Safe Medication Administration Research Articles

Using Simulation in First Year Nursing Student Curriculum to Improve Dosage Calculations

Patient safety is of the upmost importance specifically when related to medication administration. Nurses are responsible for safe medication administration as a primary responsibility. Nursing education programs, especially associate degree nursing programs, use high-fidelity simulation to enhance medication administration and dosage calculation. First year nursing students are expected to pass a dosage calculation exam with accuracy to assess safe medication practices. The purpose of this quasi-experimental ex post facto design study was to examine the causal relationship between the medication administration simulation and the dosage calculation test scores in first year, associate degree nursing students. First year nursing students who participated in the high-fidelity medication administration had statistically significant differences in their dosage calculation test scores and the odds of passing the dosage calculation test on the first attempt than the students who did not participate. Age and gender demographic information of the students who participated in the high-fidelity simulation did not show any statistically significant information based on their participation. The study aims to examine which education intervention is effective in improving dosage calculation test scores in first year nursing students. Implementation of high-fidelity simulation experiences can improve dosage calculation exams scores and contribute to a safer nursing workforce.

Using objective structured clinical examination to teach medication rights in undergraduate nursing education.

Clinical partner feedback identified insubstantial student preparation and limited understanding of safe medication administration process. Faculty initiated a new teaching and evaluation approach to prepare students for safe medication administration processes in the practice setting. The teaching method is a synthesis of situated cognition learning theory that emphasizes use of deliberate practice case scenarios in low fidelity simulation. Objective Structured Clinical Examination (OSCE) evaluates student critical thinking and application of the medication rights administration process. Data collection includes first and second attempt OSCE pass rates, occurrence of incorrect answers, and student feedback regarding the testing experience. Findings include a greater than 90% pass rate on first attempt, 100% pass rate on second attempt, and positive testing experience. Faculty now use situated cognition learning methods and OSCE in one course within the curriculum.

Critical Care Nurse’s Practice Regarding Medication Administration Safety in Intensive Care Units at Governmental Hospitals in Gaza Strip

Background: Administration of medications is primarily the nurse’s responsibility. This study aimed to assess intensive care nurses’ practice of safe medication administration in governmental hospitals in the Gaza Strip. Methods: This study utilized descriptive, cross-sectional, analytical design. The sample of the study consisted of 116 ICU nurses from five governmental hospitals (Al Shifa Hospital, Indonesy Hospital, Shohada Al Aqsa hospital, European Gaza Hospital, and Nasser Hospital). For data collection, the researcher used Patient Safety Assessment in Medication Administration Questionnaire and Observation Checklist. A pilot study was conducted on 20 nurses, and reliability of the Patient Safety Assessment in the Medication Administration Questionnaire was 0.908. Results: The results showed that 66.4% of study participants were male nurses and 33.6% were female nurses, mean age was 28.97 years, 85.4% have bachelor degree, mean experience was 4.18 years, mean income was 1431.64 New Shekel, and 67.2% are working mixed shifts (morning, evening, and night). The practice of safety medication administration indicated that the highest score was in right route (93.8%), the right time (91.8%), right patient (90.7%), right way (89.5%), right recording of administered medication (88.9%), right answer (86.7%), right guidance (86.5%), right dose (86%), right medication (85.3%), and the overall score was 88.6%. Also, observation of nurses indicated high practice of safe medication administration with an average score of 83.6%. There were statistically insignificant differences in the practice of safe medication administration related to the hospital, gender, qualification, age, experience, and income. Conclusion: The study concluded that intensive care nurses handling medication safely at a moderate level and more. The authors demonstrated the need to provide adequate number of qualified nurses in Intensive Care Units, and encouraged nurses to participate in training programs about safe medication preparation and administration.

Medication Errors among Iranian Intensive Care Nurses: A Systematic Review.

