Medication Administration Practices Research Articles

Enteral nutrition and medication administration practices of nurses in a low-resource acute setting

Background: Despite the presence of evidence-based policies and guidelines, and in line with lingering issues in resource availability in low-income settings, inconsistencies are still being documented in the provision of adequate nutritional support and medication administration via the enteral route. Aims: The study aimed to, first, describe the practices of nurses in enteral nutrition and medication administration in the context of a low-resource setting and, second, explore the factors that are associated with the performance of such practices. Methods: The study used a descriptive correlational design. Quota sampling of nurses (n=138) working in wards and intensive care units of a tertiary hospital for adult patients requiring enteral nutritional support was performed. Enteral feeding and medication practices were assessed using a self-report survey. Ethical approval was obtained from an institutional review board. Findings: The majority of nurses correctly identified X-ray as the gold standard for determining tube placement (58.5%). However, only 13.5% correctly identified air insufflation as an unreliable method. Scores on knowledge and skills on enteral feeding and medication were found to have a significant, strong positive correlation (r=0.855, p<0.01). Conclusions: Strengthening of knowledge on standards of enteral nutrition and medication practices may improve the performance of the skill in actual bedside practice. Addressing documented gaps in practices and standards may have an impact on the provision of safe and quality nursing care.

Intravenous Smart Pumps During Actual Clinical Use: A Descriptive Comparison of Primary and Secondary Infusion Practices.

This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication administration delay was compared between a head-height differential system and a cassette system. A total of 301 medication administration observations were included in this study: 102 (34%) for the linear peristaltic IV smart pump (medical–surgical: N = 51; critical care: N = 51) and 199 (66%) for the cassette pump (medical–surgical: N = 88; critical care: N = 111). Results found a 0% compliance for primary line setup and 84% compliance for secondary line setup and 1 omitted medication due to a closed clamp with the linear peristaltic system. For the cassette system, there are no head-height requirements. Two roller clamps were found to be in the closed position on initiation of the secondary infusion, but the clinician was alerted by an alarm, so no medication delays occurred. These findings support that the current system requirements for flow rate accuracy using head-height differential systems are difficult to achieve consistently at the point of care. There is a need for additional human factor designed technology to replace manual actions to improve the process of care for nurses and the safety of care for patients.

Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting

Aims This study assessed the inter-rater reliability, acceptability and usability of the Medication Administration Evaluation and Feedback Tool for nurses in the clinical setting. Background Medication administration is a complex nursing task requiring multiple steps to ensure safe and accurate delivery of medications to patients. Currently, registered nurses are not routinely provided the opportunity for regular review of their practice. The Medication Administration Evaluation and Feedback Tool has been previously validated in the simulated environment. Methods Four nurse observers were trained to use the tool. Thirty nurses participated to be observed in the clinical setting. Each nurse was assessed simultaneously by two observers. Inter-rater reliability was assessed using Fleiss’ Kappa coefficient. A postobservation survey was conducted to assess user acceptability. The Guideline for Reporting Reliability and Agreement Studies Enhancing the Quality and Transparency of Health Research was used. Results The observed agreement between observers using the Medication Administration Evaluation and Feedback Tool in clinical practice was 0.90 and Fleiss’ kappa coefficient was 0.77 demonstrating excellent agreement and inter-rater reliability. Both nurses and observers reported the tool was useful and practical for use in evaluating medication administration practice in the clinical environment. Conclusions Inter-rater reliability testing of the Medication Administration Evaluation and Feedback Tool in the clinical environment demonstrated it is a reliable and valid tool when used by different observers. Both nurses and observers found using the tool a positive and useful experience when evaluating medication administration practice.

