Medication Competence Research Articles

Registered Nurses’ Experiences of Using a 3D Game in the Development of clinical Competency: A qualitative Study

Background: Health professionals should receive lifelong education to maintain competency in medication administration and ensure safe medical practice. Game-based education is one way to enhance and ensure health professionals’ medication competency. Objectives: This study aimed to describe registered nurses’ experiences of the Imagine 3D game and their views of the effectiveness of this game-based education program in improving their medication competency. Methods: This qualitative interview study included eight registered nurses who completed an education program based on the 3D game Imagine, which aims to strengthen medication administration competency. Data were collected via semi-structured interviews between March and April 2019 and analyzed using content analysis. Results: Three themes were extracted from the study with the following concepts: (1) experiences of playing; (2) the usability of the game in verifying nurses’ medication competency; and (3) the game’s effectiveness in fostering registered nurses’ medical competency. On analyzing the nurses’ personal experiences, the game-based education program was valuable in training nurses to enhance their medication administration competency. Participants reported that the game was comfortable to play and useful in repeated medication administration tasks, and it increased their self-reflection and even changed their actions based on learning. The nurses reported that the game was most beneficial to nursing students and recent graduates and was used especially during the introductory period. Moreover, based on the interviews, the game was also useful in continuing education; therefore, it should be applied in all healthcare professionals’ training. Conclusions: This study shows that a 3D computer game can be useful for nurses to foster their knowledge and expertise in medication administration tasks.

Medication Competence: A Concept Analysis

Concept analysis means clarifying the meaning of concepts for diverse reasons. Concepts are the fundamental building blocks of theory construction. Hence, it is crucial to have solid and reliable notions. Therefore, concept analysis is a good starting point for learning how to think logically in relation to terms, definitions, and uses in theory development. Hence, the purpose of the paper is to perform a detailed concept analysis on medication competence in the context of nursing. Also, to develop a precise description of the concept for use in research and to enhance its usage and communication in healthcare. For this paper, the Walker and Avant concept analysis approach was used to create a thorough knowledge of the phenomenon of nurse medication competency. The literature review was performed from different electronic databases such as Google Scholar, PubMed, PubMed Central and PakMediNet. For the literature search, keywords were used: medication competence, medication management, medication skills, medication safety, nurses, and student nurses. Results: defining attributes were found: knowledge, skills, and attitude. Antecedents for medication competence are proper training, work experience, motivation, critical thinking, pharmacovigilant, proper dose formulation, and self-confidence. Consequences for medication competence were highlighted as the accuracy of medication calculation skills, prevention of medication errors, and improved patient outcomes by maintaining patient safety practices. Additionally, nurses can use medication competence to build interprofessional collaboration, communication, leadership, and delegation skills. Additionally, it is believed that this analysis would provide insight to the nurses and other healthcare personnel as a strong foundation for clinical practice research, and theory development.

Changes to teaching and learning about medication administration within a diploma of nursing course due to the Covid-19 pandemic: A staff and student multi-method evaluation

AimThis project aimed to evaluate student and staff satisfaction with, and perspectives on, changes to delivery and format of the Medication Unit of Competency within a Diploma of Nursing Program. BackgroundMedication safety is an integral component of learning for pre-registration nursing students. The COVID-19 pandemic required rapid changes to be made to the medication competency unit being taught to students within a Diploma of Nursing, pre-registration course. Changes to sequencing of theory, mode of education delivery, class sizes, available resources and learning support were required. DesignA multi-method evaluation process was conducted. The project is reported as per SQUIRE-EDU guidelines. MethodsFocus groups and survey data were obtained from staff and students in December 2020, to evaluate responses to the changes. Student exam results and the number of learning support consultations accessed were also assessed to identify impact of changes. ResultsStaff and student evaluation identified mixed responses but overall, the change in sequence of theory and mode of delivery was positively received. Crude comparisons of final assessment results revealed improved marks compared to the previous cohort. The addition of an online medication resource was utilised by most students. The agility of staff in responding to the challenges was highlighted in the staff focus group and additional, flexible learning support was favourably received by students. ConclusionsDespite the need for rapid changes being made to the course, positive responses were received from both staff and students. Some students preferred the traditional sequencing of learning as they felt it matched their learning style. An added online resource and extra learning support supported student self-efficacy development of medication competency; however further research is needed to ascertain any associations. The online resource is still being utilised within course curriculum.

