Rationale/Background: Nursing students are expected to have developed the knowledge and skills to administer medications safely over the course of their training and education. Yet, according to the National Council of State Boards of Nursing, > 40% of new graduates report making medication administration errors. Likely contributing factors are lack of clinical experience recognizing high-risk situations, and active and latent system failures. Educating nurses to have a greater emphasis on individual patients and families rather than also focusing on complex care delivery systems may add to error incidences. Current educational practices often lack formal training about medication risk reduction principles. It is also important to note that nursing students can experience divergent requirements and expectations between clinical faculty and clinical teaching associates (Reid-Searl, Moxhan,Walker, Happell, 2009). The Quality and Safety Education for Nurses (QSEN) project recommends introducing a culture of safety early in the curriculum and emphasizing it at midpoint and throughout the final phases of the curriculum.
Description of Undertaking: Clinical faculty and clinical teaching associates on two medical-surgical units in a Pacific Northwest teaching hospital are collaborating to develop, implement, and assess a comprehensive strategy to teach medication administration by coaching. Coaching was selected as a strategy that could be used to minimize divergent expectations and craft a healthy learning environment to enhance student performance. Through coaching and reflection, nursing students are guided to explore their clinical reasoning and decision-making related to medication administration in context. A protocol outlining shared expectations, teaching tips for coaches, a pocket brochure and learning activities, was developed. Learning activities were implemented to incorporate medication administration skills into a larger discussion about a culture of safety. Examples of learning activities include exploring human factors associated with the role of a novice, recognizing risk associated with deviation from learned patterns and workarounds, and developing habits of surveillance to inform clinical judgement and decision-making around medication administration. Coaches guide students to scrutinize strategies used to prevent medication errors and mindfully develop habits that contribute to safe medication administration.
Outcomes: Pre-test/post-test comparisons will be used to assess the impact of the coaching strategy by measuring differences in learning outcomes that occur between the beginning and end of the clinical rotation. The comparisons will assess perceived changes in behavioral outcome criteria associated with medication administration as a result of coaching. Steps for pre-test/post-test comparisons include defining learning outcomes, developing a questionnaire to measure the outcomes, administering the pre-test to coaches and students, implementing the coaching strategy, administering the post-test to coaches and students, and analyzing the results. Medication error data for student nurses progressing to their senior practicum will be compared to previous student nurses who did not receive the additional interventions and coaching for safe medication administration. Long-term outcomes will be student nurses with safer medication administration practices transitioning to practice.
Conclusions/Implications: This project represents first steps toward understanding the impact of coaching on clinical judgment around medication administration. If effective, next steps would be to formalize a coaching protocol and develop best practices around coaching. Collaborative education strategies that enhance clinical judgment in nursing students will contribute to needed progress in medication safety and a reduction in adverse patient events associated with medication administration.