Assessment of The Nurse Interns' Medication Administration Safety Performance

Contents: Medication administration is an integral part of delivering quality nursing care. The nurse intern should follow the specific guidelines to enhance their medication administration safety.
 Aim: The study aims to assess the nurse intern's medication administration safety performance.
 Methods: The study conducted at Ain Shams University Hospitals using the descriptive design on 90 nurse interns by using three tools, namely, medication administration knowledge questionnaire, the observational checklist for nurse interns' safety performance, and Medication Administration safety Attitude Rating Scale.
 Results: Findings of the study revealed that the minority of nurse interns (4.3%) had satisfactory total knowledge, 39% had adequate total practice, and around two-thirds of them (62.6%) had a positive attitude. 
 Conclusion: It is concluding that the nurse interns had unsatisfactory knowledge of medication administration safety, and their related practices are mostly inadequate, although the attitude tends to be high. The study recommended that nurse internship programs should emphasize medication administration safety knowledge and practice with more focus on identified gaps and deficiencies. Further research is proposed to assess the effect of training strategies on the nurse intern's medication administration safety.

Use of a Smart Pump and Dedicated Medication Line to Reduce Peripherally Inserted Central Catheter Damage.

Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed. To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency "code" medication administration was not addressed. A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred. Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients. Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU. Safe medication administration practices for the neonatal population and barriers to that practice.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=41.

Simulation strategies to increase nursing student clinical competence in safe medication administration practices: A quasi-experimental study

BackgroundNursing student medication errors often result from deficits in knowledge and application of fundamental safe administration practices. Factors such as high faculty-student ratios and legal restrictions have decreased clinical learning opportunities for nursing students to practice safe medication administration in the clinical setting. Evidence suggests that use of a structured medication safety enhancement (MSE) simulation program can significantly improve student knowledge and competency in safe medication administration. PurposeTo examine the effects of an educational strategy using a MSE simulation program with integrated technology on the medication administration knowledge, competency, and confidence levels of undergraduate nursing students. MethodsThis quasi-experimental replication study designed and implemented medication simulations enhanced by integrated information technologies in an undergraduate-nursing curriculum. Third-year BSN students (n = 83) were randomized into intervention or control groups. Control groups participated in standard training while the intervention group received additional clinical simulation experience and debriefing sessions focused on medication safety practices. Participant knowledge was measured using pre/post Medication Safety Knowledge Assessment (MSKA) and competency was evaluated using the Medication Safety Critical Element Checklist (MSCEC). ResultsThe MSKA and MSCEC were analyzed using two-sided independent t-tests. Post-test knowledge scores increased in both groups but results were not statistically significant (α = 0. 05). Students who received the medication safetfy enhancement intervention performed significantly better in a subsequent simulation than students who did not have prior simulation experience (p < .001). ConclusionFindings suggest that educators should consider high fidelity simulation as an evidence-based teaching strategy to engage students in understanding and implementing medication safety practices in the clinical setting.

Factors that affect health-care workers' practices of medication administration to aged care residents with swallowing difficulties: An Australia-wide survey study.

To understand the barriers and facilitators of medication administration to aged care residents with swallowing difficulties. Health-care workers in aged care facilities across Australia involved in medication administration to residents completed an online survey. Of 355 respondents, 90.9% reported 'everyday' encounters with residents with swallowing difficulties and 94.1% modified medications to facilitate administration. Time constraints (63.4%) and workload (69.0%) were common barriers. Only 39.0% believed swallowing abilities are considered at the prescribing stage. Pill size (95.8%), polypharmacy (75.2%) and lack of alternative formulations (74.9%) contributed to these challenges. Support from other health-care professionals (91.5%) and training (85.9%) were the most favoured facilitators. Health-care workers are faced with various challenges when caring for residents with swallowing difficulties. Promoting multidisciplinary collaborations, provision of training and medication review services, and improving skill mix and staffing composition in aged care facilities are needed to address these challenges.

