes within the data. Results Fifteen papers were included in the review. Several automated search methods were identified, with the retract-and-reorder (RAR) method and the Void Alert Tool (VAT) the most prevalent. Included studies used automated search methods to identify background error rates in isolation, or in the context of an intervention. Risk factors for WPOE were identified, with technological factors and interruptions deemed the biggest risks. Minimal data on how providers identify their own errors were identified. Discussion RAR is the most widely used method to identify WPOE, with a good positive predictive value (PPV) of 76.2%. However, it will not currently identify other error types. The VAT is nonspecific for WPOE, with a mean PPV of 78%-93.1%, but the voiding reason accuracy varies considerably. Conclusion Automated search methods are powerful tools to identify WPOE that would otherwise go unnoticed. Further research is required around self-identification of errors.
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Affiliation(s)
- Mathew Garrod
- Corresponding Author: Mathew Garrod, MPharm, Department of Pharmacy, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK;
| | - Andy Fox
- Department of Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Rutter
- School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
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Silvestre JH, Spector N. Nursing Student Errors and Near Misses: Three Years of Data. J Nurs Educ 2023; 62:12-19. [PMID: 36652577 DOI: 10.3928/01484834-20221109-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Understanding the magnitude of errors and near misses in all health care situations is crucial to preventing them from occurring in the future. However, little research is available on the type or extent of nursing student errors in the United States. METHOD Nursing student error and near miss data were submitted by more than 200 participating prelicensure nursing programs via a secured online repository. RESULTS Medication errors represented more than half (58.8%, n = 613) of the total error and near-miss data (n = 1,042) submitted. Errors and near misses were attributed to students not adhering to three major patient safety procedures: checking the patient's identification, checking the patient's allergy status, and following the rights of medication administration. CONCLUSION Results indicate collecting data on nursing students' errors and near misses can help nursing programs identify system issues, promote transparency, and make quality improvements. [J Nurs Educ. 2023;62(1):12-19.].
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Stolic S, Ng L, Southern J, Sheridan G. Medication errors by nursing students on clinical practice: An integrative review. NURSE EDUCATION TODAY 2022; 112:105325. [PMID: 35339836 DOI: 10.1016/j.nedt.2022.105325] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medication errors are a serious concern and often due to multiple factors. The largest workforce in healthcare are nurses. Nurses play a major role in medication management especially in medication administration. To become proficient in safe medication administration undergraduate nurses, need to be provided with adequate training in clinical settings. Aim This integrative review aims to identify literature that reports medication errors including prevalence, types, causes and barriers of reporting whilst nursing students are on clinical placement. METHODS A review was conducted of five electronic databases to identify original empirical research published between 2007 and 2021. An integrative review method using Strengthening the Report of Observational Studies in Epidemiology guidelines was used to direct this review. FINDINGS The initial search yielded 1574 articles. A total of six full text articles met the eligibility criteria were reviewed. The prevalence of medication errors made by nursing students on clinical placement was 6-1.1%. Causes were due to student, education and environmental factors. Types of errors medication calculations, incorrect name of patient, wrong medication and omission of medication administration. DISCUSSION This review confirms previous studies with 10-5% of all errors by nurses are medication errors in hospitals. Strategies to improve medication administration are increasing staffing, communication, education and supervision of students. CONCLUSION Medication administration is a multifactorial process that involves medication skills. Closer supervision, improved education on technology and consistency is required in number of rights of medication administration.
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Affiliation(s)
- Snezana Stolic
- School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich 4305, Australia.
| | - Linda Ng
- School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich 4305, Australia
| | - Joanne Southern
- School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich 4305, Australia
| | - Georgina Sheridan
- School of Nursing and Midwifery, Faculty of Science, Engineering and Health, University of Southern Queensland, Salisbury Road, Ipswich 4305, Australia
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Davidson KM, Morgan P, Ferreira C, Thomas CM, Nowell L. Adapting a Distraction and Interruption Simulation for Safe Medication Preparation: An International Collaboration. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heinemann S, Kasper-Deußen AK, Weiß V, Marx G, Himmel W. [Experiences when handling sleep medicines: Group discussions with nursing students about benzodiazepines and Z-drugs]. Pflege 2021; 35:95-103. [PMID: 34854326 DOI: 10.1024/1012-5302/a000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Experiences when handling sleep medicines: Group discussions with nursing students about benzodiazepines and Z-drugs Abstract. Background and aims: Helping patients who have difficulties falling or staying asleep is one of the challenges of hospital care. The goal of this study was to explore how nursing students experience patients' sleeping problems as well as the usage of sleep-inducing drugs, especially benzodiazepines and Z-drugs in the hospital setting. Methods: In four focus group discussions, we collected data exploring the experiences of nursing students with regards to sleeping problems and sleep-inducing drugs. The transcripts of the discussion were analysed, using documentary method. Results were finally summarized to main categories, using qualitative content analysis. Results: Students experience a generous distribution of sleep-inducing drugs, which are considered as the best possible solution for sleeping problems - in spite of weak evidence. Non-drug alternatives are seldom taught, are often unavailable on the ward and their use is rarely trained. Pharmacological knowledge is too shallow and / or the transfer of theoretical knowledge to practical action is unsuccessful. Sleep and sleeping problems, e. g. in contrast to pain management, are not a topic of priority in the hospital setting. Conclusions: More knowledge and greater sensibility about sleeping problems is needed. For example, nurses' training should incorporate knowledge about medications and non-drug alternatives and how to apply them in critical situations. Doctors and nurses should offer nursing students good role models in these situations.
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Affiliation(s)
| | | | - Vivien Weiß
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen
| | - Gabriella Marx
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen
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Berg TA, Hebert SH, Chyka D, Nidiffer S, Springer C. Use of Simulation to Measure the Effects of Just-in-Time Information to Prevent Nursing Medication Errors: A Randomized Controlled Study. Simul Healthc 2021; 16:e136-e141. [PMID: 33273421 DOI: 10.1097/sih.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Medication administration error (MAE) is the improper dispensing of medication. It is a significant contributor to the occurrence of medical errors. A novel systems thinking approach using a pediatric simulation and student nurses were used to evaluate the benefit of applying just-in-time information (JITI) to reduce medication errors. Just-in-time information applies highly focused information delivered when needed. METHODS A smart device app was developed to provide JITI medication administration information. The effect JITI had on MAE occurrence was assessed via a controlled study. The study population included 38 teams having 2 to 3 senior nursing students on each team. The teams were separated into a control and 2 intervention groups to complete a medication administration simulation. RESULTS The intervention groups (100%, N = 10) that made significant use of the JITI app demonstrated improved performance for medication administration over the control group. Familiarity with the app was pivotal to how frequently it was used and to the success of the groups in administering medications. Although those with access to the app having limited training successfully executed the simulation 27.3% (n = 11) of the time, those with extended training had a success rate of 77.8% (n = 9). CONCLUSIONS Providing JITI significantly reduced the occurrence of MAEs for these student nurses. Familiarity with the app, including extended training opportunities, contributed significantly to student success.
