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Smith NT, Muller Spiti J, Padley J, Davies E. Mapping simulation-based activities for health professionals in rural and remote contexts in high-income countries: a scoping review protocol. JBI Evid Synth 2024; 22:1636-1644. [PMID: 38655637 PMCID: PMC11321600 DOI: 10.11124/jbies-23-00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This scoping review will aim to map the existing academic literature on simulation-based activities that are designed with and delivered for health professionals in geographically rural and remote contexts in high-income countries. INTRODUCTION Simulation-based health care activities are implemented in health services to increase patient safety because they allow health professionals to prepare, learn, practice, rehearse, and improve clinical performance and teamwork. Simulation-based activities are increasingly being used in rural and remote areas, where resources are limited compared with metropolitan areas. INCLUSION CRITERIA This review will include all primary and peer-reviewed research articles and abstracts that report health simulation methodologies and activities that have been used in rural and remote health care contexts in high-income countries. METHODS The proposed review will follow the JBI guidelines for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. Databases to be searched will include Embase, Emcare, and MEDLINE (all searched via Ovid), Scopus, PubMed, and the Cochrane Database. Titles and abstracts will be screened independently by 2 reviewers, followed by full-text screening. Data will be extracted and analyzed to address the review questions. REVIEW REGISTRATION Open Science Framework https://osf.io/pu6gv.
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Affiliation(s)
- Naomi Tarus Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Julia Muller Spiti
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - James Padley
- Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Ellen Davies
- Adelaide Health Simulation, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Bokka L, Ciuffo F, Clapper TC. Why Simulation Matters: A Systematic Review on Medical Errors Occurring During Simulated Health Care. J Patient Saf 2024; 20:110-118. [PMID: 38126804 DOI: 10.1097/pts.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Over the past decade, the implementation of simulation education in health care has increased exponentially. Simulation-based education allows learners to practice patient care in a controlled, psychologically safe environment without the risk of harming a patient. Facilitators may identify medical errors during instruction, aiding in developing targeted education programs leading to improved patient safety. However, medical errors that occur during simulated health care may not be reported broadly in the simulation literature. OBJECTIVE The aim of the study is to identify and categorize the type and frequency of reported medical errors in healthcare simulation. METHODS Systematic review using search engines, PubMed/MEDLINE, CINAHL, and SCOPUS from 2000 to 2020, using the terms "healthcare simulation" AND "medical error." Inclusion was based on reported primary research of medical errors occurring during simulated health care. Reported errors were classified as errors of commission, omission, systems related, or communication related. RESULTS Of the 1105 articles screened, only 20 articles met inclusion criteria. Errors of commission were the most reported (17/20), followed by systems-related errors (13/20), and errors of omission (12/20). Only 7 articles reported errors attributed to communication. Authors in 16 articles reported more than one type of error. CONCLUSIONS Simulationists and patient safety advocates must continually identify systems-related errors and training deficits that can lead to inaction, improper action, and poor communication. Recent dialogs in the simulation community have also underscored the potential benefits of developing a registry of errors across simulation centers, with a goal of aggregating, analyzing, and disseminating insights from various simulation exercises.
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Affiliation(s)
- Leshya Bokka
- From the Weill Cornell Medicine, New York, New York
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Richard O, Jollant F, Billon G, Attoe C, Vodovar D, Piot MA. Simulation training in suicide risk assessment and intervention: a systematic review and meta-analysis. MEDICAL EDUCATION ONLINE 2023; 28:2199469. [PMID: 37073473 PMCID: PMC10120456 DOI: 10.1080/10872981.2023.2199469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Suicide is a major cause of preventable death worldwide. Adequate training in risk assessment and intervention is key to suicide prevention. The use of simulation (role plays, simulated patients, virtual reality…) for practical training is a promising tool in mental health. The purpose of this study was to assess the effectiveness of simulation training in suicide risk assessment and intervention for healthcare professionals and gatekeepers. METHODS We conducted a systematic review in Medline and PsycINFO up to 31 July 2021 of randomized controlled trials (RCTs), non-randomized controlled trials, and pre/post-test studies. RCTs were furthermore included in a meta-analysis. We assessed the methodological quality of all studies with the Medical Education Research Study Quality Instrument, and the Cochrane Risk of Bias tool 2.0 for RCTs. Primary outcomes were changes in Kirkpatrick criteria: attitudes, skills, knowledge, behaviors, and patient outcomes. RESULTS We included 96 articles representing 43,656 participants. Most pre/post-test (n = 65) and non-randomized controlled (n = 14) studies showed significant improvement in attitudes, skills, knowledge, and behaviors. The meta-analysis of 11 RCTs showed positive changes in attitudes immediately after training and at 2-4 months post-training; in self-perceived skills at 6 months post-training; but not in factual knowledge. Studies assessing benefits for patients are still limited. CONCLUSIONS The heterogeneity of methodological designs, interventions, and trained populations combined with a limited number of RCTs and studies on patients' outcomes limit the strength of the evidence. However, preliminary findings suggest that simulation is promising for practical training in suicidal crisis intervention and should be further studied.
