Background and Problem: Medication administration can absorb a significant amount of nursing time in the acute care setting, and medication errors have been reported to occur in as many as 47.5% of administrations (Holland, et. Al., 2012). Errors have been identified at all points in the medication administration process, from calculation of dosage to delivery of the dose to the patient, and in all patient populations, including the physiologically vulnerable pediatric population. Medication errors can be particularly devastating to pediatric patients as a function of physiologic differences from adults (Gonzales, 2010; Kaushal, Bates, Landrigan, McKenna, Clapp, Federico et al., 2001). Decreasing medication errors is a national safety goal, and error prevention must be, and is addressed in pre-licensure nursing curricula (IOM, 2011). However, evidence in support of the best education practices to address this important issue is scant. Traditional methods for ensuring medication administration and safety competencies often include dosage calculations tests coupled with medication administration experiences in the clinical setting. This model has become increasingly inadequate, as clinical sites that are able to provide the needed skills are increasingly in short supply (Butler & Veltre, 2009). To address this concern and facilitate the development of appropriate knowledge, skills and attitudes (KSAs), we developed and evaluated a medication administration safety competency simulation experience for a baccalaureate-level pediatric nursing course (Harder, 2010; Leigh, 2008).
Methods: The quality and Safety Education (QSEN) competencies were utilized to develop four simulations involving the process of medication administration to infants and children, incorporating pertinent knowledge, skills and attitudes (KSAs) for safe and effective nursing practice. Simulations were piloted in a group of eight students from a semester-long nursing of children course and were further utilized with 107 students in a subsequent semester. Analysis of student outcomes from the pilot project resulted in refinement and expansion of the scenarios. After completion of the simulation exercises, students completed a 10-question evaluation of the experience.
Findings: A majority of students demonstrated competencies related to planning for and administration of pediatric medications, accuracy of dosage calculation, knowledge of medication therapeutics, modification of interventions by developmental levels of children. Student feedback was uniformly positive. Students expressed increased understanding of components of medication administration to infants and children and confidence in their abilities to administer medications. They recommended additional focused simulation experiences. Post-simulation competencies were retained in the clinical context.
Implications: Further exploration of outcomes of such simulation experiences, related to quality and safety, will expand the evidence base for best educational strategies to promote medication competencies. We plan to expand the use of this educational intervention, and collect skill, competency, safety, and nursing efficacy-related data in a multi-site study.
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