Medication Safety Simulation: A Comparison of Students' Knowledge, Perceptions and Comfort

Background: Nurses have a major role in contributing to safe, quality patient care; however, student nurses and new graduates have deficiencies in skills, knowledge, and judgments related to safely administering medications. Simulation facilitates learning of skills, priority-setting, and decision-making. A review of the literature on simulation evaluation instruments revealed no valid and reliable instruments to measure knowledge and competency related specifically to safe medication administration.

Aim of the Study: The purpose of this medication safety simulation intervention study was to: 1) develop, conduct psychometric testing, and pilot test two new instruments to evaluate student knowledge (Medication Safety Knowledge Assessment–MKSA) and competency (Medication Safety Critical Element Competency Checklist-MSCEC) related to safe medication administration; and one revised instrument (Healthcare Professionals Patient Safety Assessment-HPPSA) to measure perceptions and comfort level about patient safety; 2) pilot test new/revised simulation scenarios with a medication safety focus; and 3) test the differences in scores on the MSKA, MSCEC, and HPPSA for junior level students who did and did not participated in safety enhanced medication simulations. The safety-enhanced simulations included the skill of giving medications to standardized patients, as well as knowing the significance of safe medication administration. These instruments and simulations can provide reliable and valid methods to assess outcomes of simulation on medication safety. 

Sample and Setting: Junior-level undergraduate nursing students at a mid-size undergraduate nursing program in the Mid-Atantic region.

Method: Following IRB approval, students were divided into intervention and control groups using a convenience sample of their clinical groups. On the first day of class, all students who consented to particpate in the study completed the Medication Knowledge Safety Assessment (MSKA) pre-test and the Healthcare Professionals Patient Safety Assessment (HPPSA). The control group particpated in the usual simulations and debriefing for the medical surgical class, while the intervention group particpated in one additional medication administration simulation, as well as a simulation that was enhanced with additional medication safety. During the final clinical simulation of the semester, students' competency in medication administration and safety was rated using the Medication Safety Critical Element Checklist. Following all simulations for both groups, all students particpated in the MSKA and HPPSA posttests. Relibaility and validity of all instruments were determined.

Results: Data for the MSKA were analyzed based on a Knowledge Pass/Fail cut score of 21 correct answers or more to pass, with less than 21 correct answers as a failing score. The HPPSA scores were analyzed using paired t-tests and the MSCEC between groups scores were compared. Pearson correlations were also performed to determine the relationship between the MKSA, MSCEC, and HPPSA scores for the intervention and control groups. Study results will be reported.

Conclusions/Implications: Medication safety is a crucial aspect to ensuring patient safety. Evidence that supports the outcomes of simulation as an effective strategy to improve student knowledge, perceptions, comfort, and competency in medication administration is important to ensuring that new graduates are well-prepared to address issues related to medication safety.