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Affiliation(s)
- Océane Richard
- Department of child and adolescent psychiatry,Université Paris Cité, AP-HP, Academic Hospital Necker-Enfants Malades, Reference center for autism and learning disorders, Paris, France
| | - Fabrice Jollant
- Department of psychiatry, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France; Department of psychiatry, CHU Nimes, Nimes, France; Department of Psychiatry, School of Medicine, Paris-Saclay University, le Kremlin-Bicêtre, France; McGill University, McGill Group for Suicide Studies, Montreal, Canada; Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
| | - Grégoire Billon
- Mental helath simulation center, Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Attoe
- Mental helath simulation center, Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominique Vodovar
- Université Paris Cité, UFR de médecine, 75010 Paris; UMRS 1144, Faculté de pharmacie, 75006 Paris; Centre AntiPoison de Paris, Paris
| | - Marie-Aude Piot
- Department of child and adolescent psychiatry, Université Paris Cité, AP-HP, Academic Hospital Necker-Enfants Malades Reference center for autism and learning disorders; Ilumens, Simulation Center; Paris-Saclay University, Paris, France
- CONTACT Marie-Aude Piot Department of child and adolescent psychiatry, Academic Hospital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
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Hussain T, Namvar S, Jones M. Authentic Pathology Specimen Reception: A Valuable Resource for Developing Biomedical Science Student Competencies and Employability. Br J Biomed Sci 2023; 80:11731. [PMID: 37818106 PMCID: PMC10561093 DOI: 10.3389/bjbs.2023.11731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023]
Abstract
Background/Introduction: The pathology specimen reception is fundamental to the services provided by Biomedical Science laboratories worldwide. To ensure patient safety and that samples are of adequate quality to send for analysis, prospective Biomedical Scientists should have a robust knowledge of the processes involved and the acceptance criteria of the pathology specimen reception. This knowledge has been highlighted by employers as a current gap in Biomedical Science graduates and therefore needs to be addressed within higher education settings. To do this, this study aimed to 1) design a practical session to simulate the key processes of the pathology specimen reception and 2) to understand Biomedical Science students' opinions on these activities and the development of transferable skills required for post-graduate employment. Methods: The practical session was designed based on industrial requirements and academic knowledge of student skill sets to ensure suitability. Qualitative information regarding participant demographics and career interests was acquired through open-answer or multiple-choice questions. Quantitative student feedback was acquired via questionnaires utilising a 5-point Likert scale (n = 77). Results: The scenario-based practical session provided students with a positive learning experience with 98.7% of participants enjoying the session, with 87.0% stating they learned a lot by completing the session. It was also identified that participants preferred this style of learning to that of conventional higher education teaching modalities with 97.4% stating they would prefer simulated employment focussed scenarios embedded into the curriculum more often. The majority of participants also thought this session was helpful for the development of their key transferrable skills including teamworking, communication, and confidence. When stratified based on demographic data, there was minimal difference between cohorts and in the majority of cases, those participants from non-traditional university entry backgrounds had a more positive experience and better transferable skill development following the completion of this style of learning experience. Conclusion: This study highlights simulation-based learning as a tool to develop core Biomedical Science knowledge, build student graduate capital, and ensure the preparedness of students for post-graduation employment.
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Affiliation(s)
- T. Hussain
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
| | - S. Namvar
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Biomedical Research Centre, School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - M. Jones
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Biomedical Research Centre, School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
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Syyrilä T, Vehviläinen-Julkunen K, Mikkonen S, Härkänen M. Measuring health professionals' perceptions of communication contributing to medication incidents in hospitals - scale development and primary results of weekly perceived communication challenges. BMC Nurs 2023; 22:285. [PMID: 37626368 PMCID: PMC10463788 DOI: 10.1186/s12912-023-01455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Communication challenges are one of the main contributors for medication incidents in hospitals, but health professionals' perceptions about variety of the contributing communication factors and the factors' occurrence frequencies are studied little. This cross-sectional descriptive study aimed to (1) operationalize a literature-based framework into a scale for measuring health professionals' perceptions of communication factors, which contribute to medication incidents either directly or indirectly in hospitals, (2) to measure the construct validity and internal consistency of the scale and (3) to describe the primary results of the measured weekly perceived communication challenges. METHODS The structured online questionnaire with 82 communication related items was developed based on a framework in literature. A content validity index of expert panelists' answers was used for item reduction. Data was collected between November 1st, 2019, and January 31st, 2020, by convenience sampling. The study sample (n = 303) included multiple health professional groups in diverse specialties, unit types and organizational levels in two specialized university hospital districts in Finland. Exploratory factor analysis with Maximum Likelihood method and Oblique rotation produced a six factors scale consisting of 57 items and having acceptable construct validity and internal consistency. RESULTS The six communication factors contributing to medication incidents concerned (1) medication prescriptions, (2) guidelines and reporting, (3) patient and family, (4) guideline implementation,5) competencies and responsibilities, and 6) attitude and atmosphere. The most frequently perceived communication challenges belonged to the Medication prescription related factor. Detailed item frequencies suggested that the most usual weekly challenges were: (1) lack or unclarity of communication about medication prescriptions, (2) missing the prescriptions which were written outside of the regular physician-ward-rounds and (3) digital software restricting information transfer. CONCLUSIONS The scale can be used for determining the most frequent detailed communication challenges. Confirmatory factor analysis of the scale is needed with a new sample for the scale validation. The weekly perceived communication challenges suggest that interventions are needed to standardize prescribing documentation and to strengthen communication about prescriptions given outside of regular ward-rounds.
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Affiliation(s)
- Tiina Syyrilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
- Kuopio University Hospital (KUH), Kuopio, Finland
| | - Santtu Mikkonen
- Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), Kuopio, Finland
- Department of Technical Physics, Faculty of Science, Forestry and Technology, University of Eastern Finland (UEF), Kuopio, Finland
| | - Marja Härkänen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland (UEF), PO Box 1627, Kuopio, 70211, Finland
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Bejani M, Taghizadieh A, Samad‐Soltani T, Asadzadeh A, Rezaei‐Hachesu P. The effects of virtual reality-based bronchoscopy simulator on learning outcomes of medical trainees: A systematic review. Health Sci Rep 2023; 6:e1398. [PMID: 37415680 PMCID: PMC10320745 DOI: 10.1002/hsr2.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Background and Aims Conventional medical training routes of bronchoscopy may decrease patients' comfort and increase procedure-related morbidity. Virtual reality (VR)-based bronchoscopy is a beneficial and safe solution for teaching trainees. The aim of this systematic review was to study the effectiveness of VR-based bronchoscopy simulators on the learning outcomes of medical trainees. Methods Well-known sources (i.e., Scopus, ISI Web of Science, and Medline via PubMed) were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on December, 2021. Peer-reviewed English papers that used VR-based simulation for bronchoscopy training were included. The articles that were studying other technologies, or those that were unrelated to the topic, were excluded. The risk of bias was assessed using the Joanna Briggs Institute checklists for quasi-experimental studies and randomized controlled trials (RCTs). Results Out of 343 studies, 8 of them met our inclusion criteria. An appropriate control group and statistical analysis were the most common and unavoidable sources of bias in included non-RCTs, and lack of blinding in participants was the most common source of bias in RCTs. The included studies evaluated learning outcomes regarding dexterity (N = 5), speed (N = 3), the accuracy of procedures (N = 1), and the need for verbal assistance (N = 1). Based on the results, 100% (5/5) and 66% (2/3) of studies showed that the use of VR-based simulation on the learning outcomes of medical trainees led to improvement in manual ability (i.e., dexterity) and swiftness of execution (i.e., speed in performance), respectively. Additionally, improving the accuracy of subjects' performance, and reducing the need for verbal guidance and physical assistance was reported in studies that evaluated these variables. Conclusion VR bronchoscopy simulator as a training method for teaching medical trainees, especially for novices has the potential to improve medical trainees' performance and reduce complications. Further studies are needed to evaluate the positive effects of VR-based simulation on the learning outcomes of medical trainees.