NEW GRADUATE NURSE'S MEDICATIONS EXPERIENCE BASED ON BENNER'S MODEL OF CLINICAL COMPETENCY AT KSA

Nursing competence is a life-threatening factor that is directly related to improved and positive patient consequences. A main intention in Benner’s from beginner to expert model, competence is a continuous procedure of getting information, practice, and experience. Aim: Explore the medication experience among new graduate nurse's based on Benner's model of clinical competency at Qassim University, king Saudi Arabia. Subject and methods: A descriptive exploratory research design on 104 graduates nurses from Qassim university. One tool is divided into two main parts; demographic data, and Medication's competency and experience assessment sheet . Results: There are nearly two-third of graduate's nurses (72.1%) have a high level of medications experience competency. There are a statistically significant relation was found between graduate's medications experience with their socio-demographic characteristics except in the item related to position of their graduate's or internship. There are a statistically significant relation was found between graduate's nurses medications experience with their competency level in all items as they assigned to drug calculation before administered drugs , experience administration of hazard medications ps=(0.001) except the item related they faced drug injury during their work Ps= (0.342) . Conclusion &recommendations: half of graduates strongly agree on that nurse mentors have had an important role in their learning of medication administrations. Additionally, there are nearly two-third of graduate's nurses have a high level of medications experience competency. However , there are a statistically significant relation was found between graduate's medications experience with their socio-demographic characteristics except in the item related to position of their graduate's or internship. Additionally , there are a statistically significant relation was found between graduate's nurses medications experience with their competency level in all items as they assigned to drug calculation before administered drugs , experience administration of hazard medications except the item related they faced drug injury during their work . Graduates nurses need for receive regular; periodic in-service program contains methods of drug calculation and how to prevent medication errors. Further studies are needed to study the factors that influence graduate's nurses' medication competency.

A National Survey of Medication Dosage Calculation Teaching Methods and Competency Criteria on Nursing Student Success: Recommendations for Nurse Educators.

The purpose of this study was to synthesize the current landscape of medication dosage calculation (MDC) education for prelicensure nursing students in the United States. There is little consistency in the format of MDC education and evaluation in prelicensure nursing education, yet consequences of not passing MDC exams can affect the number of graduating nurses. Consequences can include withdrawal from the course, delayed progression of a semester or more, or dismissal from the nursing program. An electronic survey was emailed to prelicensure administrators of 1,620 associate, bachelor's, and master's entry programs in the United States. Surveys were received from 210 programs. Results confirmed inconsistent methods used to teach and evaluate MDC competency. Inconsistent teaching methods and competency criteria can affect retention and subsequent growth of the nursing workforce. Based on the characteristics associated with MDC success, recommendations are made for nurse educators.

Medication competence: a concept analysis

ObjectiveThis paper aims to provide a thorough concept analysis of medication competence, within the context of nursing education. Also, to establish a clear definition of the concept for research purposes, and to improve the communication and use of the concept in healthcare practice. Design & methodsThe Walker and Avant concept analysis was utilized as a framework to develop a comprehensive understanding of the phenomena of medication competence in nursing education. Data sourcesA review of literature on medication competence was conducted using the electronic databases of EBSCOhost, CINAHL Complete, Web of Science, Ovid full text, ERIC, ScienceDirect, International Nursing Association for Clinical Simulation and Learning (INASCL), PubMed, Google Scholar, and PsychLit. Search terms included medication competence, medication safety, medication management, medication skills, healthcare, nursing, and nursing students. ResultsThe literature search resulted in 39 articles that met the inclusion criteria. Three defining attributes were identified: pharmacovigilant, effective skills competence, and interprofessionality. Antecedents, consequences, and empirical referents of the concept medication competence were also highlighted. ConclusionsInsight gleaned from this concept analysis will enhance the ability of nurse educators to effectively educate and assess medication competence among nursing students. By defining medication competence it validates the importance of further quantitative and qualitative research exploration of medication competence among nursing students and other healthcare specialties. Thus, this concept analysis establishes the springboard for innovative educational interventions, as well as future research in nursing education.