The Essential Steps of Medication Administration Practices Project medication administration improvement practices among acute inpatients in a tertiary hospital

The current project aimed to conduct an audit of nursing medication administration practices, to implement evidence-based best practice recommendations and assess the effectiveness of these changes in maximizing medication administration safety and reducing the risks of adverse incidents across 10 wards/units in a large tertiary hospital.Medications are the most common treatment used in healthcare. Because they are so commonly used, medications are associated with a higher incidence of errors and adverse events than other healthcare interventions. Nurses are primarily involved in the administration of medications to patients and this duty is an important aspect of professional practice. The Australian Commission on Safety and Quality in Healthcare has recognized medication safety as a National Standard, thus reinforcing its importance.The project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 200 observations of medication administration was conducted and measured against eight best practice recommendations, followed by the implementation of targeted strategies and follow-up audits.The baseline audit revealed deficits between current practice and best practice in three of the eight criteria. Identification of barriers for implementation of medication administration best practice criteria were made by the project team and reflective practice and ward/unit led strategies were implemented. There were improved or sustained outcomes across all best practice criteria in the follow-up audits.The findings showed how audit may be used to promote best practice in healthcare and that reflective practice and front-line led strategies can have a positive impact on clinical practice. Some of the measured criteria did not reach 100%, leaving room for improvement; however, by the end of the project attitudes towards medication administration had been 'transformed' from a passive, routine 'must do' task, to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.

Nurses Practices Regarding Medication Administration through a Central Venus Catheter

Objective: The purpose of this study was to examine nurses’ practices related to medication administration through the CVC.&#x0D; Material and Methods: A cross-sectional observational study was conducted at Tertiary Hospital. The study subjects were the female Nurses aged between 21 – 60 years (n = 133). A convenient sampling technique was used.Data collected through an observational checklist which contain two sections; demographic and 19 items of their practices. A pilot study was done on 20 participants to assess the reliability of the observational checklist. Data analyzed by using SPSS version 25.&#x0D; Results: 82.7% participants’ ages were between 21 – 30 years, 13.5% were between 31 – 40 years and 3.8% were between 41 – 50 years. Participants’ education was as follows: general nursing diploma (84.2%), BS Nursing Post RN (registered nurse) (11.3%), BSN -Bachelor Science in Nursing (Generic) (4.5%). Only 41.4% participants performed hand hygiene before procedure and 58.6% did not perform. 34.6% participants remove gloves and perform hand hygiene; remaining 65.4% did not perform hand hygiene correctly. All participants 100% performed documentation on drug chart.&#x0D; Conclusion: The significance of quality care, combined with good practices, particularly when medicines are administered through the Central Venous Catheter. Incorrect practices of medication administration through CVC increase the risk of blood stream infection. This research study shows 50% unsatisfactory practices.

Effectiveness of Clinical Nurses’ interventions in reducing medication errors in a paediatric ward

To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses' medication administration practice. Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. An Action Research (AR) three-phase quantitative study. Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empowers them to find solutions that are tailored to their own practice culture and environment.

Factors affecting Australian aged care facility workers in administering oral medication to residents with swallowing difficulties.

Swallowing difficulties are common in older people and can complicate the administration of oral medications. The aim of this study was to explore factors affecting healthcare workers in their practices of oral medication administration to aged care residents with swallowing difficulties. A purposeful sample of 17 healthcare workers composed of clinical/care managers, registered nurses (RNs), enrolled nurses (ENs), and assistants in nursing (AINs) from three aged care facilities in Queensland, Australia participated in semi-structured interviews. Leximancer was used for quantitative content analysis. The responses centered on three main factors. Participants discussed workprocess-related factors including time, workload, and stress and frustrations resulting from work processes. Medication-related factors included strategies to facilitate medication administration, uncertainties around modifying medications, availability/cost of alternatives, multidisciplinary medication management, prescribing considerations, and polypharmacy. Resident-related factors were discussed around individualized needs of residents especially those with dementia-associated swallowing difficulties. Ideas differed among the four groups of participants. Managers discussed workprocess-related factors pertaining to staff and facility. RNs focused on how clinical aspects of the medication practices were affected by work processes. ENs were task-oriented and their responses focused on work processes. AIN responses centered on reliance on RNs in performing medication tasks. The findings suggest that healthcare workers' practices of medication administration to residents with swallowing difficulties are affected by various factors associated with work processes, medications, and resident characteristics. Although these factors affect all levels of healthcare workers, the needs of each group vary depending on their level of training and responsibilities.