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Affiliation(s)
- Mahmud Bejani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Ali Taghizadieh
- Department of Emergency Medicine, Tuberculosis and Lung Research Center, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Afsoon Asadzadeh
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Peyman Rezaei‐Hachesu
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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Sharma KA, Murry LL, Bharti J, Kaur R, Meena J, Kulshrestha V, Mansoor S, Soni S, Kumar S. Blended Teaching Methodology of E-learning and Simulation Training in Obstetrics and Gynecology for Undergraduate Medical and Nursing Trainees. Cureus 2023; 15:e40062. [PMID: 37425568 PMCID: PMC10325928 DOI: 10.7759/cureus.40062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Context The concept of simulation-based teaching has become a standard practice for health education in the present era. However, there is a paucity of literature on integrating simulation-based teaching in the conventional training of undergraduate medical and nursing students. Aim To explore the effectiveness and benefits of e-learning along with low-fidelity simulation in obstetrics and gynecology among undergraduate medical and nursing students at a tertiary care center in India. Methodology It was a prospective study conducted on 53 final-year undergraduate medical students and 61 final-year undergraduate nursing students. All students underwent a knowledge-based pre-test followed by exposure to an e-learning module on four selected obstetrics and gynecology skills, namely, conducting normal delivery, episiotomy suturing, pelvic examination, and insertion of intrauterine device. Students practiced these four skills on low-fidelity simulators. After this, they underwent a post-test assessment and gave feedback. A focused group discussion was conducted to explore their experiences. Results There was a statistically significant difference between the pre-test and post-test knowledge scores of all the students (p =< 0.001). Students found this teaching strategy useful and reported an increase in self-assessed confidence. Focused group discussion revealed various themes like improved satisfaction and ability to practice repeatedly without fear of harming patients. Conclusions Based on the results, this teaching methodology should be integrated as an adjunct method of teaching in the undergraduate curriculum from the first year itself, which will motivate students to participate in clinical care and will result in quality improvement of health care.
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Affiliation(s)
- K Aparna Sharma
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - L Levis Murry
- College of Nursing, All India Institute of Medical Sciences, New Delhi, IND
| | - Juhi Bharti
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Jyoti Meena
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Vidushi Kulshrestha
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sadia Mansoor
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Snigdha Soni
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sunesh Kumar
- Gynaecological Oncology, All India Institute of Medical Sciences, New Delhi, IND
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Aljuffali LA, Alnaim L, Alfakhri A, Alrasheed HH, Alkherb Z, Almalag HM. Assessing Nontechnical Skills in Senior Pharmacy Students Using an Innovative Simulation Setting. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100047. [PMID: 37288687 DOI: 10.1016/j.ajpe.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 11/21/2022] [Accepted: 12/02/2022] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate pharmacy students' nontechnical skills in a simulated session by assessing their teamwork skills and ability to identify patient safety priorities. METHODS This study involved 2 phases. Phase I was a simulated case with a total of 23 errors. Students were divided into groups and instructed to identify errors in the setting. Teamwork skills were assessed using the Individual Teamwork Observation and Feedback Tool. Phase II was a debriefing and reflection session. Quantitative data were generated using the number of errors and Individual Teamwork Observation and Feedback Tool domain scores, while qualitative data were obtained using thematic analysis. RESULTS The study participants were 78 female PharmD students who were divided into 26 groups. The average number of errors identified was 8 (range: 4-13), and the most identified error was using the wrong drug (96%). The teamwork skills displayed by most groups were shared decision-making, participating in discussions, and demonstrating respect and leadership in ways that were sensitive to the needs of the team. The students described the activity as fun and novel as it encouraged them to be more detail oriented. CONCLUSION The designed simulation setting is an innovative tool to assess students' understanding of patient safety priorities and teamwork skills.
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Affiliation(s)
- Lobna A Aljuffali
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia.
| | - Lamya Alnaim
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | | | - Hala H Alrasheed
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | | | - Haya M Almalag
- Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
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Pook CJ, Kirkman M, Simmonds S, Adam S, Haas-Heger T. Maximising preparedness from ward-based simulations: Healthcare students' perspectives. J Clin Nurs 2023; 32:1510-1511. [PMID: 34658097 DOI: 10.1111/jocn.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Celina J Pook
- GKT School of Medical Education, King's College London, London, UK
| | - Molly Kirkman
- GKT School of Medical Education, King's College London, London, UK
| | - Sophie Simmonds
- GKT School of Medical Education, King's College London, London, UK
| | - Suhaylah Adam
- GKT School of Medical Education, King's College London, London, UK
| | - Tabea Haas-Heger
- GKT School of Medical Education, King's College London, London, UK
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Nursing Students' Scenario Performance: Game Metrics in a Simulation Game. Nurs Educ Perspect 2023:00024776-990000000-00105. [PMID: 36881521 DOI: 10.1097/01.nep.0000000000001094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
AIM The purpose of this study was to examine nursing students' scenario performance in a simulation game by utilizing game metrics. BACKGROUND A significant advantage of simulation games is that they can store large amounts of data. Although game metrics enable the objective evaluation and analysis of performance, their use in the evaluation of students' performance is limited. METHOD Nursing students (N = 376) played a simulation game at home for 1 week. The resulting data consisted of game metrics stored in the game: number of playthroughs, mean scores, and mean playing times. RESULTS The total number of playthroughs was 1,923. Statistically significant differences were found between different scenarios regarding the mean score (p < .0001). Mean playing time was significantly associated with the mean score (p < .05). CONCLUSION Game metrics demonstrate nursing students' scenario performance in clinical reasoning skills in different scenarios in a simulation game.
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Budakoğlu Iİ, Coşkun Ö, Kıyak YS, Uluoğlu C. Teaching rational prescribing in undergraduate medical education: a systematic search and review. Eur J Clin Pharmacol 2023; 79:341-348. [PMID: 36622428 DOI: 10.1007/s00228-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education. METHODS This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching. RESULTS Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes. CONCLUSION The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported.
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Affiliation(s)
- Işıl İrem Budakoğlu
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey.
| | - Özlem Coşkun
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Yavuz Selim Kıyak
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Canan Uluoğlu
- Department of Medical Pharmacology, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
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Noviyanti LW, Junianto A, Ahsan A. A cross-sectional study of the knowledge, skills, and 6 rights on medication administration by nurses at emergency department. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: Medication errors occur when a patient is given the wrong drug or receives incorrect pharmacological therapy. Incorrect drug administration can cause fatal errors resulting in the patient’s death. Approximately 44,000-98,000 patients die each year due to medication errors and this condition is found often in the Emergency Room (ER) due to the complexity. Therefore, this study aims to analyze the relationship between nurses’ knowledge, skills, and 6 rights on medication at Emergency Department.
Design and Methods: This is an analytical observational study involving 70 nurses randomly selected using consecutive sampling and working at the ER department of Saiful Anwar Hospital Malang. Data were collected through a questionnaire and analyzed descriptively to determine the knowledge and skills of nurses and the implementation of the correct principles of medication administration.
Results: The results showed that most of the emergency room nurses had good knowledge and skills in applying the correct principles of medicine. However, the majority could not calculate the drug dose accurately. The spearman rank results showed that there was a relationship between knowledge and the 6 correct drug principles (p<0.001, α= 0,05; r = 0.491) with a percentage of 44%. This indicates that a higher knowledge results in the correct implementation of the drug. Similarly, there was a significant positive correlation between skills and proper medicine (p<0.001, α= 0,05; r = 0.378).
Conclusions: It can be inferred that a higher nurse’s knowledge and skill results in a better administration of medicine.
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Dutt H, Dean A, Kamal RS, Allan AL. Importance of Incorporating the Perspectives of People with Cancer into Oncology Education: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219394. [PMID: 38116493 PMCID: PMC10729629 DOI: 10.1177/23821205231219394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
Background With the shift towards person-centered care (PCC) in oncology, there is a need for parallel evolution of oncology education programs to prepare the next generation of health professionals to deliver effective PCC. These programs should be designed utilizing perspectives from individuals who have lived experience with cancer to ensure that changes to education curricula translate to improved PCC in the clinic. Objectives Our goal was to identify existing literature describing such programs as well as identify gaps for further development. Methods Keywords were agreed upon and searched across Ovid Medline, Ovid Embase, ERIC, Google Scholar, and MedEdPORTAL databases. Duplicates were removed, unique articles were screened for relevance by title and abstract, and a full text review of each article was completed for validation. Included articles describe methods for involving people with cancer in developing and/or delivering oncology-focused education programs. Results In total, 15 articles describing 12 unique oncology education programs from 7 different countries were identified, reviewed, and summarized. These programs involved learners undertaking undergraduate medical education, postgraduate medical education, continuing medical education, or training as nurses or radiation therapists. Current literature indicates that classroom-based sessions, experiential or simulated learning modalities, and/or asynchronous online modules can all feasibly be created with the integration of perspectives/narratives of people with cancer. Furthermore, involving people with cancer directly in the design and/or delivery of these education programs may contribute to improved patient experiences. Conclusions Including the perspectives of people with cancer directly in oncology curriculum development and delivery can improve established pedagogical approaches and enhance learner confidence and competency in delivering PCC. We provide recommendations for stepwise implementation of patient perspectives into oncology education, with the hope that future programs will better prepare and motivate learners to provide PCC aimed at improving cancer care, quality of life, and disease outcomes.
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Affiliation(s)
- Hanna Dutt
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Arleigh Dean
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rayyan Syed Kamal
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Alison L. Allan
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Department of Anatomy & Cell Biology, and Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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14
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Ahsani-Estahbanati E, Sergeevich Gordeev V, Doshmangir L. Interventions to reduce the incidence of medical error and its financial burden in health care systems: A systematic review of systematic reviews. Front Med (Lausanne) 2022; 9:875426. [PMID: 35966854 PMCID: PMC9363709 DOI: 10.3389/fmed.2022.875426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background and aim Improving health care quality and ensuring patient safety is impossible without addressing medical errors that adversely affect patient outcomes. Therefore, it is essential to correctly estimate the incidence rates and implement the most appropriate solutions to control and reduce medical errors. We identified such interventions. Methods We conducted a systematic review of systematic reviews by searching four databases (PubMed, Scopus, Ovid Medline, and Embase) until January 2021 to elicit interventions that have the potential to decrease medical errors. Two reviewers independently conducted data extraction and analyses. Results Seventysix systematic review papers were included in the study. We identified eight types of interventions based on medical error type classification: overall medical error, medication error, diagnostic error, patients fall, healthcare-associated infections, transfusion and testing errors, surgical error, and patient suicide. Most studies focused on medication error (66%) and were conducted in hospital settings (74%). Conclusions Despite a plethora of suggested interventions, patient safety has not significantly improved. Therefore, policymakers need to focus more on the implementation considerations of selected interventions.
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Affiliation(s)
- Ehsan Ahsani-Estahbanati
- Department of Health Policy and Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leila Doshmangir
- Department of Health Policy and Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Oxlad M, D’Annunzio J, Sawyer A, Paparo J. Postgraduate students’ perceptions of simulation-based learning in professional psychology training. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2073807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | | | - Alyssa Sawyer
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Josephine Paparo
- Department of Psychology, Macquarie University, Sydney, Australia
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16
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Maintaining Clinical Training Continuity during COVID-19 Pandemic: Nursing Students' Perceptions about Simulation-Based Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042180. [PMID: 35206368 PMCID: PMC8872332 DOI: 10.3390/ijerph19042180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
Background: Simulation-based learning (SBL) in nursing education is an innovative pedagogical approach that has significantly improved nursing education. Adopting SBL provides a controlled environment for meeting educational objectives without the risk of harm to real patients. Given that social distancing is required during the coronavirus disease (COVID-19) pandemic, SBL is a suitable alternative to clinical training for nursing students to learn and acquire the required clinical competencies. The study aimed to describe the effectiveness of SBL as a complete substitute for clinical experience from the perspective of students. This cross-sectional descriptive survey investigated students’ perceptions regarding the description of the effectiveness of SBL in four nursing colleges at four different universities across the Kingdom of Saudi Arabia. Settings: Four nursing colleges at four different universities across the Kingdom of Saudi Arabia. Participants included nursing students who attended simulation sessions. Data were collected by distributing a self-administrated online questionnaire, the Modified Simulation Effectiveness Tool (SET-M), which is a 19-item. Results: Approximately two-thirds of the participants were in their third (30.4%) and fourth (44.5%) academic year. The highest student presentation was for Site 1 (39.5%) and Site 2 (32.5%). Significant differences existed in all domains according to sex and university (p ≤ 0.001). There was a significant difference in relation to the level of agreement for pre-briefing, scenario, and debriefing domains (<0.001). Conclusions: SBL is a valuable teaching strategy that enhances nursing students’ self-awareness, self-confidence, clinical performance, and efficiency in performing procedures with considerable gender variation. Female students had more positive perceptions toward simulation effectiveness.
