The Generation, Prevalence, and Typology of Medication Errors in Clinical Simulation Among Baccalaureate Nursing Students

Purpose: Given the complexities that may contribute to the generation of medication errors, medication errors are common within the healthcare system. The Institute of Medicine (2007) has indicated that hospitalized patients on average experience a minimum of one medication error per day. Further, medication errors are considered to be a medical error and may lead to both health and financial consequences (Samp, Touchette, Marinac, & Kuo, 2014). Within the medication process chain, medication errors that are specifically generated in the administration process are the most common cause of patient harm in acute care and inpatient healthcare settings (Ofosu & Jarrett, 2015). The medication administration process involves the specific act in which the health care providers (i.e., registered nurse) physically administers medications to their patients. Medication administration is considered to be one of the most common clinical tasks for nurses given their scope of practice and responsibilities (Karabağ Aydin & Dinç, 2017). As such, pre-licensure nursing education has aimed to prepare nursing students to become competent practitioners with sound knowledge in both the theoretical and clinical components of nursing practice, including but not limited to medication administration (Bourbonnais & Caswell, 2014). Given these potential variations, influences, and significance, further research examining the relationships between nursing students and medication errors will be beneficial (Cooper, 2014). Therefore, this study will examine the types of medication errors generated by nursing students in clinical simulation with the use of an electronic medication administration record (eMAR) system, and identify if there are differences in the generation of medication errors based on nursing students’ self-perceived levels of self-efficacy (confidence) and preparedness. The theoretical underpinning of this study will be guided by Bandura's (1977) theory of self-efficacy as this framework may assist toward elucidating a greater understanding of nursing students’ confidence, subsequent behaviors, and the related outcomes. The findings of this study will assist to expand the current body of research associated with the constructs of self-efficacy (confidence), preparedness, and educational/pedagogical practices related to medication administration within nursing education.

Methods: A secondary analysis of quantitative data arising from a pragmatic randomized control trial was used in the present study. The data for the primary study was collected in two separate phases, with nursing students’ self-efficacy and preparedness measured through a self-reported survey based on a validated instrument in phase one. Phase two of data collection consisted of in-person observations to document the generation, type, and severity of medication errors made by nursing students within clinical simulation while using an eMAR system. The types and complexions captured on the heuristic tool included the particular type of medication error made by the student along with its risk of harm to the patient (i.e., no risk, low risk, moderate risk, high risk).

Results: Both descriptive and inferential analysis (Mann-Whitney U Test) was conducted in this secondary study. Nursing students reported an overall moderate level of confidence on a seven-point Likert scale (M = 4.18, SD = 1.29) regarding their ability to administer medications in clinical simulation while integrating the electronic medication administration records system; and an overall moderate level of preparedness on a seven-point Likert scale (M = 4.29, SD = 1.08) with medication administration was reported by the sample. Inferential analysis demonstrated that no statistically significant differences (p < .05)were detected between nursing student’s self-perceived confidence, preparedness, and the generation of medication errors except for between confidence and scanning (p = .04).

Conclusion: The findings of this present study demonstrated that nursing students’ perceived confidence and preparedness were not statistically significant to produce differences in their generation of medication errors, with one exception noted. Meanwhile, nursing students continue to generate medication errors within the simulated setting. Although students’ perceived levels of confidence were identified to demonstrate a significant difference with the generation of scanning-related medication errors, additional examination of the underlying contributing factors may be beneficial. The potential impact of other extraneous variables and limitations of this study provide opportunities to further examine other relationships associated with the generation of medication errors, and to provide research, practice, and educational/pedagogical implications to mitigate such errors and its associated harm and consequences for patients.