Bridging generational gaps in medication safety: insights from nurses, students, and generative AI models

BACKGROUND

This study investigated medication dose calculation accuracy among nurses, nursing students, and Generative AI (GenAI) models, examining error prevention strategies across generational cohorts.

METHODS

A cross-sectional study was conducted from June to August 2024, involving 101 pediatric/neonatal nurses, 91 nursing students, and four GenAI models. Participants completed a questionnaire on calculation proficiency and provided recommendations for error prevention. Qualitative responses were analyzed to describe attitudes and perceptions.

RESULTS

70% of nurses reported previous medication errors compared to 19.5% of students. Thematic analysis identified six key areas for error prevention: double-checking, calculation methods, work environment, training, drug configuration, and technology use. Only students recommended GenAI integration, while nurses emphasized double-checking.

CONCLUSIONS

The study highlights generational differences in medication safety approaches and suggests potential benefits of incorporating GenAI as an additional verification layer. These findings contribute to improving nursing education and practice through technological advancements while addressing persistent medication calculation challenges.

Influence of Critical Thinking Disposition, Clinical Reasoning Competence, and Nursing Practice Environment on Medication Safety Competence of Hospital Nurses

OBJECTIVES

This study examined the impact of nurses' critical thinking disposition, clinical reasoning competency, and nursing practice environment on their medication safety competency.

METHODS

A cross-sectional design was employed, involving a convenience sample of 210 nurses from four tertiary general hospitals and two general hospitals. Data were collected in September 2023 utilizing structured online self-report questionnaires and analyzed utilizing descriptive statistics, independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and stepwise multiple regression with SPSS/WIN 28.0 software.

RESULTS

Significant positive relationships (p < 0.001) were found between nurses' medication safety competence and critical thinking disposition (r = 0.47), clinical reasoning competence (r = 0.67), and nursing practice environment (r = 0.40). Factors influencing medication safety competence were identified as clinical reasoning competence (β = 0.55, p < 0.001), nursing practice environment (β = 0.30, p < 0.001), and critical thinking disposition (β = 0.19, p < 0.001). The regression model accounted for 57% of the variance in medication safety competence and was statistically significant (F = 91.70, p < 0.001).

CONCLUSIONS

These findings highlight key factors influencing medication safety competence of nurses and underscore the need for targeted strategies to enhance patient safety by optimizing critical thinking, clinical reasoning, and the nursing practice environment in healthcare settings.

Medication administration errors and predictive role of resilience and emotional exhaustion in a sample of Iranian nurses

BACKGROUND

Medication errors, mainly in the administration phase are, one of the most prevalent and critical problems in healthcare, so it is crucial to examine the factors that influence the incidence of medication administration errors among nurses. Nurses' burnout caused by emotional exhaustion often results in frequent errors, compromising patient safety. Conversely, nurses' resilience level has been linked to promoting professional development and enhancing the level of patient safety and care. This study aimed to ascertain whether nurse emotional exhaustion and resilience can predict medication administration errors.

METHODS

A cross-sectional descriptive correlational study was conducted on 272 nurses from February 2024 to April 2024 in the teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The data of the study was collected through the demographic information questionnaire, the medication administration errors questionnaire, the short version of the Resilience Scale (RS-14), and the emotional exhaustion scale. Data were analyzed using descriptive and analytical statistics such as independent t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression in SPSS-22.

RESULTS

nurses' mean scores for medication administration errors, emotional exhaustion, and resilience were 10.29 ± 10.02, 29.97 ± 7.92, and 56.65 ± 8.28, respectively. The regression model indicated that the rise in resilience, age, and work experiences are associated with decreased levels of medication administration errors as much as 0.42, 0.51, and 0.80 times respectively. This model explained 23% of the variance in medication administration errors in nurses (F = 18.054, p < 0.001).