Medication Error (ME) is a major patient safety concern in Intensive Care Units (ICUs). Critical care nurses play a crucial role in the safe administration of medication. This study was conducted to comprehensively review the literature concerning the prevalence of ME and associated factors and outcomes in Iranian ICU nurses. An extensive search of the literature was carried in international databases including PubMed, Web of Science, Scopus, and Google Scholar, as well as Persian databases such as Magiran and Scientific Information Database (SID) using ME-related keywords and the Persian equivalent of these keywords, from the first article written in this field to artcles published on March 30, 2021. The appraisal tool (AXIS tool) was used to assess the quality of the included studies. Fifteen studies were included in this systematic review. The prevalence of MEs made by ICU nurses was 53.34%. The most common types of MEs were wrong infusion rate (14.12%), unauthorized medication (11.76%), and wrong time (8.49%) errors, respectively. MEs occurred more frequently in morning work shifts (44.44%). MEs happened more frequently for heparin, vancomycin, ranitidine, and amikacin. The most important influential factor in the occurrence of MEs in ICUs was management and human factors. The prevalence of MEs made by Iranian ICU nurses is high. Therefore, nurse managers and policymakers should develop appropriate strategies, including training programs, to reduce the occurrence of MEs made by nurses in ICUs.

Safe Medication Administration: So Many Considerations

Safe Medication Administration: So Many Considerations

Team training program’s impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol

IntroductionMedication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing...

Analýza podání léčiv ve vztahu k potravě a použitým nápojům u hospitalizovaných pacientů

Proper medication administration in relation to beverage or food is one of the essential tools to achieve the pharmacotherapy goals. It is not known whether this is also considered in the care of inpatients. The aim of this study was to describe and analyse the current practice of medication administration in relation to food and beverages to patients hospitalized in four hospitals in the Czech Republic. This study was conducted based on the results of the first phase of a prospective observation study focused on the safety of medication administration performed by nurses. All data, including the timing of medication administration in relation to food and the data on beverages used, were obtained by the method of direct observation. The team of observersaccompanied the nurse during medication administration. The appropriateness of the medication administration in relationto food/beverages was assessed according to the summary of product characteristics and the published literature. In total, the administration of 5718 oral medications and 198 insulins were analysed. Unproper food timing wasobserved in 15.7% of oral medication administrations and 26.8% of insulin administrations. The highest number ofunproper food timing occurred in the proton pump inhibitors, antihypertensives, and prokinetics. Tea (63.4%) was the most used beverage. Errors with clinically serious impact have been observed in some groups of drugs. The necessity of a systemic approach in management of medication administration is required including interdisciplinary cooperation.

Nurse Child Care Health Consultants, Professional Development, and Accreditation Improve Medication Safety in Child Care Programs.

Medication administration is a critical safety issue in hospitals and the community. Children are especially at risk because of their dependence on adults to safely administer medications. The purpose of this study was to examine non-compliance with state child care medication administration regulations and factors associated with improved compliance. The data included routine, unannounced inspections of child care programs by state licensing specialists collected in two time periods over 10 years. Factors potentially associated with regulatory compliance were included in this secondary analysis. Most child care center medication administration regulations showed decreased non-compliance between the two time periods. However, regulations pertaining to prescriber orders and parent permission revealed a significant increase in non-compliance (58.4%). Factors positively associated with medication administration regulatory compliance included: compliance with annual professional development (p < 0.0001 in both periods), achievement of accreditation (p = 0.0115 in Time 1), and among centers with children under 3 years of age, compliance with a weekly mandatory visit by a nurse consultant (p = 0.0004 in Time 2). Though family child care homes had a lower frequency of medication administration non-compliance, only 19% were administering medications in Time 1. High quality, safe, and affordable child-care is essential for all children including those with special health care needs. This study highlights the importance of medication safety practices in child care programs, national child care health and safety standards, federal and state policies regarding medication administration regulations, and the critical role of nurse child care health consultants in promoting safe medication administration in child care programs.

Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events.

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

Optimizing Older Adults' Medication Use Nurses can partner with caregivers to promote safe medication administration.