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Affiliation(s)
- Thomas A Berg
- From the College of Nursing (T.A.B., S.H.H., D.C., S.N.), and Office of Information Technology (C.S.), University of Tennessee, Knoxville, TN
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Kuo SY, Thadakant S, Warsini S, Chen HW, Hu SH, Aulawi K, Duangbubpha S, Pangastuti HS, Khuwatsamrit K. Types of medication administration errors and comparisons among nursing graduands in Indonesia, Taiwan, and Thailand: A cross-sectional observational study. NURSE EDUCATION TODAY 2021; 107:105120. [PMID: 34482207 DOI: 10.1016/j.nedt.2021.105120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite medication administration safety having been introduced, practiced, and examined in nursing schools for many years, errors are commonly reported among new nurses. Understanding medication errors that nursing graduands might commit is essential for patient safety and fostering collaboration among neighboring countries. OBJECTIVES To assess and compare types of medication administration errors identified by nursing graduands in Asian countries using a medication errors scenario. DESIGN A cross-sectional observational study. SETTINGS One university four-year nursing program each in Indonesia, Taiwan, and Thailand. PARTICIPANTS A total of 145 baccalaureate nursing graduands in their last semester, including 42 from Indonesia, 35 from Taiwan, and 68 from Thailand. METHODS The medication errors scenario contained 11 errors. The faculty examiner directly observed and graded the graduands' performance in identifying medication errors using an objective structured medication administration checklist. Descriptive and inferential analyses were used. RESULTS Overall, 4.4 ± 1.8 errors on average were identified in the medication errors scenario. The most common types of errors differed among the three countries. More than half of the graduands did not check the patient's wristband (n = 75; 51.7%) or discovered the wrong name on it (n = 88; 60.7%). Giving medication without an indication (n = 129; 89.0%) and giving medication with potential for an allergic reaction (n = 111; 76.6%) were the most common errors. CONCLUSIONS Medication administration errors are common in nursing graduands. Specific types and various frequencies of errors were noted across three countries. Nursing faculties should investigate possible reasons for common types of errors and develop effective education strategies for graduands to prevent errors. Collaboration among neighboring countries is encouraged to improve overall global medication safety.
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Affiliation(s)
- Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.
| | - Streerut Thadakant
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
| | - Sri Warsini
- Department of Mental Health and Community Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Hui-Wen Chen
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Linong Street, Sec. 2, Taipei 11221, Taiwan
| | - Sophia H Hu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Linong Street, Sec. 2, Taipei 11221, Taiwan.
| | - Khudazi Aulawi
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Sumolchat Duangbubpha
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
| | - Heny S Pangastuti
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Gedung Ismangun, Lt.2 Jl. Farmako, Sekip Utara, Yogyakarta, Indonesia.
| | - Kusuma Khuwatsamrit
- Ramathibodi School of Nursing, Mahidol University Faculty of Medicine Ramathibodi Hospital, Rama 6 Road, Payathai District, Rachathewi, Bangkok 10400, Thailand.
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Clinical Reasoning, Judgment, and Safe Medication Administration Practices in Senior Nursing Students. Nurse Educ 2021; 47:51-55. [PMID: 34359065 DOI: 10.1097/nne.0000000000001059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Medication errors occur at alarming rates. Safe medication administration practices require more than observing patient safety rights and psychomotor skills. The purpose of this study was to explore the relationships between clinical judgment skills and reasoning processes and safe medication practices in senior nursing students. METHODS Using a cross-sectional design, 29 students from 3 schools of nursing watched a video simulation of a nurse administering medications in a clinical setting. At predetermined times, reflections on the medication administration practices were journaled. Journals were scored for clinical reasoning processes and clinical judgment using the Clinical Judgment Rubric-Reflective Journal (CJR-RJ) and for medication administration best practices. RESULTS Students scored low on the CJR-RJ (mean [SD], 5.2 [1.7]). We found a positive relationship between clinical judgment skills and safe medication practices (r = 0.39, t27 = 2.94, P = .018). The clinical reasoning process of Interpreting was a significant indicator of best practices (b = 1.4, t28 = 2.81, P = .010). CONCLUSION Our findings suggest that students struggle to connect theory to practice, emphasizing the need to plan experiential learning opportunities for students to develop clinical reasoning, particularly in Interpreting, and judgment skills to prevent medication errors upon entry to practice.
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Abraham J, Galanter WL, Touchette D, Xia Y, Holzer KJ, Leung V, Kannampallil T. Risk factors associated with medication ordering errors. J Am Med Inform Assoc 2021; 28:86-94. [PMID: 33221852 DOI: 10.1093/jamia/ocaa264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We utilized a computerized order entry system-integrated function referred to as "void" to identify erroneous orders (ie, a "void" order). Using voided orders, we aimed to (1) identify the nature and characteristics of medication ordering errors, (2) investigate the risk factors associated with medication ordering errors, and (3) explore potential strategies to mitigate these risk factors. MATERIALS AND METHODS We collected data on voided orders using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. Interviews were informed by the human factors-based SEIPS (Systems Engineering Initiative for Patient Safety) model to characterize the work systems-based risk factors contributing to ordering errors; chart reviews were used to establish whether a voided order was a true medication ordering error and ascertain its impact on patient safety. RESULTS During the 16-month study period (August 25, 2017, to December 31, 2018), 1074 medication orders were voided; 842 voided orders were true medication errors (positive predictive value = 78.3 ± 1.2%). A total of 22% (n = 190) of the medication ordering errors reached the patient, with at least a single administration, without causing patient harm. Interviews were conducted on 355 voided orders (33% response). Errors were not uniquely associated with a single risk factor, but the causal contributors of medication ordering errors were multifactorial, arising from a combination of technological-, cognitive-, environmental-, social-, and organizational-level factors. CONCLUSIONS The void function offers a practical, standardized method to create a rich database of medication ordering errors. We highlight implications for utilizing the void function for future research, practice and learning opportunities.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA.,Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - William L Galanter
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA.,Department of Pharmacy Systems, Outcome and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Touchette
- Department of Pharmacy Systems, Outcome and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yinglin Xia
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA
| | - Vania Leung
- Department of Medicine, College of Medicine, University of Illinois at Chicago,Chicago, Illinois, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St. Louis,St. Louis, Missouri, USA.,Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Student Nurses' Assessment of Medical Errors. Creat Nurs 2021; 27:131-137. [PMID: 33990455 DOI: 10.1891/crnr-d-20-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the quality of nursing students' assessment of cases of medical error. METHOD This descriptive cross-sectional study was conducted with 145 nursing students in İzmir, Turkey. The epidemiology of the medical errors that the students witnessed during clinical practice was examined. Then, the success of the students in using the Text-Based Medical Error cases tool developed by the researchers was examined. RESULTS Of the students, 24.1% had witnessed medical errors during clinical practice. The percentage of students successfully analyzing cases of medical errors related to patient identification, falling, medication administration, blood transfusions, health-care-associated infections, and pressure ulcers were 51.72%, 7.59%, 17.24%, 8.28%, 45.52%, and 56.55%, respectively. CONCLUSION The students' ability to evaluate cases of medical error needs improvement.