CONCLUSIONS

The level of resilience among nurses was found to play a very important role not only in preventing medication administration errors but also in preventing nurse emotional exhaustion. Accordingly, teaching positive coping methods when dealing with stressful situations must be given top priority in all healthcare settings to promote nurses' standard of care, reduce the likelihood of medical errors, and prevent emotional exhaustion. Additionally, nurses must receive continuous, dedicated training on drug knowledge, including side effects, as well as the correct techniques of drug administration.

Deliberate practice of medication administration among nursing students: a pilot study

OBJECTIVES

The objective of this pilot study was to investigate the deliberate practice teaching method with medication administration skills to prepare for a future larger study.

METHODS

A multi-methods repeated measures design was used. Pre-licensure nursing students engaged in deliberate practice across two study visits that were spaced four to eight weeks apart. Simulated scenarios served as the pre-posttests.

RESULTS

Study procedures were feasible to implement. Medication error rates decreased from 80.9 to 22.2 %. Students voiced a need for more skills practice and that deliberate practice is beneficial.

CONCLUSIONS

The deliberate practice teaching method was feasible to implement, skills improved, and students attributed their improvements to the teaching method. Skills were retained over a 4-8 week span suggesting that skill decay did not occur in this timeframe.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Worldwide, improvements in medication administration safety are required. Changes in the methods used to teach medication administration may contribute to these necessary improvements.

Examining nursing students' awareness of various medical errors during clinical internships to enhance patient safety: A multi-center cross-sectional study

BACKGROUND

Patient safety is a global concern within health facilities, primarily attributed to medical errors, constituting a significant global public health issue. Patients experiencing medication errors face serious problems, with increasing mortality rates and escalating hospital costs.

AIM

The study aims to examine nursing students' awareness of various medical errors during their clinical internships at Al- Ahsa, identifying types of errors to enhance patient safety.

METHODS

A cross-sectional study was conducted among 160 nursing students during their internship at King Faisal University, Al Ahasa, Saudi Arabia.A total of 131 participants completed a self-administered questionnaire based on a medical error scale consisting of 43 items across six subscales. Data were analyzed using SPSS version 22. The outcomes of interest included falls, blood and blood Products transfusion, medication practices, care practices, communication, and controlled practices.

RESULTS

Overall, nursing students scored 188 out of 215. Among the sub-dimension scores, medication practices received the highest mean score, while Patient falls emerged with the lowest score. In our study, students ranked falling as the least significant factor.

CONCLUSION

Study findings indicate that nursing students exhibit a low tendency to commit medical errors, which is encouraging for the future implementation of patient safety protocols. This trend suggests that nursing students are developing strong competencies in safe nursing practices, which contributes to reducing the incidence of medical errors and improving overall patient safety in clinical settings.

Exploring the influence of nurses' demographics and hospital work environment on medical error reporting practices in Jordan: a cross-sectional study

OBJECTIVE

Nurses have a significant role in maintaining patient and healthcare safety. Thus, healthcare administrators should focus on nurse performance and create a friendly hospital work environment to ensure patient safety and healthcare quality. Limited studies have investigated the impact of nurses' demographics on nurses' error reporting practices and nurses' perceptions of the hospital work environment, especially in Jordan. This study aims to investigate the factors influencing nurses' medical error reporting practices in Jordan, specifically focusing on the role of nurses' demographics and the hospital work environment. Design: This is a descriptive cross-sectional study.

SETTING

Data collection was done in three hospitals (public, university-affiliated and private) in Jordan, using surveys that included demographics, the incident reporting practice scale and the Practice Environment Scale-Nursing Work Index from 11 June 2023 to 13 August 2023.

PARTICIPANTS

350 nurses with a diploma, associate degree, bachelor's degree or postgraduate degree had worked at the targeted hospitals for at least 6 months and were responsible for direct inpatient care.

PRIMARY OUTCOME MEASURE

The level of medical error reporting practices and the nursing work environment. Also, differences were assessed among demographic characteristics and investigated the factors for medical error reporting practices.

RESULTS

Jordanian nurses had low medical error reporting practices (M=2.34; SD=0.57) and nursing work environment (M=2.4; SD=0.56). Nurses who were single and in private hospitals had higher medical error reporting practices (p<0.05). Medical error reporting practices positively correlated with the nursing work environment (r=0.807, p<0.01) and negatively correlated with the average number of patients per shift (r=-0.109, p<0.05). The nursing work environment was a significant predictor, with an 81.0% variance in medical error reporting practices.

CONCLUSIONS

The study found that Jordanian nurses have low perceptions of their work environment and medical error reporting practices, which are influenced by marital status and hospital type. Enhancing the nurse work environment and providing ongoing standards training are critical for improving safety behaviours, patient outcomes and care quality. Future research should investigate the long-term consequences of interventions on reporting practices and patient outcomes.

Comparison of the effects of medication error encouragement training and problem-based scenario on the medication safety competence and knowledge of nursing students: A quasi-experimental study

BACKGROUND

Medication errors among nursing students pose a threat to medication safety. Medication Error Encouragement Training and Problem Based Scenario are two innovative educational methods used in medication education.

AIM

Compare the effects of Medication Error Encouragement Training and Problem Based Scenario on the knowledge and competency of medication safety among nursing students.

DESIGN

Quasi -experimental, double-blind, two-group pretest-posttest study.

METHOD

This study was conducted in 2023. Participants were randomly assigned to two groups: one group received the Medication Error Encouragement Training method, while the other group was taught using the Problem-Based Scenario method. Data collection was performed using the Medication Safety Critical Element Checklist and Medication Safety Knowledge Assessment before and four weeks after the intervention. Data analysis was conducted using SPSS version 16.

RESULTS

The Pair t-test demonstrated that the change in competency and knowledge scores of medication safety before and after the intervention was significant in both groups (P< 0.05). The results of the Mancova test indicated a significant increase in medication safety competency scores in the Medication Error Encouragement Training group compared with the Problem Based Scenario group after the intervention (P< 0.05), while there was no significant difference in medication safety knowledge scores between the two groups after the intervention (P> 0.05).

CONCLUSION

The Medication Error Encouragement and Problem Based Scenario methods were effective in increasing the knowledge and competency of medication safety among students, but the effectiveness of the Medication Error Encouragement method was more pronounced in achieving safe medication administration.

Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System

BACKGROUND

Local institutional guidelines and order sets were updated in June 2023 to recommend first-line cefoxitin monotherapy for the treatment of intra-amniotic infections (IAIs) and endometritis. This study evaluated the clinical impact of this change.

METHODS

This was a retrospective, observational cohort study in an 11-campus health system comparing clinical outcomes of patients with chorioamnionitis, endometritis, or septic abortion receiving intravenous antimicrobial therapy before and after implementation of first-line cefoxitin monotherapy recommendations for the treatment of these infections. Primary outcome was a composite of serious clinical events postdelivery (ie, intensive care unit admission, death, hospital readmission related to IAI or endometritis within 30 days, additional surgery or procedures, or deep surgical site infection). Baseline characteristics between the pre- and post-cefoxitin groups were compared via Student's t tests for continuous variables and chi-square tests for categorical variables. Outcomes were evaluated via generalized linear modeling.

RESULTS

A total of 472 patients were enrolled, 350 (74%) in the pre-cefoxitin group and 122 (26%) in the post-cefoxitin group. Groups were significantly different by race, healthcare payor, and hospital campus. Cefoxitin was rarely used in the pre-cefoxitin group (n = 2, <0.1%) and commonly used in the post-cefoxitin group (n = 112, 91.8%). After controlling for group differences, odds of experiencing serious clinical event postdelivery in the post-cefoxitin group were noninferior to those in the pre-cefoxitin group (adjusted odds ratio, .37; 95% CI, .17-.76; P = .010).

CONCLUSIONS

Local institutional guidelines with predominant use of cefoxitin therapy were noninferior to traditional antimicrobial therapy regimens for the treatment of IAI.