This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Zonsius, M.C., et al. Optimizing Older Adults' Medication Use. Am J Nurs 2022; 122(3): 38-43.

Medication administration errors made among undergraduate nursing students: A need for change in teaching methods.

Systems factors, such as interruptions, contribute to nursing errors. Gaining an understanding of what contributes to nursing student errors can inform educational strategies aimed to improve patient safety. The aims of this study were to investigate: (a) within-subjects differences in error rates among nursing students during interrupted compared to uninterrupted simulated medication administration, (b) types of medication administration errors made by nursing students, and (c) nursing students' perceptions of their ability to independently administer medication. A descriptive comparative within-subjects design was utilized in this two-site study. Data on errors were collected via direct observation. Senior baccalaureate nursing student participants discussed their experience of interrupted and uninterrupted simulated medication administration during individual debriefing sessions. Nearly one-third of participants made errors. Error rates were similar in interrupted (19.4%) and uninterrupted (16.7%) conditions. Near-misses, which were not included in the error rates, were reported by 8% of participants. The most common error types were documentation and dose errors. Students attributed the interruption and lack of independent medication administration practice as causes for errors. Educational programs must adequately prepare nursing students for independent safe medication administration in complex work environments. The inclusion of systems factors in educational modalities is critical.

Patientensicherheit in der Kindernotfallversorgung

The treatment of critically ill children is a time-critical task that requires effective collaboration between different professional groups and specialist disciplines. Rapid recognition of the medical problem, establishment of a joint working hypothesis, coordinated implementation and regular re-evaluation of treatment are essential for patient safety. Several tools are in place to ensure that care is delivered safely. These include standardized emergency equipment that everyone can use, cognitive aids for safe medication administration and checklists for the preparation and performance of critical procedures. Furthermore, standardization of communication, a clear distribution of roles and tasks, and regular debriefings are helpful. The establishment of a safety culture and regular training are essential for the implementation of the measures.

Development of the Leapfrog Group's Bar Code Medication Administration Standard to Address Hospital Inpatient Medication Safety.

Medication errors are the most common type of error in hospitals and reflect a leading cause of avoidable harm to patients. Bar code medication administration (BCMA) systems are a technology designed to help intercept medication errors at the point of medication administration. This article describes the process of developing, testing, and refining a standard for BCMA adoption and use in U.S. hospitals, as measured through the Leapfrog Hospital Survey. Building on the published literature and an expert panel's collective experience in studying, implementing, and using BCMA systems, the expert panel recommended a standard with 4 key domains. Leapfrog's BCMA standard provides hospitals with a "how-to guide" on what best practice looks like for using BCMA to ensure safe medication administration at the bedside.

Use of simulation to improve nursing students’ medication administration competence: a mixed-method study

BackgroundMedication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students’ perceptions of this activity.MethodsSecond-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018–2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the ‘six rights’. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students’ tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question.ResultsThe simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care.ConclusionsSimulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.

Relationship between nursing supervision and the incidence of medication administration errors

Background Nursing supervision has an essential role in staff development and quality improvement through development of professional practice, safeguarding the standards of patient care, ensuring that registered nurses have the necessary skills and knowledge to reduce patient harm as well as the incidence of medication errors, and providing safe administration of medication by nurses. Aim The current study aimed to assess the relationship between nursing supervision and the incidence of medication administration errors. Design A descriptive correlational design was utilized. Setting The current study was conducted at Al-Mattar Psychiatric and Addiction Health Hospital. The study sample was composed of all staff nurses (70 nurses) who were working in inpatient departments and accepted to participate in the study. Tools Data were collected using two tools: the first tool was a nursing supervision questionnaire developed by researchers. It was designed to assess nursing supervision efficacy. It contained 77 items. The second tool was the medication administration error observational checklist developed by Kim and Bates (2012). Result Regarding nursing supervision, the highest mean percentage for staff nurses about nursing supervision was personal issues (84.63%) and the lowest mean percentage was finding time (69.20%). Regarding the incidence of medication administration errors, the highest mean percent age for staff nurses’ medication administration errors was for adherence to basic infection regulation and safety regulation: external and oral administration (78.3), whereas the lowest mean percentage was for adherence to the five rights of medication safety (65.5%). Conclusion There was no statistically significant correlation between perceived nursing supervision and observed medication administration errors. There was a significant correlation between adherence to the five rights of medication safety and finding time. Recommendation A supportive and establishing healthy work environment that helps nurses to reflect on their personal and professional-work related issues should be provided. Periodic formal and informal evaluation of nurses’ performance should be conducted, and guidelines should be developed on how to prevent medication administration errors.

