Using algorithms to teach dosage calculation

Characteristics of medication errors made by students during the administration phase: a descriptive study

Faculty concentrate on teaching nursing students about safe medication administration practices and on challenging them to develop skills for calculating drug dose and intravenous flow rate problems. In spite of these efforts, students make medication errors and little is known about the attributes of these errors. Therefore, this descriptive, retrospective, secondary analysis study examined the characteristics of medication errors made by nursing students during the administration phase of the medication use process as reported to the MEDMARX, a database operated by the United States Pharmacopeia through the Patient Safety Program. Fewer than 3% of 1,305 student-made medication errors occurring in the administration process resulted in patient harm. Most were omission errors, followed by errors of giving the wrong dose (amount) of a drug. The most prevalent cause of the errors was students' performance deficits, whereas inexperience and distractions were leading contributing factors. The antimicrobial therapeutic class of drugs and the 10 subcategories within this class were the most commonly reported medications involved. Insulin was the highest-frequency single medication reported. Overall, this study shows that students' administration errors may be more frequent than suspected. Faculty might consider curriculum revisions that incorporate medication use safety throughout each course in nursing major courses.

Numeracy needs of the beginning registered nurse

The literature indicates: Nursing students demonstrate serious numeracy skills deficits. Consensus that such skills are necessary, particularly for medication administration. Diagnostic testing and remediation are desirable, or basic mathematics is pre-requisite for entry into nursing courses. Calculation skills mastered at one point in time diminish if ongoing practise is not maintained. The frequency with which nurses perform drug calculation in the clinical setting is decreasing. This study aimed to identify and analyze numeracy skills required by beginning registered nurses to facilitate development of numeracy skills by nursing students. A convenience sample of metropolitan and rural health care facilities in New South Wales (NSW) was selected. Within each facility an area where nursing graduates customarily work was selected. Numeracy input required to complete patients' charts was identified. Additional counting, measuring or computation the nurses performed was also identified. Except for paediatric areas, the frequency with which a nurse has to perform other than a simple calculation in order to administer a medication, or calculate a per minute drip rate is low. However, the necessity to calculate drug doses does exist. Creative ideas are needed to enable nurses to do this accurately. Three general approaches are suggested. A number of recommendations are presented.