Risk of Patient Harm Related to Unnecessary Dilution of Ready-to-Administer Prefilled Syringes: A Literature Review.

Unnecessary dilution of ready-to-administer (RTA) syringes could increase the risk of patient harm attributed to errors related to incorrect dose, improper labeling, and the potential for microbial contamination. Although published guidelines endorse the use of commercially available RTA syringes, recent surveys indicate that best practices are not always implemented. The purpose of this article is to review the existing literature and to assess the incidence and nature of errors related to the unnecessary dilution of RTA intravenous (IV) push medications in the inpatient clinical setting. The PubMed database was searched to identify studies of errors related to the use of RTA syringes for IV push medications within the last 10 years. An additional search was conducted using other search engines to identify relevant articles in the grey literature. This literature review concludes that unnecessary dilution of IV push medication in RTA syringes is an unsafe practice that occurs routinely. This practice increases the risk of patient harm through errors related to incorrect dose, improper labeling of syringes, and the potential for microbial contamination of the product. Greater awareness of the risks associated with unnecessary dilution of RTA syringes is still needed to eliminate this unsafe IV push medication administration practice and to thereby further improve outcomes.

Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.

To describe paediatric postdischarge concerns manifesting in the first 96hr after hospital discharge. Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use. We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected. Overall, nurses documented at least one concern in 56% (N=367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N=58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N=49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N=56). Nurses completed referrals to other providers/services in 12% of visits (N=78), most frequently to primary care providers. In 13% of visits (N=85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation. Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge. Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge. Concerns about medication safety were most frequent followed by concerns related to housing and general safety. The results are important for clinicians preparing children and families for discharge and for community clinicians caring for discharged children.

Medication Use in Schools.

This article serves as a Position Statement of the Pediatric Pharmacy Association (PPA), which supports safe and effective medication use in schools. PPA recommends that schools develop comprehensive medication use policies to support safe and appropriate administration of both chronic and emergency medication in schools. These policies must address issues specific to pediatric patients, including off-label and over-the-counter medication use, various pediatric dosage forms, as well as appropriate medication storage, administration, and disposal practices. PPA also advocates for continued staff development and education regarding laws, regulations, and policies surrounding medication use in school to ensure safe and effective care of children and adolescents in the school setting.

Effect of Implementing Guidelines Regarding Administering Inotropic Medications for Critically Ill Patients on Nurses’ Practice

Background: There was Limited teaching guidelines depicted for improving the practice of nurses towardsinotropic medication administration, which emphasizes the importance of teaching guidelines in improvingnurses’ practice,Purpose: To assess the effect of implementing guidelines regarding administering inotropic medications forcritically ill patients on nurses’ practice.Method: This single-hospital, Quasi-experimental research design was used in the study. The present studywas carried out at Critical Care Units. A convenient sample of all staff nurses (60 nurses), the data werecollected using one tool named nurses’ observational checklist.Results: 93.3% of studied nurses had satisfactory level of practice regarding inotropic medications postimplementing intervention guidelines. The post and follow up-intervention practice mean score was high48.80, 48 respectively when compared with pre-intervention practice mean score 31.40 with P value &lt; .001*.Conclusion: There was significant difference in the nurses’ practice mean scores regarding inotropicmedications in post and follow-up implementing guidelines when compared with pre-intervention meanpractice score with P value &lt; .001. .