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Psychometric validity of the Arabic versions of the Simulation Design Scale, Educational Practices Questionnaire, and the Students Satisfaction and Self-Confidence in Learning Scale among Saudi nursing students. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Hawkins SF, Morse JM. Untenable Expectations: Nurses’ Work in the Context of Medication Administration, Error, and the Organization. Glob Qual Nurs Res 2022; 9:23333936221131779. [PMID: 36387044 PMCID: PMC9663611 DOI: 10.1177/23333936221131779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
We explored nurses’ work in the context of medication administration, errors, and the organization. Secondary analysis of ethnographic data included 92 hours of non-participant observation, and 37 unstructured interviews with nurses, administrators, and pharmacists. Think-aloud observations and analysis of institutional documents supplemented these data. Findings revealed the nature of nurses’ work was characterized by chasing a standard of care, prioritizing practice, and renegotiating routines. The rich description identified characteristics of nurses’ work as cyclical, chaotic and complex shattering studies that explained nurses’ work as linear. A new theoretical model was developed, illustrating the inseparability of nurses’ work from contextual contingencies and enhancing our understanding of the cascading components of work that result in days that spin out of the nurses’ control. These results deepen our understanding why present efforts targeting the reduction of medication errors may be ineffective and places administration accountable for the context in which medication errors occur.
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19
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Jones JR, Boltz M, Allen R, Van Haitsma K, Leslie D. Nursing students' risk perceptions related to medication administration error: A qualitative study. Nurse Educ Pract 2022; 58:103274. [PMID: 34922091 PMCID: PMC8792253 DOI: 10.1016/j.nepr.2021.103274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/03/2023]
Abstract
AIM The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university. BACKGROUND Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making. DESIGN This descriptive, exploratory study involved a qualitative design. METHODS A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted. RESULTS The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors. CONCLUSIONS The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.
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Affiliation(s)
- Joanne Roman Jones
- The Pennsylvania State University, College of Nursing, 120 Little
Branch Trail, Chapel Hill, NC 27517
| | - Marie Boltz
- Elouise Ross Eberly and Robert Eberly Endowed Chair, Professor of
Nursing, The Pennsylvania State University, College of Nursing, 306 Nursing
Sciences Building, University Park, PA 16802
| | - Rachel Allen
- Assistant Research Professor of Nursing, The Pennsylvania State
University, College of Nursing
| | | | - Douglas Leslie
- Professor and Vice Chair for Education, Department of Public Health
Sciences, Chief, Division of Health Services and Behavioral Research,
Professor, Department of Psychiatry and Behavioral Health, The Pennsylvania
State University
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20
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Ciapponi A, Fernandez Nievas SE, Seijo M, Rodríguez MB, Vietto V, García-Perdomo HA, Virgilio S, Fajreldines AV, Tost J, Rose CJ, Garcia-Elorrio E. Reducing medication errors for adults in hospital settings. Cochrane Database Syst Rev 2021; 11:CD009985. [PMID: 34822165 PMCID: PMC8614640 DOI: 10.1002/14651858.cd009985.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death. OBJECTIVES To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible. MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131). Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724). Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311). Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88). Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775). AUTHORS' CONCLUSIONS Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.
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Affiliation(s)
- Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Simon E Fernandez Nievas
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mariana Seijo
- Quality of Health Care and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belén Rodríguez
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Vietto
- Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Sacha Virgilio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana V Fajreldines
- Quality and Patient Safety, Austral University Hospital, Buenos Aires, Argentina
| | - Josep Tost
- Urgencias � Calidad y Seguridad de pacientes, Consorcio Sanitario de Terrassa, Barcelona, Spain
| | | | - Ezequiel Garcia-Elorrio
- Quality and Safety in Health Care, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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21
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The application of reusable learning objects (RLOs) in preparation for a simulation laboratory in medication management: An evaluative study. TEACHING AND LEARNING IN NURSING 2021. [DOI: 10.1016/j.teln.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Changuiti O, Moustarhfir N, Marfak A, Saad E, Hilali A, Youlyouz-Marfak I. Simulation Based-Learning from Simple to Complicated Clinical Situations for Midwifery Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:881-886. [PMID: 34408529 PMCID: PMC8366778 DOI: 10.2147/amep.s318560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/21/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE A health professional's learning curriculum should lead to the acquisition of technical and non-technical skills. This study aims at demonstrating the impact of simulation-based learning (SBL) experience on the learning of midwifery students. PATIENTS AND METHODS Using an experimental design, the experimental group (n=14) received pretest, high fidelity simulation, then a post-test. Whereas the control group (n=14) received pretest, revision of the theoretical course instead of simulation, post-test 1, high fidelity simulation, then a post-test 2. The first scenario was about a normal childbirth when the midwifery students were in their 2nd year. And then the second one was about immediate postpartum hemorrhage when the students moved to their 3rd year. RESULTS During the simulation sessions, the experimental group had a higher mean score in the post-test than the control group. This indicated that the simulation significantly (p<0.001) increased the students' knowledge. Also, for both eutocic and dystocic delivery simulation experiments, students obtained higher score in the second simulation sessions (19.69 and 19.4 for eutocic and dystocic, respectively) than in the first session (11.23 and 9.12 for eutocic and dystocic, respectively; p<0.0001). CONCLUSION These findings confirm that SBL offers an opportunity for learners to be immersed in an environment that is closer to reality, thus improving learning in a safe environment.
