One of the leading causes of death in the United States today is medical errors (Makary & Daniel, 2016). According to the Agency for Healthcare Research and Quality (2019), adverse drug events are one of the most common types of inpatient errors and occur to nearly 5% of hospitalized patients. Nurses play a critical role within the medication administration process and it is imperative that nurse educators provide students with the pharmacologic knowledge, critical thinking skills, and decision making ability to function safely in the complex healthcare environment. Treiber and Jones (2018) surveyed 168 recent nursing graduates concerning medication errors in practice. Nearly 75% of responding nurses indicated that they felt well prepared for medication administration, however, several nurses expressed a need for specific training related to the mistakes made by others involved in medication administration such as doctors and pharmacists.
Nursing students enrolled in a pharmacology course at a Midwest university have participated in a high-fidelity simulation experience related to medication administration knowledge and skills for many years. During this simulation, modeled after a simulation described by Thompson and Bonnel (2006), students receive an order for an opioid pain medication from a healthcare provider via telephone. The overwhelming majority of students fail to question the excessive dose and subsequently make a serious medication error which requires the administration of an antidote. Faculty have observed that students place trust in the healthcare provider and fail to question the order or perform any other checks of the medication dosage. The National Coordinating Council for Medication Error Reporting and Prevention [NCCMERP] has identified intimidation as one cause of medication error in the healthcare setting. The NCCMERP reported that nearly one half of nurses surveyed in 2003 (49%) and again in 2013 (44%) reported that intimidation had played a role in how they handled order clarifications or questions about medication orders (2014). Intimidation can be overt in nature or more subtle such as tone of voice or impatience (Malone, 2016). In addition, it is natural and reasonable for nurses to defer final judgment to a person who they perceive to be more qualified. This is referred to a logical deference (Institute for Safe Medication Practices, 2012).
Methods:
In order to better understand the cause of the medication error, first-semester baccalaureate nursing students will complete an 8-question, short answer, anonymous survey immediately following the simulation experience starting in the fall 2019 semester. Survey questions were designed to identify students perceptions related to feelings of intimidation and likeliness to question a medication order that may lead to patient harm.
Results:
The results of this study will be used to guide future educational experiences which may involve the use of repeated simulations.
Conclusion:
The survey findings presented in this poster will allow nurse educators to explore the use of simulation technology in order to assist students in understanding medication errors, mitigate risk, and practice resolving conflicts related to intimidation. Intentionally using educational strategies to foster safety in professional practice is a necessity for all undergraduate nursing students.