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Dehvan F, Dehkordi AH, Gheshlagh RG, Kurdi A. The Prevalence of Medication Errors Among Nursing Students: A Systematic and Meta-analysis Study. Int J Prev Med 2021; 12:21. [PMID: 34084318 PMCID: PMC8106284 DOI: 10.4103/ijpvm.ijpvm_418_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 06/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health promotion and preserving patients' safety are the main purposes of care in health-therapeutic systems. With regard to nursing profession, nursing students are exposed to medications errors (MEs) during clinical activities, which can be considered as a threat to patients' safety. The study aimed to determine the prevalence of MEs among nursing students using a systematic and meta-analysis approach. METHODS 8 studies (in 9 groups) in English and Persian from inception to March 2019, were collected. Searched was conducted in SID, MagIran, IranMedex, Google Scholar, Web of Science, PubMed and Scopus. The meta-analysis method and the random effects model were used to analyze the data. In addition, the I2 statistic was used to examine heterogeneity among studies. The analyses were conducted using Stata, version 11. RESULTS Analysis of 8 studies (in 9 groups) with a total sample size of 688 showed that the overall MEs' prevalence among nursing students was 39.68% (95% CI: 22.07-57.29) and the prevalence of lack of reporting MEs was 48.60% (95%CI: 27.33-69.86). There were no relationships between the prevalence of MEs and lack of reporting MEs in nursing students with the sample size and the mean age of students. CONCLUSIONS Considering the relatively high prevalence of MEs and lack of MEs reporting among nursing students and the importance of their effect on the level of patients' safety, measures such as educations, monitoring by clinical trainers, and examining and eliminating the causes of MEs are essential.
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Affiliation(s)
- Fazel Dehvan
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Hassanpour Dehkordi
- School of Allied Medical Scinces, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Reza Ghanei Gheshlagh
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
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Berg TA, Li X, Sawhney R, Wyatt T. Agent-Based Modeling Simulation of Nurse Medication Administration Errors. Comput Inform Nurs 2020; 39:187-197. [PMID: 33787523 DOI: 10.1097/cin.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It has been 20 years since the National Academy of Medicine released its report, "To Err Is Human," which shocked the healthcare community on the pervasiveness of medical error. While errors in medication administration are a significant contributor to medical error, research seeking to understand the complex systems nature and occurrence of medication administration error is limited. Computer modeling is increasingly being used in the healthcare industry to assess the impact of changes made to healthcare processes. The objective of the study is to evaluate the use of agent-based modeling, a type of computer modeling that allows the simulation of virtual individuals and their behavior, to simulate nurse performance in the medication administration process. The model explores the effect of Just-in-Time information, as an intervention, on the occurrence of medication error. The model demonstrated significant utility in understanding the interplay of the system elements of the nurse medication administration process. Therefore this approach, using systems-level computer simulation such as agent-based models, can help administrators understand the effects of changes to the medication administration process as they work to reduce errors and increase performance.
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Affiliation(s)
- Thomas A Berg
- Author Affiliations: Health Innovation Technology Simulation Laboratory, College of Nursing (Drs Berg and Wyatt), and Health Innovation Technology Simulation Laboratory Industrial and Systems Engineering (Dr Li) and Industrial and Systems Engineering (Dr Sawhney), College of Engineering, The University of Tennessee-Knoxville
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13
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The relationship between moral sensitivity and medical errors attitude in nursing students. J Forensic Leg Med 2020; 73:101981. [DOI: 10.1016/j.jflm.2020.101981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/20/2020] [Accepted: 05/09/2020] [Indexed: 11/17/2022]
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Silverio SA, Cope LC, Bracken L, Bellis J, Peak M, Kaehne A. The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital. Res Social Adm Pharm 2020; 16:1768-1774. [PMID: 32035869 DOI: 10.1016/j.sapharm.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. OBJECTIVES To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. METHODS A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. RESULTS We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. CONCLUSIONS TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Louise C Cope
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer Bellis
- Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Axel Kaehne
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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Bickel AE, Villasecas VX, Fluxá PJ. Characterization of adverse events occurring during nursing clinical rotations: A descriptive study. NURSE EDUCATION TODAY 2020; 84:104224. [PMID: 31670227 DOI: 10.1016/j.nedt.2019.104224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/14/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Patient safety is a pillar of quality health care. Nursing students may commit errors during clinical practice, compromising patient safety. OBJECTIVE Analyze the adverse events, as well as the factors associated with the errors, reported by students from a private university in Santiago, Chile during nursing clinical rotations. METHODS Quantitative cross-sectional descriptive study. A total of 68 errors by first- through fifth-year nursing students were reported between 2012 and 2018. The data collection instrument was the Adverse Events Notification Form from the School of Nursing. This form documented information about the study as well as about the event. RESULTS After this reporting system was established in 2012, the number of events reported increased steadily each year. The greatest numbers of reported errors were committed by fifth-year students (73.5%), and the most common type of error was associated with medication administration (94.2%), including incorrect dose (27.9%) and incorrect medication (17.6%). The major factors contributing to errors were failure to review the "10 rights of medication administration" (85.3%) or lack of critical judgment (7.4%). Most of the errors occurred in public institutions (72.1%). CONCLUSION The results suggest that it would be beneficial to re-evaluate how safety and quality of care are taught at the school of nursing, with an emphasis on understanding the learning styles of students and teaching strategies of instructors. It is crucial that the academic institution remain actively involved in teaching safety-related skills to future nursing professionals. Furthermore, we suggest modifications to the adverse events reporting system that would avoid the need for personal interpretations of the event by the student.
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Kahriman İ, Ozturk H. DEVELOPMENT OF A MEDICAL ERROR SCALE FOR NURSING STUDENTS: A METHODOLOGICAL STUDY. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/clinexphealthsci.599907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ardahan-Akgül E, Özgüven-Öztornacı B, Doğan Z, Yıldırım-Sarı H. Determination of Senior Nursing Students' Mathematical Perception Skills and Pediatric Medication Calculation Performance. Florence Nightingale Hemsire Derg 2019; 27:166-172. [PMID: 34267971 PMCID: PMC8127605 DOI: 10.26650/fnjn382707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022] Open
Abstract
Aim Math skills in the health field are often used to calculate drug dosage and liquid quantity, body mass and cost analysis. The aim of this research is to determine the senior nursing students' mathematical perception skills and pediatric medication calculation performance. Method The population of this descriptive cross-sectional research is composed of 103 nursing students in attending a state university in Izmir, Turkey. Of the 103 nursing students, 97 who answered all the questions comprised the study sample. All the participants took one-month training in the pediatric clinics during the last year of their education. The data were collected using the "Personal Information Form and Mathematics Perception, Information and Pediatric Drug Calculator Skills Survey" developed by the researchers by reviewing the literature. Results The mean age of the study participants was 22.24±0.89. Of them, 76.3% were female, 23.7% completed their Pediatric Internship Training in the pediatric inpatient units or the Pediatric Intensive Care Unit (PICU), 68% thought that their basic mathematics knowledge was adequate, and %30 stated that their dosage calculation, solution preparation and drug preparation skills were insufficient. In addition, the rate of the correct answers they gave to the questions on percentages, fractions and conversions was low. Conclusion In the drug application process; not only practical skills, but also the theoretical knowledge should be considered. A nurse's responsibility does not end once he/she administers medication. Being careful throughout the entire process is one of the nurse's legal and ethical responsibilities. In this study, the students' drug calculation skills were inadequate.
