Pharmaceutical care in paediatric intensive care unit: activities and interdisciplinary learning in a Spanish hospital

Student nurses' experiences regarding their clinical learning opportunities in a public academic hospital in Gauteng province, South Africa

Background

During the training of student nurses, clinical placement is a compulsory requirement, as it exposes them to learning opportunities for the acquisition of clinical skills. This prepares them to become safe and competent professional nurses. However, the increased intake of student nurses in the Gauteng nursing colleges led to overcrowding in a public academic hospital, thus negatively influencing their learning experiences and availability of clinical learning opportunities.

Aim

The purpose was to explore and describe the student nurses' experiences regarding their clinical learning opportunities to make recommendations to enhance their clinical learning opportunities in order to address the optimisation of their learning experiences.

Methodology

A qualitative, exploratory, descriptive and contextual research design was used. A purposive sampling method was used to select second-year student nurses registered in the Regulation (R425) programme for qualifying as a nurse (general, psychiatry and community) and midwife, as they would have acquired at least 1 year of clinical experience. Four focus groups, which comprised six to eight participants, were constituted, and research was conducted until data were saturated. Field notes were simultaneously taken to enrich the data collected. Thematic coding of qualitative data was used. Principles of trustworthiness and ethical principles were adhered to.

Results

The study revealed four themes. Three were negative experiences that included overcrowding, negative emotional experiences of student nurses and challenges of professional nurses. A theme concerning positive experience entailed knowledge-sharing amongst various health care disciplines.

Conclusion

It was evident that student nurses had more negative emotional experiences than positive experiences. Therefore, the need to enhance their clinical learning opportunities in order to address the optimisation of learning experiences is eminent.

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

OBJECTIVE

Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children.

METHOD

We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories.

RESULTS

We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (β = -.21; 95% CI, -0.41 to -0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (β = -.61; 95% CI, -1.31 to 0.08; P = .07).

CONCLUSION

The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit.