Discussion: Avoiding medication errors as a new nurse

Discussion: Avoiding medication errors as a new nurse ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Avoiding medication errors as a new nurse I need the introduction to be well stated, with three well defined sentences, (could have more sentences, but at least three) and the purpose statement be clearly defined and reflect the assignment criteria. APA format The tittle of the paper is “Avoiding Medication Errors as a new Nurse” Discussion: Avoiding medication errors as a new nurse Discussion: Avoiding medication errors as a new nurse 1 page Please cite at least one of the articles attached, those will be the ones I am using as sources to write the paper. Feel free to cite any other source but at least one of the articles provided. attachment_1 attachment_2 Nurse Education in Practice 15 (2015) 203e211 Contents lists available at ScienceDirect Nurse Education in Practice journal homepage: www.elsevier.com/nepr Learning and teaching in clinical practice Patient safety and technology-driven medication e A qualitative study on how graduate nursing students navigate through complex medication administration Janne Orbæk a, b, *, Mette Gaard c, 1, Pia Fabricius d, 2, Rikke S. Lefevre b, e, 3, Tom Møller f, 4 a Department of Gastroenterology, University Amager-Hvidovre Hospital, Denmark University Amager-Hvidovre Hospital, Denmark Department of Medicine, University Amager-Hvidovre Hospital, Denmark d Department of Development and Quality, University Amager-Hvidovre Hospital, Denmark e Department of Emergency, University Amager-Hvidovre Hospital, Denmark f University Hospitals Center for Nursing and Care Research, Denmark b c a r t i c l e i n f o a b s t r a c t Article history: Accepted 19 November 2014 Background: The technology-driven medication process is complex, involving advanced technologies, patient participation and increased safety measures. Medication administration errors are frequently reported, with nurses implicated in 26e38% of in-hospital cases. This points to the need for new ways of educating nursing students in today’s medication administration. Aim: To explore nursing students’ experiences and competences with the technology-driven medication administration process. Methods: 16 pre-graduate nursing students were included in two focus group interviews which were recorded, transcribed and analyzed using the systematic horizontal phenomenological-hermeneutic template methodology. Results: The interviews uncovered that understanding the technologies; professionalism and patient safety are three crucial elements in the medication process. The students expressed positivity and con?dence in using technology, but were fearful of committing serious medication errors. From the nursing students’ perspective, experienced nurses deviate from existing guidelines, leaving them feeling isolated in practical learning situations. Conclusion: Having an unclear nursing role model for the technology-driven medication process, nursing students face dif?culties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient adherence to the medication process, still remains to be studied. © 2014 Elsevier Ltd. All rights reserved. Keywords: Nursing student Medication administration Technology Patient safety Background Medication administration in health care is a dynamic, interdisciplinary and complex process involving several professional * Corresponding author. Department of Gastroenterology, University AmagerHvidovre Hospital, Denmark. Tel.: þ45 38621629. E-mail addresses: [email protected] (J. Orbæk), [email protected] (M. Gaard), [email protected] (P. Fabricius), [email protected] (R.S. Lefevre), [email protected] (T. Møller). 1 Tel.: þ45 38626562. 2 Tel.: þ45 38623470. 3 Tel.: þ45 26850890. 4 Tel.: þ45 35457366. http://dx.doi.org/10.1016/j.nepr.2014.11.015 1471-5953/© 2014 Elsevier Ltd. All rights reserved. competencies, theoretical knowledge, critical re?ection, use of advanced technologies and comprehensive patient participation to ensure high performance on patient safety (Leape et al., 2002; Choo et al., 2010; Sulosaari et al., 2011; Wulff et al., 2011; WHO, 2013). In 1999, The Institute of Medicine (IoM), USA, developed a manifesto entitled “To Err is Human” that aimed to increase safety in the health care sector by approaching safety systems to minimize errors occurring at the individual level. This important milestone has reinforced the introduction and development of medical technology to be the primary strategic tool in eliminating errors from prescribing to administration in medication processes (Institute of Medicine, 1999; Hassan et al., 2010; WHO, 2013). 