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Affiliation(s)
- Esra Ardahan-Akgül
- İzmir Katip Çelebi University Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey
| | - Beste Özgüven-Öztornacı
- İzmir Katip Çelebi University Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey
| | - Zehra Doğan
- İzmir Katip Çelebi University Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey
| | - Hatice Yıldırım-Sarı
- İzmir Katip Çelebi University Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey
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The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic. Nurse Educ Pract 2019; 36:34-39. [PMID: 30851637 DOI: 10.1016/j.nepr.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 10/22/2018] [Accepted: 02/27/2019] [Indexed: 11/24/2022]
Abstract
Despite efforts to increase patient safety, medical incidents and near misses occur daily. Much is still unknown about this phenomenon, especially due to underreporting. This study examined why nursing students and clinical instructors underreport medical events, and whether they believe that changes within their institutions could increase reporting. 103 third- and fourth-year nursing students and 55 clinical instructors completed a validated questionnaire. The results showed that about one-third of the instructors and one-half of the nursing students believed that circumstances and lack of awareness, and fear of consequences, lead to underreporting. Both nursing students and clinical instructors ranked "fear of consequences" as the main reason for not reporting, yet students ranked this higher than their instructors. Moreover, both groups believed that incident reporting could be increased following changes in the clinical field, mainly by increasing awareness and knowledge. A large percentage of participants also wrote that they do not report errors that are the result of circumstances and lack of awareness, mainly fear of consequences. Therefore, hospitals and academic institutions may need to create a more accepting organizational climate. Moreover, institutions that allow incident reports to be submitted anonymously and that take educational (not disciplinary) action, may increase incident reporting.
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La Cerra C, Dante A, Caponnetto V, Franconi I, Gaxhja E, Petrucci C, Alfes CM, Lancia L. Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis. BMJ Open 2019; 9:e025306. [PMID: 30798316 PMCID: PMC6398734 DOI: 10.1136/bmjopen-2018-025306] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes. DESIGN A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. DATA SOURCES PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references. STUDY SELECTION To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis. REVIEW METHOD Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria. SYNTHESIS METHOD For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI. RESULTS Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected. CONCLUSIONS Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.
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Affiliation(s)
- Carmen La Cerra
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Angelo Dante
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Valeria Caponnetto
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Ilaria Franconi
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Elona Gaxhja
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Celeste M Alfes
- Center for Nursing Education, Simulation, and Innovation, France Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Noviyanti LW, Handiyani H, Gayatri D. Improving the implementation of patient safety by nursing students using nursing instructors trained in the use of quality circles. BMC Nurs 2018; 17:53. [PMID: 30574017 PMCID: PMC6299492 DOI: 10.1186/s12912-018-0318-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background It is recognised worldwide that the skills of nursing students concerning patient safety is still not optimal. The role of clinical instructors is to instil in students the importance of patient safety. Therefore, it is important to have competent clinical instructors. Their experience can be enhanced through the application of quality circles. This study identifies the effect of quality circles on improving the safety of patients of nursing students. Patient safety is inseparable from the quality of nursing education. Existing research shows that patient safety should be emphasised at all levels of the healthcare education system. In hospitals, the ratio between nursing students and clinical instructors is disproportionately low. In Indonesia, incident data relating to patient safety involving students is not well documented, and the incidents often occur in the absence of a clinical instructor. Methods This study used a quasi-experimental research design with pre-test and post-test non-equivalent control groups. The aim of the project was to explore the implications of the quality circle on clinical instructors by comparing the students’ knowledge, attitudes, and practices of control and intervention groups. A questionnaire will be conducted to evaluate the implementation of patient safety and the impact of the intervention. The data were statistically analysed using independent t tests. The intervention was the implementation of quality circles that focused on patient safety issues for the use of clinical instructors to assess and guide student nurse behaviour in regard to patient safety. The authors of this study trained the clinical instructors on how to use quality circle methods to solve nursing problems especially with relevance to the patient safety issues of students. Results The results showed a significant increase in the behaviour of nursing students towards patient safety issues (p < 0.001; α = 0.05). Conclusions The implementation of quality circles has a significant effect on patient safety. Therefore, it is recommended to implement quality circles as a problem-solving technique to optimize patient safety.
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Affiliation(s)
- Linda Wieke Noviyanti
- 1Nursing Management Department, Brawijaya University, Malang, East Java 65145 Indonesia
| | - Hanny Handiyani
- 2Basic Nursing Department, University of Indonesia, Depok, West Java 16424 Indonesia
| | - Dewi Gayatri
- 2Basic Nursing Department, University of Indonesia, Depok, West Java 16424 Indonesia
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Palese A, Gonella S, Grassetti L, Mansutti I, Brugnolli A, Saiani L, Terzoni S, Zannini L, Destrebecq A, Dimonte V. Multi-level analysis of national nursing students' disclosure of patient safety concerns. MEDICAL EDUCATION 2018; 52:1156-1166. [PMID: 30345687 DOI: 10.1111/medu.13716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/09/2018] [Accepted: 07/18/2018] [Indexed: 05/28/2023]
Abstract
CONTEXT Error reporting is considered one of the most important mediating factors for patient safety (PS). However, reporting errors can be challenging for health care students. OBJECTIVES The aims of the study were: (i) to describe nursing students' opportunity to report errors, near misses or PS issues that emerged during their clinical learning experience; and (ii) to explore associated factors of the process of reporting itself. METHODS A national survey was conducted on 9607 (91.7%) undergraduate nursing students. The endpoint was to have reported PS issues in the last clinical learning experience (from 0 'never' to 3 'always'). Explanatory variables were set individual, nursing programme and regional levels. RESULTS A total of 4004 (41.7%) nursing students reported PS issues from 'never/rarely' to 'sometimes'. In the multi-level analysis, factors increasing the likelihood of reporting events affecting PS have been mainly at the nursing programme level: specifically, higher learning opportunities (odds ratio [OR] = 3.040; 95% confidence interval [CI], 2.667-3.466), self-directed learning opportunities (OR = 1.491; 95% CI, 1.364-1.630), safety and nursing care quality (OR = 1.411; 95% CI, 1.250-1.594) and quality of tutorial strategies OR = 1.251; 95% CI, 1.113-1.406). By contrast, being supervised by a nurse teacher (OR = 0.523; 95% CI, 0.359-0.761) prevented the disclosure of PS issues compared with being supervised by a clinical nurse. Students attending their nursing programmes in some Italian regions showed a higher likelihood (OR from 1.346 to 2.938) of reporting PS issues compared with those undertaking their education in other regions. CONCLUSIONS Nursing students continue to be reticent to report PS issues. Given that they represent the largest generation of future health care workers, their education regarding PS should be continuously monitored and improved; moreover, strategies aimed at developing a non-blaming culture should be designed and implemented both at the clinical learning setting and regional levels.