Predisposing Factors to Medication Errors by Nurses and Prevention Strategies: A Scoping Review of Recent Literature

Medication errors have serious consequences and high costs for the patient and the system. The treatment process and the care required for critically ill patients are complex, and these patients are more vulnerable to errors and potential consequences. A scoping review using the JBI methodology was conducted across PubMed, CINAHL, and MEDLINE databases and reported by the PRISMA-ScR guidelines to explore strategies that can mitigate medication errors by nurses. The search strategy focused on references published between January 2012 and April 2023. Sixteen studies were included, and the results were organized into thematic areas. Medication errors by nurses are in the areas of preparation, administration, and documentation; organizational, system-related, procedural, personal, and knowledge and training factors are predisposing factors for errors; educational intervention, verification and safety methods, organizational changes, and error reporting are the strategic areas to mitigate medication error. The organization of the data could be different, as it depends on the reviewers' experience. Knowledge of the factors that cause medication errors and interventions to mitigate them make it possible to outline strategies to minimize their occurrence and achieve health gains. The protocol preceding this review has been registered in the Open Science Framework and published.

Prescription Precision: A Comprehensive Review of Intelligent Prescription Systems

Intelligent Prescription Systems (IPS) represent a promising frontier in healthcare, offering the potential to optimize medication selection, dosing, and monitoring tailored to individual patient needs. This comprehensive review explores the current landscape of IPS, encompassing various technological approaches, applications, benefits, and challenges. IPS leverages advanced computational algorithms, machine learning techniques, and big data analytics to analyze patient-specific factors, such as medical history, genetic makeup, biomarkers, and lifestyle variables. By integrating this information with evidence-based guidelines, clinical decision support systems, and real-time patient data, IPS generates personalized treatment recommendations that enhance therapeutic outcomes while minimizing adverse effects and drug interactions. Key components of IPS include predictive modeling, drug-drug interaction detection, adverse event prediction, dose optimization, and medication adherence monitoring. These systems offer clinicians invaluable decision-support tools to navigate the complexities of medication management, particularly in the context of polypharmacy and chronic disease management. While IPS holds immense promise for improving patient care and reducing healthcare costs, several challenges must be addressed. These include data privacy and security concerns, interoperability issues, integration with existing electronic health record systems, and clinician adoption barriers. Additionally, the regulatory landscape surrounding IPS requires clarification to ensure compliance with evolving healthcare regulations. Despite these challenges, the rapid advancements in artificial intelligence, data analytics, and digital health technologies are driving the continued evolution and adoption of IPS. As precision medicine gains momentum, IPS is poised to play a central role in revolutionizing medication management, ultimately leading to more effective, personalized, and patient-centric healthcare delivery.

Investigation of Nurses' Wellbeing towards Errors in Clinical Practice-The Role of Resilience

Background and Objectives: The fatigue, stress, and burnout of nurses lead to them frequently making mistakes, which have a negative impact not only on the safety of the patients but also on their psychology. The ability to bounce back from mistakes is crucial for nurses. Nursing staff members' physical and mental health, particularly their depression, is far from ideal, and this ill health is directly correlated with the frequency of self-reported medical errors. The nurses' mental and physical health are also positively correlated with their perception of wellness support at work. This cross-sectional study aimed to investigate the status of nurses' mental and physical health regarding clinical errors and the impact of resilience on coping with these situations. Materials and Methods: A total of 364 healthcare professionals participated in this research; 87.5% of them were females and 12.5% of them were males. Most of the participants were 22-35 years old. The median number of years of employment was nine. Clinical nurses anonymously and voluntarily completed a special structured questionnaire that included questions from different validated tools in order to assess their state of physical and mental wellbeing after events of stress and errors made during their practice. Results: In total, 49.4% of the nurses had made an error on their own, and 73.2% had witnessed an error that someone else had made. At the time of the error, 29.9% of the participants were in charge of more than 20 patients, while 28.9% were responsible for a maximum of three patients. Participants who were 36-45 years old had more resilience (p = 0.049) and experienced fewer negative emotions than participants who were 22-35 years old. The participants who mentioned more positive feelings according to their mental state had greater resilience (p > 0.001). Conclusions: Errors were likely to happen during clinical practice due to nurses' negative experiences. The level of resilience among the nursing population was found to play a very important role not only in making mistakes but also in coping with errors during their daily routine. Wellness and prevention must be given top priority in all healthcare systems across the country in order to promote nurses' optimal health and wellbeing, raise the standard of care, and reduce the likelihood of expensive, avoidable medical errors. Healthcare administrations should promote prevention programs for stress occurrence in order to support nurses' wellbeing maintenance.