204 J. Orbæk et al. / Nurse Education in Practice 15 (2015) 203e211 Alongside, public mandatory reporting systems have been established nation-wide (Institute of Medicine, 1999; Hassan et al., 2010) to provide feedback on health care performance and reinforce learning from errors (Bates and Gawande, 2003). Recent data shows that approximately 5000 cases of medication errors are reported every month in the UK. In US at least 1.5 million people are injured by medication errors every year (Weeks et al., 2013a), leading to potential fatal consequences, prolonged admission, substantial hospital costs and even death (Gurwitz et al., 2005; Page and McKinney, 2007). Comparable ?ndings has been reported by The Danish Association for Patient Safety, which is based on an opportunity for anonymous reporting, showing that 32% of all reported adverse incidents were medication related in 2009 (Danish Association for Patient Safety, 2011). Empirical studies claim that 5e30% of hospitalized patients will experience harmful or adverse incident (Rothschild et al., 2006; Hicks and Becker, 2006; Elliott and Liu, 2010). Furthermore, it has been revealed that medication errors are the most prevalent nursing error type recorded (Weeks et al., 2013a), implicated in 26e38% of medication errors in hospitalized patients (Leape et al., 2002; Bates, 2007). Errors may occur at several points along the continuum, e.g. being due to a professional’s lack of knowledge of pharmacology, kinetics and dynamics, calculation skills or not using available supportive technology as i.e. Personal Device Assistant (PDA)/Barcode scanner and the Electronic Patient Medication (EPM) (King, 2004b; Richardson et al., 2012; Weeks et al., 2013b). These electronic equipment’s are intended to verify the patient’s identity by using barcode scanner and check whether the dispensed drug is consistent with the doctor’s prescription during medication administration (Lisby et al., 2005). Discussion: Avoiding medication errors as a new nurse The overall rationale for applying such technologies into clinical practice are to strengthen implementation, use and safety with respect to the so-called “?ve right” principle, i.e. “right” patient receives “right” medication at the “right” dosage and at the “right” time via the “right” route (Eisenhauer et al., 2007; Folkmann and Rankin, 2010). Though surveillance and awareness of medication errors in almost a decade (Fowler et al., 2009), errors worldwide and in Denmark are still frequent reported including: patient not receiving medication; receiving wrong dosage or form of medication; receiving medication at the wrong time or via wrong route of administration (Digital Professional Medication Reference, 2013; Lisby et al., 2005; NPSA, 2009). Consequently, the medication process is a tremendous educational challenge in the ongoing quali?cations of nurses and nursing students and in particular, when targeting discontinuities between the educational and practice sectors (Gregory et al., 2007; Meechan et al., 2011; Sabin et al., 2013; Weeks et al., 2013b; Wright, 2009). Findings from a recent systematic review reveal that simulationenhanced clinical experiences may decrease medication errors (Shearer, 2013), although some researchers have questioned it’s superiority for nursing educational praxis regarding medication safety (Blum and Parcells, 2012). A 20-year program entitled “The Authentic World”, researchers have identi?ed three core competences in safe medication: a conceptual-, calculation- and a technical measurement competence. The computer based authentic assessment program focuses on how nurses develop medication dosage calculation problem-solving skills, which brings new knowledge about how nurses are prone to make medication errors (Weeks et al., 2013b). Inspired by simulated learning processes and with the aim to improve patient safety by increasing medication competencies at our institution, Hvidovre Hospital, in Denmark, we developed a 2½day intensive training program in medication administration for pre-graduate nursing students. The training combined theoretical teaching and use of technology (EPM and PDA) in simulated clinical practice in skill laboratories. The current qualitative study explores how pre-graduate nursing students experience and perceive a complex technologydriven medication process and the interrelation with trained staff, when adopting acquired skills in this crucial area of patient care and safety. Setting The current study was carried out at Hvidovre Hospital, a University Hospital in Capital Region of Denmark, accredited since 2002 by the International Joint Commission and in 2012 by the Danish Quality Model Program for Hospitals. Since 2006, the Capitol Region’s hospitals use the EPM with the associated device PDA (Danish Association for Patient Safety, 2005). Ethical considerations According to the Regional Scienti?c Committee of the Capital Region of Copenhagen, interviews and questionnaires must only be noti?ed if included human biological material is collected, why the present qualitative study is not under its jurisdiction. The hospital management of Hvidovre Hospital was informed in advance and approved the study. The respondents were informed in writing about the study and that participation was voluntary and would not in?uence the evaluation of their clinical stay. Interviews were anonymously transcript and recording tapes immediately deleted. Research design The study was designed as a qualitative investigation and evaluation of a medication-training program for nursing students and carried out as two focus groups