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Green C. Contemporary issues: The pre-licensure nursing student and medication errors. NURSE EDUCATION TODAY 2018; 68:23-25. [PMID: 29883911 DOI: 10.1016/j.nedt.2018.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/16/2018] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
In Modern health care, the creation of cultures of safety for patients is of the upmost importance. Impacting the institutional stabilization of health care facilities safety initiatives, is the preparation of pre-licensure nursing students to safely administer medications to patients. Therefore, preparation of the pre-licensure nursing student must be evidence-based practice focused and incorporate innovative ways to reduce the potential for medication errors.
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Affiliation(s)
- Cheryl Green
- Southern Connecticut State University, Department of Nursing, Jennings Hall Office 121, United States.
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Motycka C, Egelund EF, Gannon J, Genuardi F, Gautam S, Stittsworth S, Young A, Simon L. Using interprofessional medication management simulations to impact student attitudes toward teamwork to prevent medication errors. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:982-989. [PMID: 30236437 DOI: 10.1016/j.cptl.2018.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/24/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND We developed and implemented a project incorporating ACPE Standard 11 and all Core IPEC competencies at a public University located at a medical center. The project was a collaboration between the colleges of nursing, pharmacy, and medicine at a distance campus location. INTERPROFESSIONAL EDUCATION ACTIVITY Our Interprofessional Education Activity, which targeted all three elements of ACPE Standard 11, provided TeamSTEPPS® training followed by four medical error simulations. A debriefing took place after each scenario within a team as well as with all four groups following each simulation session. The Teamwork Attitudes Questionnaire (TTAQ) was used to evaluate the activity. DISCUSSION Findings from our interprofessional education activity indicate that while students entered the activity already perceiving teamwork as a positive aspect of safe care delivery, significant improvement in attitudes post training toward specific team constructs was seen across all five domains. The project helped inform the structure of a replication of this effort that is currently underway, with a focus on embedding it in the curricula of all three programs (medicine, pharmacy, and nursing) across campuses. IMPLICATIONS In summary, working collaboratively in a team while being exposed to a series of medication management scenarios enhances teamwork attitudes as well as potentially improving performance. Based on the positive initial results, plans have begun to extend the experience to other campuses and include a wider group of students.
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Affiliation(s)
- Carol Motycka
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, 580 W. 8th Street, Jacksonville, FL 32209, United States.
| | - Eric F Egelund
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, 580 W. 8th Street, Jacksonville, FL 32209, United States
| | - Jane Gannon
- Family, Community and Health System Science, College of Nursing, University of Florida, Jacksonville, FL, United States
| | - Frank Genuardi
- Pediatrics, College of Medicine, University of Florida, Jacksonville, FL, United States
| | - Shiva Gautam
- Department of Biostatistics, College of Medicine, University of Florida, Jacksonville, FL, United States
| | - Shannon Stittsworth
- Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, 580 W. 8th Street, Jacksonville, FL 32209, United States
| | - Amanda Young
- College of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Leslie Simon
- College of Medicine, Mayo Clinic, Jacksonville, FL, United States
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Özyazıcıoğlu N, Aydın Aİ, Sürenler S, Çinar HG, Yılmaz D, Arkan B, Tunç GÇ. Evaluation of students' knowledge about paediatric dosage calculations. Nurse Educ Pract 2017; 28:34-39. [PMID: 28942096 DOI: 10.1016/j.nepr.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/09/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
Medication errors are common and may jeopardize the patient safety. As paediatric dosages are calculated based on the child's age and weight, risk of error in dosage calculations is increasing. In paediatric patients, overdose drug prescribed regardless of the child's weight, age and clinical picture may lead to excessive toxicity and mortalities while low doses may delay the treatment. This study was carried out to evaluate the knowledge of nursing students about paediatric dosage calculations. This research, which is of retrospective type, covers a population consisting of all the 3rd grade students at the bachelor's degree in May, 2015 (148 students). Drug dose calculation questions in exam papers including 3 open ended questions on dosage calculation problems, addressing 5 variables were distributed to the students and their responses were evaluated by the researchers. In the evaluation of the data, figures and percentage distribution were calculated and Spearman correlation analysis was applied. Exam question on the dosage calculation based on child's age, which is the most common method in paediatrics, and which ensures right dosages and drug dilution was answered correctly by 87.1% of the students while 9.5% answered it wrong and 3.4% left it blank. 69.6% of the students was successful in finding the safe dose range, and 79.1% in finding the right ratio/proportion. 65.5% of the answers with regard to Ml/dzy calculation were correct. Moreover, student's four operation skills were assessed and 68.2% of the students were determined to have found the correct answer. When the relation among the questions on medication was examined, a significant relation (correlation) was determined between them. It is seen that in dosage calculations, the students failed mostly in calculating ml/dzy (decimal). This result means that as dosage calculations are based on decimal values, calculations may be ten times erroneous when the decimal point is placed wrongly. Moreover, it is also seen that students lack maths knowledge in respect of four operations and calculating safe dose range. Relations among the medications suggest that a student wrongly calculating a dosage may also make other errors. Additional courses, exercises or utilisation of different teaching techniques may be suggested to eliminate the deficiencies in terms of basic maths knowledge, problem solving skills and correct dosage calculation of the students.
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Affiliation(s)
- Nurcan Özyazıcıoğlu
- Department of Pediatric Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Ayla İrem Aydın
- Department of Pediatric Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Semra Sürenler
- Department of Management Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Hava Gökdere Çinar
- Department of Management Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Dilek Yılmaz
- Department of Fundamental Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Burcu Arkan
- Department of Psychiatric Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
| | - Gülseren Çıtak Tunç
- Department of Psychiatric Nursing, Faculty of Health Sciences, Uludağ University, Bursa, Turkey.
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Wheeler JS, Duncan R, Hohmeier K. Medication Errors and Trainees: Advice for Learners and Organizations. Ann Pharmacother 2017; 51:1138-1141. [PMID: 28805068 DOI: 10.1177/1060028017725092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Limited information exists regarding medication errors and trainees (students or residents). Yet during the experiential education component of their training, learners are expected to assume significant responsibilities in the medication use process. This commentary addresses both trainees and organization leaders on medication safety practices and the incorporation of learners into the organization's medication safety culture.