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Affiliation(s)
- Omaima Changuiti
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
| | - Nawar Moustarhfir
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
| | - Abdelghafour Marfak
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
- National School of Public Health, Rabat, 10000, Morocco
| | - Elmadani Saad
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
| | - Abderraouf Hilali
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
| | - Ibtissam Youlyouz-Marfak
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco
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23
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Ralston BH, Willett RC, Namperumal S, Brown NM, Walsh H, Muñoz RA, Del Castillo S, Chang TP, Yurasek GK. Use of Virtual Reality for Pediatric Cardiac Critical Care Simulation. Cureus 2021; 13:e15856. [PMID: 34327083 PMCID: PMC8301287 DOI: 10.7759/cureus.15856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/07/2022] Open
Abstract
Simulation is a key component of training in the pediatric cardiac intensive care unit (CICU), a complex environment that lends itself to virtual reality (VR)-based simulations. However, VR has not been previously described for this purpose. Two simulations were developed to test the use of VR in simulating pediatric CICU clinical scenarios, one simulating junctional ectopic tachycardia and low cardiac output syndrome, and the other simulating acute respiratory failure in a patient with suspected coronavirus disease 2019. Six attending pediatric cardiac critical care physicians were recruited to participate in the simulations as a pilot test of VR’s feasibility for educational and practice improvement efforts in this highly specialized clinical environment. All participants successfully navigated the VR environment and met the critical endpoints of the two clinical scenarios. Qualitative feedback was overall positive with some specific critiques regarding limited realism in some mechanical aspects of the simulation. This is the first described use of VR in pediatric cardiac critical care simulation.
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Affiliation(s)
- Bradford H Ralston
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Renee C Willett
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
| | | | - Nina M Brown
- Simulation Center, Children's National Hospital, Washington, DC, USA
| | - Heather Walsh
- Simulation Center, Children's National Hospital, Washington, DC, USA
| | - Ricardo A Muñoz
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
| | - Sylvia Del Castillo
- Cardiac Critical Care, Children's Hospital Los Angeles, Los Angeles, USA.,Critical Care Anesthesiology, Keck School of Medicine at University of Southern California, Los Angeles, USA
| | - Todd P Chang
- Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, USA.,Division of Emergency Medicine, Keck School of Medicine at University of Southern California, Los Angeles, USA
| | - Gregory K Yurasek
- Cardiac Critical Care, Children's National Hospital, Washington, DC, USA.,Division of Cardiac Critical Care, George Washington University, Washington, DC, USA
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Høghaug G, Skår R, Tran TN, Diep LM, Bredal IS. Three-month follow-up effects of a medication management program on nurses' knowledge. Nurse Educ Pract 2021; 51:102979. [PMID: 33588183 DOI: 10.1016/j.nepr.2021.102979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/21/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.
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Affiliation(s)
- Grete Høghaug
- Department of Medicine, Health and Development, Oslo University Hospital, Oslo, Norway.
| | - Randi Skår
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Thien Ngoc Tran
- Hospital Pharmacy Enterprises, South Eastern Norway, Norway.
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Oslo, Norway.
| | - Inger Schou Bredal
- Department of Oncology, Oslo University Hospital, Institute for Health and Society, University in Oslo, Norway.
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25
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Alrabadi N, Shawagfeh S, Haddad R, Mukattash T, Abuhammad S, Al-rabadi D, Abu Farha R, AlRabadi S, Al-Faouri I. Medication errors: a focus on nursing practice. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Objectives
Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.
Methods
A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.
Key findings
This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.
Conclusions
Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaima Shawagfeh
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Daher Al-rabadi
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Abu Farha
- Department of Pharmacology and Pharmacotherapy, Applied Science Private University, Amman, Jordan
| | - Suzan AlRabadi
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Ibrahim Al-Faouri
- Department of Nursing, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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Czerwińska-Jelonkiewicz K, Montero S, Bañeras J, Wood A, Zeid A, De Rosa S, Guerra F, Tica O, Serrano F, Bohm A, Ahrens I, Gierlotka M, Masip J, Bonnefoy E, Lettino M, Kirchhof P, Sionis A. Current status and needs for changes in critical care training: the voice of the young cardiologists. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:94-101. [PMID: 33580774 DOI: 10.1093/ehjacc/zuaa027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/03/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023]
Abstract
AIMS The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (<40 years) from ESC countries. METHODS AND RESULTS The survey (March-July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26-43) years old, 55% males were surveyed. Place and duration of acc training differed between countries and between centres in the same country. Although the majority of the respondents (91%) had completed their acc training, the average self-confidence to perform invasive procedures and to manage acc clinical scenarios was low-44% (27.3-70.4). The opportunities for simulation-based learning were scarce-18% (5.8-51.3), as it was previous leadership training (32%) and knowledge about key teamwork principles was poor (48%). The need for further acc training was high-81% (61.9-94.3). Male gender, higher level of training centres, professional qualifications of respondents, longer duration of acc/intensive care training, debriefings, and previous leadership training as well as knowledge about teamwork were related to higher self-confidence in all investigated aspects. CONCLUSIONS The current cardiology training program is burdened by deficits in acc technical/non-technical skills, substantial variability in programs across ESC countries, and a clear gender-related disparity in outcomes. The forthcoming ESC Core Curriculum for General Cardiology is expected to address these deficiencies.