Interventions to Minimize Medication Error by Nurses in Intensive Care: A Scoping Review Protocol

Medication errors represent a concern for healthcare organizations due to their negative consequences. In the nursing context, these errors represent a threat to the quality of care and patient safety. Many factors have been identified as potential causes for these errors in intensive care units. A scoping review will be developed to identify interventions/strategies to minimize the occurrence of medication errors by nurses, considering the Joanna Briggs Institute (JBI) methodology. A search will be conducted in the EbscoHost (CINAHL Complete and MEDLINE), Embase and PubMed databases. Data analysis, extraction and synthesis will be carried out by two reviewers independently. This review will attempt to map which interventions are more specific to minimizing medication error by nurses in intensive care and to recognize which factors influence this type of error to mitigate practices that may lead to error. This protocol acts as the framework for a scoping review in the strategy to map the interventions and which factors contribute to the medication error by intensive care nurses. This study was prospectively registered with the Open Science Framework on 21 April 2023 with registration number DOI 10.17605/OSF.IO/94KH3.

Awareness of reporting practices and barriers to incident reporting among nurses

BACKGROUND

Adequate incident reporting practices for clinical incident among nurses and even all healthcare providers in clinical practice settings is crucial to enhance patient safety and improve the quality of care delivery. This study aimed to investigate the level of awareness of incident reporting practices and identify the barriers that impact incident reporting among Jordanian nurses.

METHODS

A descriptive design using a cross-sectional survey was employed among 308 nurses in 15 different hospitals in Jordan. Data collection was conducted between November 2019 and July 2020 using an Incident Reporting Scale.

RESULTS

The participants showed a high level of awareness of the incident reporting with a mean score of 7.3 (SD = 2.5), representing 94.8% of the highest score. Nurses perceived their reporting practices at the medium level, with a mean score of 2.23 out of 4. The main reporting barriers included worrying about disciplinary actions, fearing being blamed, and forgetting to make a report. In regard to awareness of incident reporting, there were statistically significant differences in the mean for total awareness of the incident reporting system scores according to the type of hospital (p < .005*). In regard to self-perceived reporting practices, nurses working in accredited hospitals demonstrated statistically significant differences in self-perceived reporting practices (t = 0.62, p < .005).

CONCLUSIONS

The current results provide empirical results about perceived incident reporting practices and perceived barriers to reporting frequently. Recommendations are made to urge nursing policymakers and legislators to provide solutions for those barriers, such as managing staffing issues, nursing shortage, nurses' empowerment, and fear of disciplinary actions by front-line nurse managers.

Nurses’ knowledge regarding children antibiotic use and resistance in Jordan: A cross-sectional study

<b>Purpose: </b>This study aimed at examining nurses’ knowledge, attitudes, and practices related to antibiotics use and resistance. A second objective was to identify Jordanian nurses’ sources of information about antibiotics.<br /> <b>Method: </b>A cross-sectional design was used for this study. Nurses (n=594) completed an online survey using Google Forms. Google Forms web link was distributed on Facebook, LinkedIn, Twitter, and other social media applications. The study included Jordanian nurses who worked in hospitals<b> </b>and healthcare institutions. the European Center for Diseases Control and Prevention survey was used that took about 15 minutes to complete.<br /> <b>Results: </b>According to the study, 48.2% of nurses prescribed antibiotics to patients daily or multiple times per day in the previous week; 13.3% of nurses offered support for daily or more frequent antibacterial drug use or infection control; and 42.3% of nurses mentioned they did not give antibiotics advice because they did not have a leaflet about their use and because the patients did not receive one.<br /> <b>Conclusion: </b>The study found that<b> </b>the most reported source for antibiotics information was Facebook and Instagram. Nurses need further education on proper use of antibiotics. Antimicrobial stewardship can benefit from the study findings, which can help develop interventions to improve antibiotics proper use.