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Affiliation(s)
- James S Wheeler
- 1 University of Tennessee Health Science Center, Nashville, TN, USA
| | | | - Kenneth Hohmeier
- 1 University of Tennessee Health Science Center, Nashville, TN, USA
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Wright J, Lawton R, O’Hara J, Armitage G, Sheard L, Marsh C, Grange A, McEachan RRC, Cocks K, Hrisos S, Thomson R, Jha V, Thorp L, Conway M, Gulab A, Walsh P, Watt I. Improving patient safety through the involvement of patients: development and evaluation of novel interventions to engage patients in preventing patient safety incidents and protecting them against unintended harm. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundEstimates suggest that, in NHS hospitals, incidents causing harm to patients occur in 10% of admissions, with costs to the NHS of > £2B. About one-third of harmful events are believed to be preventable. Strategies to reduce patient safety incidents (PSIs) have mostly focused on changing systems of care and professional behaviour, with the role that patients can play in enhancing the safety of care being relatively unexplored. However, although the role and effectiveness of patient involvement in safety initiatives is unclear, previous work has identified a general willingness among patients to contribute to initiatives to improve health-care safety.AimOur aim in this programme was to design, develop and evaluate four innovative approaches to engage patients in preventing PSIs: assessing risk, reporting incidents, direct engagement in preventing harm and education and training.Methods and resultsWe developed tools to report PSIs [patient incident reporting tool (PIRT)] and provide feedback on factors that might contribute to PSIs in the future [Patient Measure of Safety (PMOS)]. These were combined into a single instrument and evaluated in the Patient Reporting and Action for a Safe Environment (PRASE) intervention using a randomised design. Although take-up of the intervention by, and retention of, participating hospital wards was 100% and patient participation was high at 86%, compliance with the intervention, particularly the implementation of action plans, was poor. We found no significant effect of the intervention on outcomes at 6 or 12 months. The ThinkSAFE project involved the development and evaluation of an intervention to support patients to directly engage with health-care staff to enhance their safety through strategies such as checking their care and speaking up to staff if they had any concerns. The piloting of ThinkSAFE showed that the approach is feasible and acceptable to users and may have the potential to improve patient safety. We also developed a patient safety training programme for junior doctors based on patients who had experienced PSIs recounting their own stories. This approach was compared with traditional methods of patient safety teaching in a randomised controlled trial. The study showed that delivering patient safety training based on patient narratives is feasible and had an effect on emotional engagement and learning about communication. However, there was no effect on changing general attitudes to safety compared with the control.ConclusionThis research programme has developed a number of novel interventions to engage patients in preventing PSIs and protecting them against unintended harm. In our evaluations of these interventions we have been unable to demonstrate any improvement in patient safety although this conclusion comes with a number of caveats, mainly about the difficulty of measuring patient safety outcomes. Reflecting this difficulty, one of our recommendations for future research is to develop reliable and valid measures to help efficiently evaluate safety improvement interventions. The programme found patients to be willing to codesign, coproduce and participate in initiatives to prevent PSIs and the approaches used were feasible and acceptable. These factors together with recent calls to strengthen the patient voice in health care could suggest that the tools and interventions from this programme would benefit from further development and evaluation.Trial registrationCurrent Controlled Trials ISRCTN07689702.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jane O’Hara
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Leeds Institute of Medical Education, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Gerry Armitage
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Claire Marsh
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Angela Grange
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary RC McEachan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kim Cocks
- York Trials Unit, University of York, York, UK
| | - Susan Hrisos
- Institute of Health & Society, University of Newcastle, Newcastle, UK
| | - Richard Thomson
- Institute of Health & Society, University of Newcastle, Newcastle, UK
| | - Vikram Jha
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Liz Thorp
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | | | - Peter Walsh
- Action against Medical Accidents, Croydon, UK
| | - Ian Watt
- Department of Health Sciences, University of York, York, UK
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Valizadeh S, Feizalahzadeh H, Avari M, Virani F. Effect of Education of Principles of Drug Prescription and Calculation through Lecture and Designed Multimedia Software on Nursing Students' Learning Outcomes. Electron Physician 2016; 8:2691-9. [PMID: 27648199 PMCID: PMC5014511 DOI: 10.19082/2691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/03/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Medication errors are risk factors for patients' health and may have irrecoverable effects. These errors include medication miscalculations by nurses and nursing students. This study aimed to design a multimedia application in the field of education for drug calculations in order to compare its effectiveness with the lecture method. METHODS This study selected 82 nursing students of Tabriz University of Medical Sciences in their second and third semesters in 2015. They were pre-tested by a researcher-made multiple-choice questionnaire on their knowledge of drug administration principles and ability to carry out medicinal calculations before training and were then divided through a random block design into two groups of intervention (education with designed software) and control (lecturing) based on the mean grade of previous semesters and the pre-test score. The knowledge and ability post-test was performed using the same questions after 4 weeks of training, and the data were analyzed with IBM SPSS 20 using independent samples t-test, paired-samples t-test, and ANCOVA. RESULTS Drug calculation ability significantly increased after training in both the control and experimental groups (p<0.05). However, no significant difference emerged between the two groups in terms of medicinal calculation ability after training (p>0.05). The results showed that both training methods had no significant effect on study participants' knowledge of medicinal principles (p>0.05), whereas the score of knowledge of medicinal principles in the control group increased non-significantly. The results of the Kolmogorov-Smirnov test show that, since p>0.05, the data in the variable of knowledge of drug prescription principles and ability of medicinal calculations had a normal distribution. CONCLUSION The use of educational software has no significant effect on nursing students' drug knowledge or medicinal calculation ability. However, an e-learning program can reduce the lecture time and cost of repeated topics, such as medication, suggesting that it can be an effective component in nurse education programs.
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Affiliation(s)
- Sousan Valizadeh
- Associate Professor, Department of Pediatrics Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Feizalahzadeh
- Assistant Professor, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Avari
- M.Sc. Student of Nursing, Tabriz University Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faza Virani
- M.Sc. of Nursing, Educational Member, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Gaard M, Orbæk J. Supervising nursing students in a technology-driven medication administration process in a hospital setting: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:52-57. [PMID: 27635745 DOI: 10.11124/jbisrir-2016-003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of this review is to identify, describe and synthesize the experiences of nurse supervisors and the factors that influence the supervision of pre-graduate nursing students in undertaking technology-driven medication administration in hospital settings.The current review seeks to answer the following questions.
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Affiliation(s)
- Mette Gaard
- 1Department of Medicine: University Amager-Hvidovre Hospital, Hvidovre, Denmark 2Department of Gastroenterology: University Amager-Hvidovre Hospital, Hvidovre, Denmark
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Gorgich EAC, Barfroshan S, Ghoreishi G, Yaghoobi M. Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Glob J Health Sci 2016; 8:54448. [PMID: 27045413 PMCID: PMC5016359 DOI: 10.5539/gjhs.v8n8p220] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction and Aim: Medication errors as a serious problem in world and one of the most common medical errors that threaten patient safety and may lead to even death of them. The purpose of this study was to investigate the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Materials & Methods: This cross-sectional descriptive study was conducted on 327 nursing staff of khatam-al-anbia hospital and 62 intern nursing students in nursing and midwifery school of Zahedan, Iran, enrolled through the availability sampling in 2015. The data were collected by the valid and reliable questionnaire. To analyze the data, descriptive statistics, T-test and ANOVA were applied by use of SPSS16 software. Findings: The results showed that the most common causes of medications errors in nursing were tiredness due increased workload (97.8%), and in nursing students were drug calculation, (77.4%). The most important way for prevention in nurses and nursing student opinion, was reducing the work pressure by increasing the personnel, proportional to the number and condition of patients and also creating a unit as medication calculation. Also there was a significant relationship between the type of ward and the mean of medication errors in two groups. Conclusion: Based on the results it is recommended that nurse-managers resolve the human resources problem, provide workshops and in-service education about preparing medications, side-effects of drugs and pharmacological knowledge. Using electronic medications cards is a measure which reduces medications errors.