each interviewed twice with a total 16 pre-graduate nurses. Discussion: Avoiding medication errors as a new nurse Qualitative analyses were based on a phenomenological-hermeneutic approach (King, 2004a). Methods Description of the medication training program The medication training program combined theoretical teaching by tutors, pharmacists and physicians with the use of EPM and PDA in clinical simulation situations in skill laboratories and workstations set up by a clinical nurse specialist and tutors. The theoretical part of the medication training was certi?ed with a multiple-choice test. Clinical simulation training was combined with debrie?ngs to enhance the students’ learning experience. In the mandatory activity, the clinical tutor support the students in transferring the newly acquired medication administration skills into actions, in clinical practice. An overview of the medication training program and the research study evaluation is illustrated in Fig. 1. Respondent selection 65 nursing students participated in the training program during spring, 2012. 62 students (95%) completed the training. Respondents were strategically selected according to age and specialty in order to obtain the broadest possible representation (Patton, 1990) within a population of 20 students. Two focus groups of 8e10 students each were formed. The focus groups were interviewed twice. First round occurred immediately following participation in the medication training (baseline). The second interview J. Orbæk et al. / Nurse Education in Practice 15 (2015) 203e211 205 Fig. 1. An Overview of the medication training program and qualitative study evaluation. was held 10 weeks after participation in the program. Each interview had a planned duration of two hours. All four interviews were taped and later transcribed verbatim. All respondent agreed to participate in focus group interviews. Only a few respondents did not participate due to sickness. Thus, the total number of respondents in the two focus groups was 15 students in the ?rst interview round and 16 in the second. Focus group interviews and the interview guide Empirical data were collected from the interviews using a semistructured interview guide. The structure was based on an interactive model (Halkier, 2008; Kvale, 2009). The ?ve themes identi?ed in the interview guide (Interruptions, Information and Patient Guidance, EPM/PDA, Information on Patients’ Status and Appearance and Interaction with the Patient) were generated from an earlier medication training program. Key themes were identi?ed from the scienti?c literature. An interviewer, a moderator and members of the project team participated in each interview. The themes and questions were projected on a screen and reviewed with the students prior to each interview. The interviews were held in a quiet meeting room where students could express themselves freely. All present in the room provided their agreement to maintain trust and con?dentiality and were conscious of the fact that personal issues and dilemmas might be raised when students spoke about their experiences in clinical practice. In those cases, the particular students were offered follow-up counseling and/or interviewing with a project team member. Analysis King’s phenomenological-hermeneutic template method was used as a systematic horizontal and cross-cutting qualitative analysis strategy for the four focus group interviews This qualitative systematic analysis method provided an opportunity for stringent processing of the empirical evidence in which the respondents’ statements and themes could be identi?ed and interpreted (King, 2004a). Four project group members reviewed all of the data using continuous comparison to ensure that the essence of meaning could target the ?ve themes. This process led to inclusion of an extra theme as well as a split of an existing theme into two; concluding the analysis with the use of a total of 7 themes (Fig. 2). Thematic de?nition and categorization of the students’ statements led to a hierarchical sorting of the interview data into three general categories; “Patient Safety”, “Technology” and “Professional Identity and Professionalism”. These categories re?ected the students’ main issues and views on safe medication administration (Fig. 3). Underneath each theme a selection of illustrative quotations are used. Results The ?nal template The students broadly expressed that the correct use of medication-driven technology and professional competences are the most important prerequisites for optimizing patient safety. Being able to monitor and understand the patients overall health situation and to combine this knowledge to the patients speci?c needs and the prescribed medication was a challenge. The three major themes highlights the students’ constantly attempt to increase their knowledge cultivate their skills and gain practical experience. They ?nd themselves balancing and maneuvering in a complex clinical practice, trying hard to emerge as credible and con?dent professionals in their relation with patients. The experienced nurses are role models in the students’ learning process and how