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Affiliation(s)
- Katarzyna Czerwińska-Jelonkiewicz
- Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzinskiego 1, 30-705 Krakow, Poland.,Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, UB9 6JH, London, UK
| | - Santiago Montero
- Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Departament de Medicina, Universitat Autònoma de Barcelona, Plaça Cívica 08193 Bellaterra, Barcelona, Spain
| | - J Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 119, 08035 Barcelona, Spain
| | - A Wood
- University Hospital of Leicester, Leicester, LE3 9QP, UK
| | - A Zeid
- El Maamoura Chest Hospital-Cardiology Department, Alexandria, Egypt
| | - S De Rosa
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, 88100 Calabria, Italy
| | - F Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", 60121 Ancona Italy
| | - O Tica
- Faculty of Medicine and Pharmacy, Medical Discipline, University of Oradea, 1st of December Square, no 10, Oradea, Bihor County, Romania
| | - F Serrano
- The European Society of Cardiology, Sophia Antipolis, CS 80179 Biot, France
| | - A Bohm
- Department of Acute Cardiology, National Institute of Cardiovascular Diseases, 833 48 Bratislava 37, Slovakia
| | - I Ahrens
- Cardiology and Medical Intensive Care, Augustinerinnen Hospital, 50678 Cologne, Germany
| | - M Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, pl. Kopernika 11a 45-040 Opole, Poland
| | - J Masip
- Intensive Care Department, Consorci Sanitari Integral University of Barcelona, Barcelona, AVENIDA JOSEP MOLINS, 29 - 41 08906, Spain
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Cardiologic Hospital Louis Pradel, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - M Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Via Pegolesi 33 20900 Monza, Italy
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK.,University Heart and Vascular Center, UKE Hamburg, Martinistraße 52 20246, Hamburg, Germany
| | - A Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
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Koukourikos K, Tsaloglidou A, Kourkouta L, Papathanasiou IV, Iliadis C, Fratzana A, Panagiotou A. Simulation in Clinical Nursing Education. Acta Inform Med 2021; 29:15-20. [PMID: 34012208 PMCID: PMC8116070 DOI: 10.5455/aim.2021.29.15-20] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Simulation constitutes a teaching method and a strategy for learning and understanding theoretical knowledge and skills in the nursing and medical field. Objective: To review and present modern data related to this issue. Methods: Literature review of data related to the issue derived from Medline, Cinhal, and Scopus databases, in English, using the following keywords: nursing, simulation, simulator, nursing laboratory. Results: The implementation of simulation enables students to practice their clinical and decision-making skills for some significant issues they may face in their daily work. The protected environment and the sense of security enhance students’ self-esteem and confidence, thus promoting learning. In this way, the gap between theory and practice is substantially reduced. Conclusion: The further development of simulation, along with other instructional techniques, can significantly help the efforts made by the students to become integrated and successful healthcare professionals.
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Affiliation(s)
- Konstantinos Koukourikos
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece.,Nursing Department, University of Peloponnese, Tripoli, Greece
| | - Areti Tsaloglidou
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Lambrini Kourkouta
- Nursing Department, Alexander Campus, International Hellenic University, Thessaloniki, Greece
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Oñatibia-Astibia A, Malet-Larrea A, Mendizabal A, Valverde E, Larrañaga B, Gastelurrutia MÁ, Ezcurra M, Arbillaga L, Calvo B, Goyenechea E. The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach. Aten Primaria 2020; 53:43-50. [PMID: 32994060 PMCID: PMC7752972 DOI: 10.1016/j.aprim.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/14/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care. DESIGN Non-controlled before-and-after study. SETTING Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain. PARTICIPANTS The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking. OUTCOMES The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs. RESULTS The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n=152). The main GPs' decision was to withdraw the treatment (54.8%, n=125), which meant that the number of medicines per patient was reduced by 0.92 (9.12±3.82 vs. 8.20±3.81; p<.0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61±.13 vs 0.52±0.91; p=.405 and 0.17 (0.33±0.66 vs. 0.16±0.42; p=.007), respectively. The cost per patient was reduced by €444.9 (€1003.3±2165.3 vs. €558.4±1273.0; p=.018). CONCLUSION The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.
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Affiliation(s)
- Ainhoa Oñatibia-Astibia
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain; Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, P. Universidad 7, 01006 Vitoria, Spain.
| | - Amaia Malet-Larrea
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Amaia Mendizabal
- Primary Care Pharmacy, Bidasoa Integrated Healthcare Organisation (Osakidetza), Spain
| | - Elena Valverde
- Primary Care Pharmacy, Bidasoa Integrated Healthcare Organisation (Osakidetza), Spain
| | - Belen Larrañaga
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Miguel Ángel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
| | - Martín Ezcurra
- Martin Ezcurra Fernandez Pharmacy, Harmugarrieta 2, 20305 Irun, Spain
| | - Leire Arbillaga
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
| | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, P. Universidad 7, 01006 Vitoria, Spain
| | - Estibaliz Goyenechea
- Official Pharmacist Association of Gipuzkoa, Prim 2, 20006 Donostia/San Sebastian, Spain
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29
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Cicero MX, Adelgais K, Hoyle JD, Lyng JW, Harris M, Moore B, Gausche-Hill M. Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP. PREHOSP EMERG CARE 2020; 25:294-306. [PMID: 32644857 DOI: 10.1080/10903127.2020.1794085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Millions of patients receive medications in the Emergency Medical Services (EMS) setting annually, and dosing safety is critically important. The need for weight-based dosing in pediatric patients and variability in medication concentrations available in the EMS setting may require EMS providers to perform complex calculations to derive the appropriate dose to deliver. These factors can significantly increase the risk for harm when dose calculations are inaccurate or incorrect. METHODS We conducted a scoping review of the EMS, interfacility transport and emergency medicine literature regarding pediatric medication dosing safety. A priori, the authors identified four research topics: (1) what are the greatest safety threats that result in significant dosing errors that potentially result in harm to patients, (2) what practices or technologies are known to enhance dosing safety, (3) can data from other settings be extrapolated to the EMS environment to inform dosing safety, and (4) what impact could standardization of medication formularies have on enhancing dosing safety. To address these topics, 17 PICO (Patient, Intervention, Comparison, Outcome) questions were developed and a literature search was performed. RESULTS After applying exclusion criteria, 70 articles were reviewed. The methods for the investigation, findings from these articles and how they inform EMS medication dosing safety are summarized here. This review yielded 11 recommendations to improve safety of medication delivery in the EMS setting. CONCLUSION These recommendations are summarized in the National Association of EMS Physicians® position statement: Medication Dosing Safety for Pediatric Patients in Emergency Medical Services.
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30
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Suclupe S, Martinez-Zapata MJ, Mancebo J, Font-Vaquer A, Castillo-Masa AM, Viñolas I, Morán I, Robleda G. Medication errors in prescription and administration in critically ill patients. J Adv Nurs 2020; 76:1192-1200. [PMID: 32030796 DOI: 10.1111/jan.14322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/16/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine the prevalence and magnitude of medication errors and their association with patients' sociodemographic and clinical characteristics and nurses' work conditions. DESIGN An observational, analytical, cross-sectional and ambispective study was conducted in critically ill adult patients. METHODS Data concerning prescription errors were collected retrospectively from medical records and administration errors were identified through direct observation of nurses during drug administration. Those data were collected between April and July 2015. RESULTS A total of 650 prescription errors were identified for 961 drugs in 90 patients (mean error 7[SD 4.1] per patient) and prevalence of 47.1% (95% CI 44-50). The most frequent error was omission of the prescribed medication. Intensive care unit stay was a risk factor associated with omission error (OR 2.14; 1.46-3.14: p < .01). A total of 294 administration errors were identified for 249 drugs in 52 patients (mean error 6 [SD 6.7] per patient) and prevalence of 73.5% (95% CI 68-79). The most frequent error was interruption during drug administration. Admission to the intensive care unit (OR 0.37; 0.21-0.66: p < .01), nurses' morning shift (OR 2.15; 1.10-4.18: p = .02) and workload perception (OR 3.64; 2.09-6.35: p < .01) were risk factors associated with interruption. CONCLUSIONS Medication errors in prescription and administration were frequent. Timely detection of errors and promotion of a medication safety culture are necessary to reduce them and ensure the quality of care in critically ill patients. IMPACT Medication errors occur frequently in the intensive care unit but are not always identified. Due to the vulnerability of seriously ill patients and the specialized care they require, an error can result in serious adverse events. The study shows that medication errors in prescription and administration are recurrent but preventable. These findings contribute to promote awareness in the proper use of medications and guarantee the quality of nursing care.