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Affiliation(s)
- Enam Alhagh Charkhat Gorgich
- Student Scientific Research Center, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Bravo KS, Pozehl B, Kupzyk K. Revision and Psychometric Testing of the Safe Administration of Medications Scale. J Nurs Meas 2016; 24:147-65. [PMID: 27103250 DOI: 10.1891/1061-3749.24.1.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE This study describes revision and psychometric testing of the Safe Administration of Medications-Revised (SAM-R) scale. METHODS The SAM-R scale was revised and tested to assess Bachelor of Science in Nursing (BSN) students' readiness to safely deliver medications through simulated case studies and associated vignettes. Subjects were junior- and senior-level BSN students (N = 227) from a large Midwestern university. Both classical testing and item response theory (IRT) were used to analyze item and group results. RESULTS Face, content, and construct validity were assessed. Internal consistency reliability of the scale was .736. IRT provided item-level information, using a one-parameter logistic model, but the sample size was inadequate for testing more complex models. CONCLUSION Evidence was obtained for reliability, face, content, and construct validity. Further revisions, and a larger sample size, are warranted.
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Ghamari Zare Z, Adib-Hajbaghery M. Performance of Clinical Nurse Educators in Teaching Pharmacology and Medication Management: Nursing Students' Perceptions. Nurs Midwifery Stud 2016; 5:e29913. [PMID: 27331055 PMCID: PMC4915211 DOI: 10.17795/nmsjournal29913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/28/2015] [Accepted: 10/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators’ performance in this critical issue. However, the Iranian nurse educators’ performance in teaching pharmacology and medication management are not adequately studied. Objectives The current study aimed to investigate the nursing students’ perceptions on the status of clinical pharmaceutical and medication management education. Materials and Methods A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students’ perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators’ performance in teaching pharmacology and medication management and two questions about students’ satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities. Results Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students’ learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students’ satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level. Conclusions Nursing students gave a relatively low score in several aspects of their instructors’ performance regarding teaching pharmacology and medication management. It seems that many clinical nurse educators in the studied settings were incompetent especially in teaching pharmacology and medication management, while these are critical areas and need special attention.
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Affiliation(s)
- Zohre Ghamari Zare
- Faculty of Nursing and Midwifery, Qom Branch, Islamic Azad University, Qom, IR Iran
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
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Hayes C, Jackson D, Davidson PM, Power T. Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. J Clin Nurs 2015; 24:3063-76. [PMID: 26255621 DOI: 10.1111/jocn.12944] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. BACKGROUND Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. DESIGN Systematic, critical literature review. METHODS Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. RESULTS Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. CONCLUSIONS Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. RELEVANCE TO CLINICAL PRACTICE Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety.
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Affiliation(s)
- Carolyn Hayes
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | | | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Alteren J, Nerdal L. Relationship between High School Mathematics Grade and Number of Attempts Required to Pass the Medication Calculation Test in Nurse Education: An Explorative Study. Healthcare (Basel) 2015; 3:351-63. [PMID: 27417767 PMCID: PMC4939530 DOI: 10.3390/healthcare3020351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/15/2015] [Indexed: 11/21/2022] Open
Abstract
In Norwegian nurse education, students are required to achieve a perfect score in a medication calculation test before undertaking their first practice period during the second semester. Passing the test is a challenge, and students often require several attempts. Adverse events in medication administration can be related to poor mathematical skills. The purpose of this study was to explore the relationship between high school mathematics grade and the number of attempts required to pass the medication calculation test in nurse education. The study used an exploratory design. The participants were 90 students enrolled in a bachelor’s nursing program. They completed a self-report questionnaire, and statistical analysis was performed. The results provided no basis for the conclusion that a statistical relationship existed between high school mathematics grade and number of attempts required to pass the medication calculation test. Regardless of their grades in mathematics, 43% of the students passed the medication calculation test on the first attempt. All of the students who had achieved grade 5 had passed by the third attempt. High grades in mathematics were not crucial to passing the medication calculation test. Nonetheless, the grade may be important in ensuring a pass within fewer attempts.
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Affiliation(s)
- Johanne Alteren
- Faculty of Professional Studies, University of Nordland, Campus Helgeland, Postboks 614, N-8607 Mo i Rana, Norway.
| | - Lisbeth Nerdal
- Faculty of Professional Studies, University of Nordland, Campus Helgeland, Postboks 614, N-8607 Mo i Rana, Norway.
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Simonsen BO, Daehlin GK, Johansson I, Farup PG. Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study. BMC Health Serv Res 2014; 14:580. [PMID: 25413244 PMCID: PMC4243274 DOI: 10.1186/s12913-014-0580-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. METHODS Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD). RESULTS Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001). CONCLUSIONS The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in clinical practice to improve the nurses' medication knowledge and reduce the risk of error.
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Mostafaei D, Barati Marnani A, Mosavi Esfahani H, Estebsari F, Shahzaidi S, Jamshidi E, Aghamiri SS. Medication errors of nurses and factors in refusal to report medication errors among nurses in a teaching medical center of iran in 2012. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e16600. [PMID: 25763202 PMCID: PMC4329755 DOI: 10.5812/ircmj.16600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 06/21/2014] [Accepted: 08/30/2014] [Indexed: 11/26/2022]
Abstract
Background: About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries. Objectives: The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses. Patients and Methods: The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses. Results: The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study. Conclusions: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.
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Affiliation(s)
- Davoud Mostafaei
- Department of Health Economic and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ahmad Barati Marnani
- Department of Health Service, School of Medical Information Management, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Ahmad Barati Marnani, Deptartment of Health Services Management, School of Medical Information Management, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794301, Fax: +98-2188793805, E-mail:
| | - Haleh Mosavi Esfahani
- Department of Health Services, School of Medical Information Management, Iran University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Estebsari
- Department of Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Shiva Shahzaidi
- Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ensiyeh Jamshidi
- Research Center of Community Based Participatory, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR Iran
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Teaching successful medication administration today: More than just knowing your ‘rights’. Nurse Educ Pract 2014; 14:391-5. [DOI: 10.1016/j.nepr.2014.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/05/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022]
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Renata Grou Volpe C, Moura Pinho DL, Morato Stival M, Gomes de Oliveira Karnikowski M. Medication errors in a public hospital in Brazil. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:552-559. [PMID: 24933543 DOI: 10.12968/bjon.2014.23.11.552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes the analysis of the frequency, type and risk factors relating to errors in the preparation and administration of medications in patients admitted to a public hospital in Brasilia Federal District, Brazil, which serves a population of approximately 500,000 inhabitants. Patients are commonly affected and harmed by medication errors, almost half of which are preventable. This is a cross-sectional, descriptive and exploratory study conducted in a clinical medicine unit. Direct observations were made by eight nurse technicians. The type of error, the type of drug involved and associated risk factors were analysed. Relationships between the occurrence of errors and risk factors were studied with logistic regression models. Of the 484 observed doses, 69.5% errors occurred during drug administration, 69.6% during the preparation stage, 48.6% were timing errors, 1.7% were dose-related errors and 9.5% were errors of omission. More than one error was detected in 34.5% of occasions. Unlabelled drugs increased the risk of timing errors by a factor of 13.72. Interruptions in preparation increased the risk of errors by a factor of 3.75. Caring for a larger number of patients (8-9) increased the risk of timing errors by a factor of 8.27. The research shows the need to manage the risk of medication errors in their real-life contexts by interposing safety barriers between the hazards and potential errors.