to acquire professional identity. They are not necessarily perceived to re?ect best practices in the polarization between using medical technology and optimizing patient safety. Several students 206 J. Orbæk et al. / Nurse Education in Practice 15 (2015) 203e211 Fig. 2. Template. felt they were already familiar with technology and had easily adapted the technology-driven medication process. Students did not doubt the technology as a tool for improving patient safety. In contrast, they observed that technology use was not necessarily linked to the professional identity of their role models, the experienced nurses. The students pointed to the need for seamlessness during the process from the doctors prescribing during the process of calculating and dispensing medication as an essential factor in preventing medication errors in this complex learning process. experienced that use of the EPM/PDA could reduce errors and increase patient safety: Major theme 1: patient safety Use of EPM/PDA According to the students, the experienced nurses did not use technology to the same extent and as the guidelines prescribe. The students were convinced that using the EPM and PDA reduces errors and increases patient safety. They had no doubts about the technology’s legitimacy. On the contrary, they spent time familiarizing themselves with the technology and its potential problems. The students experienced on several occasions that experienced nurses, role models, deviated from existing guidelines in several areas of the medication administration process. The experienced nurses deviated from what the students had learned and were trained in during the medication training program. The students at both the baseline focus group interview and at the interview held 10 weeks after maintained this observation. Several had “I had a situation in which the PDA did not work. My supervisor told me just to administer the medication. I gave the PDA one more go for 10 or 15 minutes and got it to work. When I scanned the patient’s [identi?cation] bracelet, it was the wrong patient. I’m happy that I took the time to get the PDA to work.” (March 2012, Personal communication). Discussion: Avoiding medication errors as a new nurse “The PDA is a good security … it shows me that I’m working with the right medication to the right patient.” (March 2012, Personal communication). After the students participated in the 10-week clinical practice, the students had gained more knowledge about standard drugs in the department as well as the department’s rules and routines. They experienced being able to inform and guide the patients more con?dently. For example some students increasingly used Digital Professional Medication Reference (ProMed) while others used similar type options to a more limited extent. The students were more aware of the need to ensure patient compliance and safety. “You can go into ProMed and read, and after feel more con?dent when informing the patient.” (May 2012, Personal communication). Fig. 3. Action in practice. A quiet and uninterrupted zone The students experienced a divergence between their own and experienced nurses’ behavior in the medications room. The trained nurses’ chatting and interruptions in the medication room impacted them, especially when they had a compelling need for a quiet atmosphere to avoid medication errors. Interruptions were J. Orbæk et al. / Nurse Education in Practice 15 (2015) 203e211 seen by the students as a main cause of disturbance that could negatively impact patient safety. “It is important that there is peace and quiet in the medications room to avoid medication errors.” (March 2012 Personal communication). After 10-weeks clinical practice, several students expressed that they were not as affected by disturbances as earlier. It seems they had become used to interruptions and they claimed, that being able to adapt to disturbances made them feel more experienced. One student developed a strategy to handle interruptions: “I’m not as affected by interruptions anymore. I’m more con?dent. I also developed a good routine of putting a mark on the next medicinal product that I’m about to work on. Then I know where I am if I’m interrupted.” (May 2012, Personal communication). Other students experienced dif?culty with requesting quietness. They pointed out: “… it’s hard to confront the older nurses”. It would be much easier just to point to a sign for quietness.” 207 honest with patients in order to portray the image of being a responsible representative of health professionals. Calculation of correct dosages while dispensing medication “is still an important challenge” (May 2012, Personal communication) for many of the students following their 10-week clinical training. Several experienced their skills in working with numbers falling short of expectations and they often relied on the mathematical help function in the EPM. One student expresses: “It’s awesome to be able to use the function in the EPM. I use it a lot to double check.” (May 2012 Personal communication). Thr … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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