Psychometric evaluation of medication safety competence scale for clinical nurses

BackgroundNurses are the most important members of the health care system for medication safety, there are few tools to evaluate their medication safety competence. This study aimed to translate the Medication Safety Competence Scale into Chinese and validate its reliability and validity among clinical nurses.MethodsA total of 894 clinical nurses were recruited from three cities in China. The original version of the Medication Safety Competence Scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability, and stability. The validity of the scale was assessed by the content validity index, exploratory factor analysis and confirmatory factor analysis.ResultsThe Cronbach’s coefficient of the scale was 0.940, and the coefficient values for the six domains ranged between 0.843 and 0.948. The split-half reliability and stability were 0.671 and 0.703, respectively. The content validity index of the scale was 0.952. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot accounted for 71.485 % of the total variance. Moreover, as a result of the confirmatory factor analysis, the average variance extracted values were 0.55 to 0.70, and the model fitting indexes were all in the acceptable range.ConclusionsThe Chinese version of the Medication Safety Competence Scale had ideal reliability and validity among clinical nurses. The evaluation results of the scale can provide a reference for nursing managers to formulate education plans and intervention measures to improve clinical nurses’ safe medication competence.

Educational intervention to improve the safety medication process: a review using the GRADE approach

Abstract Objectives Medication errors are frequent and affect patient safety in all the world. This review using the GRADE approach aims to identify the educational intervention which improves nursing medication competences and knowledge. Methods According to PRISMA statement, a review was conducted. Key findings In this review of nine studies, we determined that there is a lot of educational intervention aimed to improve nursing knowledge, such as traditional classroom training, simulation, e-learning, slide show presentations and the use of posters and pamphlets or mobile application. All of these can improve the medication process and nursing skills. Only three studies reached moderate, and two studies reached low-quality ratings. Conclusions Our findings show that all educational interventions can lead to medication without harm. This work will inform regulators, public health initiatives and policy makers considering the nursing educational intervention for increasing patient safety and improve medication competence and knowledge.

Development and Validation of the Medication Safety Competence Scale for Nurses.

Nurses are the most important health care personnel for medication safety. A scale to measure nurse medication competency, such as the Medication Safety Competence Scale (MSCS), would move research forward. Preliminary items were developed through a literature review and in-depth interviews. Content validity was established by ten experts. Nurses (n = 607) participated in a survey to evaluate the validity and reliability of the scale. Exploratory and confirmatory factor analyses and correlation analyses were conducted to assess construct, concurrent, and criterion validity. The 36 items and 6 factors were derived with the exploratory factor analysis, which accounted for 63.2% of the variance. The confirmatory factor analysis revealed that the hypothesized factor structure was a good fit. Criterion and discriminant validity were present. The internal consistency of the MSCS was .97, and the test-retest reliability was .78. The MSCS is a valid and reliable instrument to measure nurses' medication safety competence.

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.

Registered Nurses' medication administration skills: a systematic review.

The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. A systematic literature review. The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018. Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis. A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety. Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.

The relationship between nurse manager's transformational leadership style and medication safety.

To describe medication safety, transformational leadership and their relationship as evaluated by Registered Nurses. Medication safety is one of the aspects of patient safety and an important part of nurses' daily practices. Nurse managers can ensure medication safety by adopting a transformational leadership style. However, little evidence exists regarding how transformational leadership relates to medication safety. Data were collected from Registered Nurses (n=161) in three Finnish hospitals in May 2016 using an electronic questionnaire incorporating the Transformational Leadership Scale (TLS) and Medication Safety Scale (MSS). Data were analysed using statistical analyses including descriptive analyses, principal component analysis and multivariate analyses. STROBE reporting guidelines were followed (see Appendix S1). Nurses evaluated medication safety and transformational leadership in their units to be excellent and good, respectively. There was a moderate but statistically significant correlation between transformational leadership and medication safety. The medication competence of nurses and the management of nursing processes were significantly related to medication safety. Nurse managers' transformational leadership style can promote medication safety in units. The medication competence of nurses must be addressed because assurance and confidence in their own expertise in pharmacotherapeutic tasks positively affects their perceptions of medication safety.

Medication Management in a Home Healthcare OT Practice

Abstract Date Presented 04/04/19 Exploring and understanding OTs’ experiences of working with home healthcare clients to manage their medication will provide useful information to develop appropriate medication management guidelines and competency standards to improve overall OT in home healthcare practice. OTs who know their role in medication management and are well-informed about medication can collaborate with the home healthcare team more effectively. Primary Author and Speaker: Julie Blum Additional Authors and Speakers: Jennifer Fogo, Judith Malek-Ismail

Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study

BackgroundIndividual and organizational factors correlate with perceived barriers to error reporting. Understanding medication administration errors (MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and allows healthcare providers to report perceived and identified errors more frequently. Therefore, an emphasis must be placed on medication competence, including medication administration knowledge and decision-making. It can be helpful to utilize an organizational approach, such as collaboration between nurses and physicians, but this type of approach is difficult to establish and maintain because patient-safety culture starts at the highest levels of the healthcare organization. This study aimed to examine the canonical correlations of an individual self-efficacy/bottom-up organizational approach variable set with perceived barriers to reporting MAEs among nurses.MethodsWe surveyed 218 staff nurses in Korea. The measurement tools included a questionnaire on knowledge of high-alert medication, nursing decision-making, nurse-physician collaboration satisfaction, and barriers to reporting MAEs. Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson’s correlation coefficient, and canonical correlations were used to analyze results.ResultsTwo canonical variables were significant. The first variate indicated that less knowledge about medication administration (− 0.83) and a higher perception of nurse-physician collaboration (0.42) were related to higher disagreement over medication error (0.64). The second variate showed that intuitive clinical decision-making (− 0.57) and a higher perception of nurse-physician collaboration (0.84) were related to lower perceived barriers to reporting MAEs.ConclusionsEnhancing positive collaboration among healthcare professionals and promoting analytic decision-making supported by sufficient knowledge could facilitate MAE reporting by nurses. In the clinical phase, providing medication administration education and improving collaboration may reduce disagreement about the occurrence of errors and facilitate MAE reporting. In the policy phase, developing an evidence-based reporting system that informs analytic decision-making may reduce the perceived barriers to MAE reporting.

Medication Competence, Numeracy, and Health Literacy.

Two studies investigated the association between medication literacy and numeracy. Study 1 revealed an association between both variables in a sample of adults. Study 2 replicated the finding in a sample of parents of young children, even after controlling for level of parental health literacy. Both studies employed the Medication Literacy in Spanish and English (MedLitRxSE) assessment tool. Objective and subjective numeracy scores were significantly correlated with MedLitRxSE scores in both studies, suggesting that interventions for reducing medication errors might benefit by simplifying the numerical information presented in medication instructions. [HLRP: Health Literacy Research and Practice. 2019;3(3):e181–e186.]

Assessment of Knowledge and Behaviour of Pharmacy Services Students in Vocational School Of Health Services for Rational Drug Use

Objective: To evaluate the knowledge and behaviour of the students about the rational drug use studying in the pharmacy services program in Vocational School of Health Services (VSHS). Methods: This cross-sectional study, conducted between 2017 October and 2018 March, was conducted on the first and second year students of a University VSHS Pharmacy Services Program. In this study, questionnaire was applied to 115 students to assess their knowledge and behaviour about the rational drug use. Results: The average age of the 115 students who participated in the study was 19.54±1.79 years. Among the causes of drug use by the participants, influenza (64.6%) was in the first place. Participants were asked to propose medication competence and 30.7% of the participants stated that they suggested prescribed drugs. The prominence of commercial advertising was questioned and 58.8% of the participants said they did not use the advertised products. Conclusion: In our study, it was seen that pharmacy technicians studying in pharmacy services program did not have sufficient knowledge about rational drug use. The content of training programs should include more information on rational drug use.

Factors Associated With Radiographers' Intravenous Pharmacotherapy Theoretical Competence: A Comparative Repeated-Measures Study

IntroductionThere are concerns that the high incidence of medicine-related adverse events is compromising patient safety. System errors and human factors, particularly inadequate knowledge of pharmacotherapy, are significant causes of medication errors. Little has been published on the continuing professional education of radiographers. We report on a study undertaken in Finland between 2012 and 2014. MethodsIn this quasi-experimental study, we explored the relationship between radiographers' backgrounds (e.g., age, clinical experience, sex) and intravenous (IV) medication theoretical competence before (n = 77) continuing pharmacotherapy education delivered with two different learning methods, 1 to 2 weeks after (n = 56) and 6 months later (n = 37). ResultsAfter the education programs, younger age, less clinical experience, and education in higher education institute (University of Applied Sciences) were significantly associated with performing better than average (more than median score) in the IV pharmacotherapy knowledge test. Both immediately after education and 6 months later, more participants performed better than average and passed more than 80% of correct answers limit after simulation-based than web-based education, respectively. DiscussionContinuing IV pharmacotherapy education improved theoretical medication competence, particularly for younger and less experienced radiographers. Evidence-based continuing education for radiographers is needed to assure patient safety.