PNS100 A STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING ADMINISTRATION OF PAEDIATRIC DOSAGE FORMS

Parental attitude is one of the important factors that affect medication use and adherence among pediatrics. Our study aims to assess the Knowledge, Attitude and Practice (KAP) of caregivers regarding medication use in children. A cross sectional study was conducted in the inpatient and outpatient pediatrics department at a tertiary care hospital over 6 months. We surveyed caregivers with children under age 18 to determine the medication administration practices. A validated questionnaire was administered to assess the Knowledge, Attitude and Practices (KAP) of the study population and responses were obtained. Correlations analysis was performed to assess correlation among various domains. A total of 149 caregivers were enrolled in the study. Majority of the primary caregivers surveyed were illiterate (65%), homemaker mothers (64%). 64% and 82.7% were unaware about 1 teaspoon and 1 tablespoon dosing respectively. Caregivers frequently reported stoppage of medicines once the child feels better (50%). Dissolving of solid oral dosage forms and mixing them with milk (61.7%) was the most frequently reported method of administration. 34.9% caregivers reported use of non-standardized liquid dosing instruments. Spearman’s correlation analysis showed significant correlation between education of caregiver and knowledge (p<0.01; 0.34) as well as attitude (p<0.01; 0.44). Medication errors were reported significantly more in the outpatient setting. The caregivers of pediatric population had poor knowledge regarding medicine administration and measurement of dosage forms. Active patient counselling sessions by healthcare professionals can make an impact among caregivers regarding medication utilization practices of pediatric dosage forms.

A meta-synthesis of how registered nurses make sense of their lived experiences of medication errors.

Medication errors are a frequent phenomenon in nursing, as the nurses are primarily responsible for preparation and administration of medications to patients. Little is known about how nurses make sense of their experiences of medication errors as a lived phenomenon. To aggregate, synthesise and interpret the qualitative evidence of studies which explored nurses' lived experiences of medication errors. A meta-synthesis is presented with thematic analysis by Thomas & Harden (BMC Medical Research Methodology, 8, 2008, 45). Qualitative studies (January 1980-June 2018) retrieved from PubMed, BNI, CINAHL, EMBASE, AMED, PsycINFO, ProQuest, ScienceDirect and Wiley Online Library. The PRISMA flow chart, CASP tool and COREQ checklist are integrated in the meta-synthesis. Eight primary research studies were included with the follow themes: "moral impact," "emotional impact," "constructive learning," "impact on professional registration and employment," "nurses' coping strategies with the experience," "patient and family," "identification of contributing factors to medication errors" and "preventive measures for medication errors." The moral and emotional impact of medication errors to nurses was devastating for themselves. Yet, they detected strategies to cope with their error and its consequences and even more translated their experience into a constructive lesson and identified ways to prevent future errors. The meta-synthesis provides a holistic perspective about how registered nurses made sense of their lived experiences of medication errors. Its findings reveal that the experience has both positive impact and negative impact to the nurses. Its findings should inform mainly the clinical nursing practice, clinical nurses, nurse educators, nurse leaders and policymakers of medication administration.

An assessment of infant medication administration and storage practices in selected communities in the Vhembe District of Limpopo Province, South Africa.

BackgroundEffective infant medication administration and storage is a major public health challenge outlined by the World Health Organization. These challenges may be exacerbated in rural or limited-resource areas.AimThe aim of this study was to investigate infant medication administration and storage practices.SettingThis study took place in selected communities in the Vhembe District of Limpopo Province, South Africa.MethodData was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch’s model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder.ResultsSix themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration.ConclusionsMany factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District.

Nurses' decision-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting.

To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings. Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. A descriptive exploratory study design. Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form; interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty; facilitating, framing and filtering information; managing interruptions and knowing and involving patients. Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.

Nursing Students' Perceived Self-Efficacy and the Generation of Medication Errors with the Use of an Electronic Medication Administration Record (eMAR) in Clinical Simulation.

Medication errors continue to be a significant issue, posing substantial threats to the safety and well-being of patients. Through Bandura's theory of self-efficacy, nursing students' self-efficacy (confidence) related to medication administration was examined to investigate its influence on the generation of medication errors with the use of an Electronic Medication Administration Record (eMAR) in clinical simulation. This study examined the generation of medication errors and the differences that may exist based on nursing students' perceived confidence. The findings of this study demonstrated that nursing students continue to generate medication errors within clinical simulation. No differences in the generation of medication errors were found between nursing students with perceived high levels of confidence and those with perceived low levels of confidence (one exception noted). Further examination of the variables and contextual factors related to safe medication administration practices is required to inform nursing education and practice.