Medication calculation competencies for registered nurses: a literature review

Abstract

Objective: To describe the literature that focuses on safe administration of medications, medication calculation skills development and maintenance of ongoing competence in nurses. Setting: University and hospital nurse education departments. Subjects: Theoretical and empirical literature focusing on nurse mediated medication administration errors Primary argument: Nurse education departments devote a high proportion of time to medication calculation skill development and testing. Annual testing is time consuming for both nurse educators and nurses, and the validity, frequency, acceptable pass mark, self‑efficacy and maintenance of skills related to medication calculation testing is largely unclear. Conclusion: The theoretical literature focuses on drug administration errors, development of tools and techniques to improve nurses’ medication calculation skills and guidelines. There is considerable debate as to nurses’ self‑perception of their arithmetical skills, their educational needs in this area and the relationship between skill level and patient outcomes. Empirical literature focuses on the incidence of errors, evaluation of medication calculation skills; the relationship between test results and errors, effectiveness of strategies to improve medication calculation skills and medication calculation testing and policy. Course content and delivery are thought to influence safe medication administration; however, there has been a lack of rigorous research demonstrating the efficacy of educational models. Several studies report low levels of calculation proficiency in nurses; however, it is unclear whether medication calculation testing affects medication administration error rates. Further research is required to determine the robustness of the current processes to assess nurses’ medication calculation competence and ensure optimal patient safety.