Define, Measure, Analyze, Improve, Control (DMAIC) Methodology as a Roadmap in Quality Improvement.

Define, Measure, Analyze, Improve, Control (DMAIC) Methodology as a Roadmap in Quality Improvement.

Engaging Nursing Students in Quality Improvement: Teaching Safe Medication Administration.

Safety and reduction of errors during medication administration is a prominent focus in nursing and nursing education. Developing simulated medication administration experiences that include opportunities for nursing students to manage interruptions in a realistic environment can help improved critical thinking and reasoning for safe administration practices. Sophomore nursing students voluntarily participated in a quality improvement project examining nursing management of interruptions during medication administration. Students observed medication administration activities for episodes of interruptions and conducted surveys in a real-time format that encouraged decision-making dialogue. After the project, student learning outcomes included improved identification of interruptions, prioritization, critical reasoning skills, and development of management techniques for better safety. Incorporating real-world experiences that allow nursing students to identify and manage interruptions during medication administration foster development of critical thinking and interruption management techniques. [J Nurs Educ. 2022;61(5):268-271.].

Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries.

To identify final-year undergraduate students and new graduate nurses' behavioural intentions towards medication safety across four countries. Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society. A multi-site cross-sectional study. A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines. Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students. Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates. Understanding student and new graduate nurses' medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.

Percepción de la administración segura de medicamentos en atención primaria

The purpose of this study was to know the perception of nurses about safety in the preparation and administration of medications in a primary care health department of the Spanish national health system. Cross-sectional descriptive study. Carried out in the Health Department 21 (Alicante, Spain) in the months of September to November 2021. 66 nurses, with a predominance of women (88.9%). A semi-structured interview with ten questions was used. The inclusion criterion took into account nurses with more than two years of experience working in the health center. The perception of nurses about the degree of safety in the preparation and administration of medications was evaluated. 81.9% of the sample did not report adverse events. The steps for secure administration were varied. A significant association was observed in the correct time of medication (p < 0.031) and antisepsis (p < 0.026) according to the number of nurses in the basic health areas. Our results indicate the perceptions of nurses about improvements in the degree of implementation of standards or tools for the safe administration of medications, with special attention to lack of knowledge, care overload (high patient/nurse ratio) and associated dilemmas with the notification.

Seguridad de medicamentos durante la pandemia COVID-19 en las enfermeras de atención primaria

ObjectiveTo know the perception of nurses about the factors that influence the safe administration of medications during the COVID-19 period, in the work context in a primary care health department of the Spanish national health system. DesignThis is a qualitative phenomenological study. SiteCarried out in the Department of Health 21 (Alicante, Spain) between the months of September 2021 and November 2021. ParticipantsFifteen nurses chosen by intentional sampling. MethodsA semi-structured interview lasting between 30 and 60min was used, recorded and transcribed verbatim by the research team. A main category called “know” is established, which encompasses all the reflections about the nurse's performance during the medication administration process. ResultsThe participants expressed concern about the performance of medication administration procedures, which made it possible to perceive safety as the greatest concern in the study unit. From this main category, the following subcategories are developed: work overload, insufficient training, distractions and communication and information failures. ConclusionKnowing the perception of nurses about the factors that influence the safe administration of medications could facilitate the use of instruments to standardize and reduce variability in the safe administration of medications. As well as improving conditions in work environments at the community level, and not favoring social, personal and professional stigmatization due to care error.