Nurses’ knowledge, motivation, behaviors, and information sources on antibiotic use and resistance in Jordan

<b>Aim:</b> This study aims to examine the nurse knowledge, motivation, and behavior about antibiotics and antibiotic resistance. A secondary objective was to study the preferred information sources used by Jordanian nurses, as well as their knowledge of the information available to promote rational prescription practices in the Jordanian health system.<b> </b><br /> <b>Method: </b>The study was cross-sectional in design and nurses (n=1,093) completed an online survey using Google Forms. Participation in the study was completely optional, and participants were free to drop out at any point. During the months of February-May 2022, nurses were asked to participate in a survey<br /> <b>Results:</b> The study found 48.2% of nurses given prescribed antibiotics to the patients daily or multiple times a day in the preceding week; 13.3% of nurses provided support on daily or more frequent antibacterial drugs use or infection management. The reason for not giving advice regarding antibiotics were no leaflet regarding the use of the antibiotics (42.3%) and the patients do not get attention for the information (30.4%).<br /> <b>Conclusion:</b> In conclusion, the findings of this study show that public health actions are needed (e.g., educational or communication campaigns). Nurses must be educated on the proper use of antibiotics and the emergence of antibiotic resistance. Antibiotic stewardship can benefit from the findings, which can be used to develop interventions aimed at improving antibiotic usage.

Exploring the relationship between nursing work environment and medical error reporting among Jordanian nurses: a cross-sectional study

Objectives

This study was conducted to explore the relationship between the nursing work environment and medical error reporting practices among Jordanian nurses.

Methods

This study was a cross-sectional survey of 334 participants who were conveniently selected from three types of hospitals (private, teaching and public) in Amman city, Jordan. The data were collected using a standardized questionnaire which was adopted from previous studies and consisted of three main sections including demographics, nursing work environment (The Practice Environment Scale-Nursing Work Index) and medical error reporting practices (incident reporting practice scale). SPSS version 26 was used for data analysis.

Key findings

The study findings detected a strong positive relationship between the nursing work environment and medical error reporting practices. ‘Nurse’s participation in hospital affairs’ showed the highest impact on medical error reporting practices among nurses. Based on the regression model, the nursing work environment explained 65.1% of variations in nurses’ medical error reporting practices. It was found that medical error reporting practices were statistically different across marital status and hospital type.

Conclusions

Based on data analysis findings, the nursing work environment was statistically strongly correlated to medical error reporting practices. To improve medical error reporting practices among nurses, decision-makers and hospital administrators should redesign their nursing work environment to create a more positive and favourable work environment.

Factors causing medication errors in an electronic reporting system

Aim

To analyse medication error data from a hospital's electronic reporting system and identify the factors affecting error types and harmfulness.

Design

A retrospective study.

Methods

The 805 near misses and adverse events reported to the hospital's electronic reporting system between January 2014 and December 2018 were analysed using descriptive statistics, chi‐square tests and logistic regression analyses.

Results

A total of 632 near misses and 173 adverse events were reported. Near misses and adverse events were the most common error type during the dispensing stage and medication administration, respectively. The odds of medication errors reported by nurses with 1–9 years of clinical experience were relatively low. After adjusting for confounders, the odds of medication errors directly observed by nurses were 65% lower than the odds of medication errors not directly detected. In clinical practice, nurses must be educated about errors in reporting depending on their degree of clinical experience.