Research Commentary: It is Time for Action: Consuming Evidence: Critical Appraisal: Part I

Health care providers can make errors when administering medicines, and when medicines are given intravenously (IV) or are high-alert medicines (e.g., contrast agents, analgesics, adrenergic agonists). Errors can result in significant patient harm. Radiology departments' professionals' medication competence should be developed and regularly evaluated using effective evidence-based learning methods. This quasi-experimental study aimed to compare IV pharmacotherapy knowledge acquisition and retention after simulation-based learning or web-based learning.Radiographers were recruited from two hospitals' clinical radiology units (experimental group, n = 36; control group, n = 41). The participants completed the same knowledge test related to IV pharmacotherapy three times: (1) before educational interventions (pretest); (2) post-test 1 to 2 weeks after the interventions; and (3) follow-up 6 months later to evaluate the sustainability of learning.Both simulation-based and web-based learning increased radiographers' knowledge of IV pharmacotherapeutics. In sensitivity analysis (groups matched for IV pharmacotherapeutics knowledge at baseline), scores in the simulation arm showed greater increase, but the difference did not reach statistical significance. The changes were sustained at 6 months. Furthermore, 82% (18 of 22) in the simulation arm had enhanced scores at post-test compared with 68% (23 of 34) in web-based arm and 62% (18 of 29) in the matched arm.The improvement in knowledge of IV pharmacotherapy was greater after simulation-based learning, and these improvements were sustained 6 months later. However, the impact of enhanced knowledge on the processes and outcomes of care require further exploration.

Simulation- and Web-Based Learning of Intravenous Pharmacotherapy: A 2-Group Comparison With 6 Months' Follow-Up

IntroductionHealth care providers can make errors when administering medicines, and when medicines are given intravenously (IV) or are high-alert medicines (e.g., contrast agents, analgesics, adrenergic agonists). Errors can result in significant patient harm. Radiology departments' professionals' medication competence should be developed and regularly evaluated using effective evidence-based learning methods. This quasi-experimental study aimed to compare IV pharmacotherapy knowledge acquisition and retention after simulation-based learning or web-based learning. MethodsRadiographers were recruited from two hospitals' clinical radiology units (experimental group, n = 36; control group, n = 41). The participants completed the same knowledge test related to IV pharmacotherapy three times: (1) before educational interventions (pretest); (2) post-test 1 to 2 weeks after the interventions; and (3) follow-up 6 months later to evaluate the sustainability of learning. ResultsBoth simulation-based and web-based learning increased radiographers' knowledge of IV pharmacotherapeutics. In sensitivity analysis (groups matched for IV pharmacotherapeutics knowledge at baseline), scores in the simulation arm showed greater increase, but the difference did not reach statistical significance. The changes were sustained at 6 months. Furthermore, 82% (18 of 22) in the simulation arm had enhanced scores at post-test compared with 68% (23 of 34) in web-based arm and 62% (18 of 29) in the matched arm. DiscussionThe improvement in knowledge of IV pharmacotherapy was greater after simulation-based learning, and these improvements were sustained 6 months later. However, the impact of enhanced knowledge on the processes and outcomes of care require further exploration.

Phone-based Intervention under Nurse Guidance after Stroke (PINGS): study protocol for a randomized controlled trial.

BackgroundHypertension is the premier modifiable risk factor for recurrent stroke. In sub-Saharan Africa (SSA) where the stroke burden is escalating, little is known about the role of behavioral interventions in enhancing blood pressure (BP) control after stroke.Our objective is to test whether an m-Health technology-enabled, nurse-led, multilevel integrated approach is effective in improving BP control among Ghanaian stroke patients within 1 month of symptom onset compared with standard of care.MethodsThis two-arm cluster randomized controlled feasibility pilot trial will involve 60 recent-stroke survivors. Using a computer-generated sequence, patients will be randomly allocated into four clusters of 15 patients each per physician: two clusters in the intervention arm and two in the control arm. Patients in the intervention arm will receive a simple pillbox, a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting BP measurements and medication intake under nurse guidance for 3 months. Tailored motivational text messages will be delivered based upon levels of adherence to the medication intake. Both groups will be followed up for 6 months to compare BP control at months 3, 6 and 9 as primary outcome measure. Physicians assessing BP control will be blinded to arms into which patients are allocated. Secondary outcome measures will include medication adherence scores and Competence and Autonomous Self-regulation Scale scores. A qualitative study is planned after follow-up to explore the lived experiences of participants in the intervention arm.DiscussionA feasible and preliminarily effective intervention would lead to a larger more definitive efficacy/effectiveness randomized controlled trial powered to look at clinical events, with the potential to reduce stroke-related morbidity and mortality in a low- to middle-income country.Trial registrationClinicalTrials.gov Identifier: NCT02568137, registered on 13 July 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1557-0) contains supplementary material, which is available to authorized users.