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Stolic S. Educational strategies aimed at improving student nurse's medication calculation skills: a review of the research literature. Nurse Educ Pract 2014; 14:491-503. [PMID: 25001180 DOI: 10.1016/j.nepr.2014.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/25/2014] [Accepted: 05/10/2014] [Indexed: 11/17/2022]
Abstract
Medication administration is an important and essential nursing function with the potential for dangerous consequences if errors occur. Not only must nurses understand the use and outcomes of administering medications they must be able to calculate correct dosages. Medication administration and dosage calculation education occurs across the undergraduate program for student nurses. Research highlights inconsistencies in the approaches used by academics to enhance the student nurse's medication calculation abilities. The aim of this integrative review was to examine the literature available on effective education strategies for undergraduate student nurses on medication dosage calculations. A literature search of five health care databases: Sciencedirect, Cinahl, Pubmed, Proquest, Medline to identify journal articles between 1990 and 2012 was conducted. Research articles on medication calculation educational strategies were considered for inclusion in this review. The search yielded 266 papers of which 20 meet the inclusion criteria. A total of 5206 student nurse were included in the final review. The review revealed educational strategies fell into four types of strategies; traditional pedagogy, technology, psychomotor skills and blended learning. The results suggested student nurses showed some benefit from the different strategies; however more improvements could be made. More rigorous research into this area is needed.
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Affiliation(s)
- Snezana Stolic
- QUT, School of Nursing, Victoria Park Rd, Kelvin Grove, Brisbane, Qld 4059, Australia.
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Developing a Reporting and Tracking Tool for Nursing Student Errors and Near Misses. JOURNAL OF NURSING REGULATION 2014. [DOI: 10.1016/s2155-8256(15)30093-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vaismoradi M, Jordan S, Turunen H, Bondas T. Nursing students' perspectives of the cause of medication errors. NURSE EDUCATION TODAY 2014; 34:434-440. [PMID: 23669600 DOI: 10.1016/j.nedt.2013.04.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/05/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Medication errors complicate up to half of inpatient stays and some have very serious consequences. To our knowledge, this is the first qualitative study of Iranian nursing students' perspectives of medication errors. OBJECTIVES To describe nursing students' perspectives of the causes of medication errors. DESIGN Four focus groups were held with 24 nursing students from 4 different academic semesters in the nursing school in Tehran, between November 2011 and November 2012. Using a qualitative descriptive design, themes and subthemes were identified by content analysis. RESULTS Two main themes emerged from the data: "under-developed caring skills in medication management" and "unfinished learning of safe medication management", which was subdivided into "drifting between being worried and being careful", and "contextualising pharmacology education". All respondents felt that their education programmes were leaving them vulnerable to "drug errors" and cited incidents where patient safety had been jeopardised. CONCLUSION Nursing curricula need to increase investment in medicines management. If nursing students are to become competent, skilful and safe practitioners, their learning will require extensive support from their academic institutions and clinical mentors.
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Affiliation(s)
- Mojtaba Vaismoradi
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom; Faculty of Professional Studies, University of Nordland, Bodø, Norway
| | - Sue Jordan
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom.
| | - Hannele Turunen
- Department of Nursing Science, Kuopio Campus, University of Eastern Finland, Kuopio, Finland
| | - Terese Bondas
- Department of Nursing Science, Kuopio Campus, University of Eastern Finland, Kuopio, Finland; Faculty of Professional Studies, University of Nordland, Bodø, Norway
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Pazokian M, Zagheri Tafreshi M, Rassouli M. Iranian nurses' perspectives on factors influencing medication errors. Int Nurs Rev 2014; 61:246-54. [PMID: 24571495 DOI: 10.1111/inr.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medical errors are one of the major threats for patient safety in all countries. Medication errors are common medical mistakes that can lead to serious consequences and even death of patients. AIM The aim of this study was to explore nurses' perspectives of factors influencing medication errors. METHODS This qualitative study based on content analysis included 20 nurses (n = 20) with at least 2 years of clinical experience working in a large teaching hospital. The nurses were selected using purposeful sampling. The data were collected using semi-structured interviews and analysed using deductive content analysis approach based on Reason's human error model. Rigor of the data was confirmed by external and member check. RESULTS Two themes were identified by the participants: (1) the individual approach including personal and psychological characteristics of nurses, patient medical history and physicians' orders errors; and (2) the cultural and organizational approach including workplace conditions, learning process, risk management strategies, nurses' pharmacological knowledge, inevitable nursing errors and medication error complications. LIMITATIONS Concern about the potential consequences related to reporting of the medication errors was the major limitation of this study. Participants' concerns were handled by keeping their identity confidential and anonymous. CONCLUSION Results show the importance of planning comprehensive educational programmes and providing constructive feedback in a favourable learning climate. IMPLICATIONS FOR NURSING AND HEALTH POLICY Findings of this study can be beneficial to managers for nurturing a transparent organizational culture, whereby staff members freely discuss their errors in patient care and seek advice for problem solving.
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Affiliation(s)
- M Pazokian
- Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
OBJECTIVE To examine the relationship between risk propensity and safe medication administration, while also providing additional evidence of validity and reliability on the Safe Administration of Medication (SAM) Scale. METHODS A convenience sample of nursing students from a private Midwest university in the United States was invited to participate in the study. Fourth-year nursing students completed 2 instruments: revised Domain-Specific Risk-Taking and Risk Perception (DOSPERT) Scale, which measures risk propensity, and the SAM Scale, which measures knowledge and performance of safe medication administration. Second-year nursing students completed the SAM Scale; their scores were used to provide evidence of construct validity. RESULTS This study demonstrated a statistically significant relationship between personal risk taking in the area of health/safety and safe medication administration in nursing students. No statistically significant relationship was found between risk perception and safe medication administration. In addition, the study provided evidence of the validity and reliability of the SAM Scale. CONCLUSIONS This study is among the first to demonstrate a relationship between risk propensity and safe medication administration. Further research into personal risk taking, risk perception and its impact on patient safety, specifically safe medication administration, is needed.
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Schneidereith TA. Using Simulations to Identify Nursing Student Behaviors: A Longitudinal Study of Medication Administration. J Nurs Educ 2014; 53:89-92. [DOI: 10.3928/01484834-20140122-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022]
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Montgomery P, Killam L, Mossey S, Heerschap C. Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting. NURSE EDUCATION TODAY 2014; 34:271-276. [PMID: 24169443 DOI: 10.1016/j.nedt.2013.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 08/27/2013] [Accepted: 09/26/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety. OBJECTIVE The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting. METHODS Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety. RESULTS Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration. CONCLUSION Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients.
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Affiliation(s)
- Phyllis Montgomery
- School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada.
| | - Laura Killam
- School of Heath Sciences and Emergency Services, Cambrian College of Applied Arts and Technology, 1400 Barrydowne Road, Sudbury, Ontario, P3A 3V8, Canada.
| | - Sharolyn Mossey
- School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada.
| | - Corey Heerschap
- School of Heath Sciences and Emergency Services, Cambrian College of Applied Arts and Technology, 1400 Barrydowne Road, Sudbury, Ontario, P3A 3V8, Canada.
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