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Affiliation(s)
- Stefanie Suclupe
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Jose Martinez-Zapata
- Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Jordi Mancebo
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Assumpta Font-Vaquer
- Intermediate Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Iris Viñolas
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Indalecio Morán
- Intensive Care Unit, University Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Gemma Robleda
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Mar University School of Nursing - Pompeu Fabra University, Barcelona, Spain
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31
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Preventing the medication errors in hospitals: A qualitative study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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32
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Teal T, Emory J, Patton S. Analysis of Medication Errors and near Misses Made by Nursing Students. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2019-0057. [DOI: 10.1515/ijnes-2019-0057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Despite extensive research and technological advancements, errors related to medication administration continue to rise annually. The body of evidence surrounding medication errors has focused largely on licensed practicing nurses. Nursing students can offer a unique perspective regarding medication administration as their foundation for professional psychomotor skills and cognitive abilities are developed. The purpose of this study was to explore the variables related to medication errors made by pre-licensure nursing students. Data were collected from 2013–2015 in a pre-licensure program. Students completed a post-error survey available in Google Forms. One hundred thirteen responses to the error report were completed. By exploring the factors related to medication errors among nursing students, teaching and learning strategies forming the foundations of medication administration can improve professional nursing practice and improve safety and quality of care.
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Affiliation(s)
- Tabatha Teal
- Nursing , Univ Arkansas , 606 N Razorback Road , Fayetteville , AR 72701 , USA
| | - Jan Emory
- Nursing , Univ Arkansas , 606 N Razorback Road , Fayetteville , AR 72701 , USA
| | - Susan Patton
- Nursing , Univ Arkansas , 606 N Razorback Road , Fayetteville , AR 72701 , USA
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Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res 2019; 19:640. [PMID: 31492188 PMCID: PMC6729050 DOI: 10.1186/s12913-019-4481-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Medication errors are a serious and complex problem in clinical practice, especially in intensive care units whose patients can suffer potentially very serious consequences because of the critical nature of their diseases and the pharmacotherapy programs implemented in these patients. The origins of these errors discussed in the literature are wide-ranging, although far-reaching variables are of particular special interest to those involved in training nurses. The main objective of this research was to study if the level of knowledge that critical-care nurses have about the use and administration of medications is related to the most common medication errors. METHODS This was a mixed (multi-method) study with three phases that combined quantitative and qualitative techniques. In phase 1 patient medical records were reviewed; phase 2 consisted of an interview with a focus group; and an ad hoc questionnaire was carried out in phase 3. RESULTS The global medication error index was 1.93%. The main risk areas were errors in the interval of administration of antibiotics (8.15% error rate); high-risk medication dilution, concentration, and infusion-rate errors (2.94% error rate); and errors in the administration of medications via nasogastric tubes (11.16% error rate). CONCLUSIONS Nurses have a low level of knowledge of the drugs they use the most and with which a greater number of medication errors are committed in the ICU.
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Affiliation(s)
- Juan Escrivá Gracia
- Department of nursing, University of Valencia, 46001 Jaume Roig St, Valencia, Spain
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Bañeras Rius J, Huelmos A, Anguita Sánchez M. Health Care Simulation in Cardiology: Promises and Realities. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:606-607. [PMID: 31109790 DOI: 10.1016/j.rec.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jordi Bañeras Rius
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, CIBERCV, Barcelona, Spain.
| | - Ana Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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35
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Franchi C, Antoniazzi S, Ardoino I, Proietti M, Marcucci M, Santalucia P, Monzani V, Mannucci PM, Nobili A. Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation. Am J Med 2019; 132:e634-e647. [PMID: 31075225 DOI: 10.1016/j.amjmed.2019.03.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. METHODS We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. RESULTS Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. CONCLUSIONS This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03188211.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo-Ospedale Piemonte, Messina, Italy
| | - Valter Monzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Burnett G, Goldberg A, DeMaria S, Levine A, Katz D. Knowledge retention after simulated crisis: importance of independent practice and simulated mortality. Br J Anaesth 2019; 123:81-87. [DOI: 10.1016/j.bja.2019.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/03/2019] [Accepted: 02/20/2019] [Indexed: 01/03/2023] Open
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Kaneko RMU, Lopes MHBDM. Realistic health care simulation scenario: what is relevant for its design? Rev Esc Enferm USP 2019; 53:e03453. [PMID: 31166535 DOI: 10.1590/s1980-220x2018015703453] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
We sought to describe the stages of scenario development with emphasis on the most relevant aspects according to the literature and guidelines of The International Nursing Association for Clinical Simulation and Learning and Best Evidence Medical Education, which are discussed and exemplified on the basis of our professional experience. The following stages were described and commented on for scenario design: planning, objectives, simulation structure and format, case description and perception of realism, pre-debriefing, debriefing, evaluation, materials and resources, and pilot test. A scenario design based on good practices involves important elements, and each stage is closely interrelated and interdependent in its creation process.
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Pang D, Liu Z, Wang L. Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center. Ir J Med Sci 2019; 188:1435-1441. [PMID: 30903451 DOI: 10.1007/s11845-019-01988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China. METHODS Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded. RESULTS No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection. CONCLUSIONS NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.
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Affiliation(s)
- Dong Pang
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Zhaojun Liu
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China.
| | - Lusi Wang
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
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Transferability of Medication Administration Simulation Training to Clinical Settings. TEACHING AND LEARNING IN NURSING 2018. [DOI: 10.1016/j.teln.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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