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Practice comment

Ongoing education would boost competency in drug calculations


Medication errors can have fatal results. Higher education institutes and trusts must continually develop students’ and nurses’ skills, say Maxine Pryce-Miller and Vernel Emanuel

Medication administration errors rank third in the list of causes leading to loss of function or patient death.  Most medication errors occur at the point of administration.

Drug administration is an integral part of the nurse’s role, which is underpinned by legal and professional requirements.  So to maintain patient safety it is imperative nurses’ pre-registration and post registration skills and knowledge are developed so that they are able to competently perform drug calculations and administer medication.

To ensure nurses are competent in this area, several potential issues need to be considered, for example, the multi-dimensional aspects of administering medication. This includes the need to combine numeracy skills, good processes and to understand the changing complexities of medication. 

To enhance pre and post registration nurses’ competence in drug administration, higher education institutes and NHS Trusts need to make a continued effort to develop and promote nurses’ mathematical skills. This is vital, given that several studies conducted have identified their poor mathematical competency as a key element of medication administration errors.

There is also a need for new approaches to teaching and assessing drug administration. To support the development of the skills and knowledge of pre and post registration nurses, good processes need to be in place. For example, pre-registration nursing education should involve the use of computer based blended learning activities, which would be invaluable in helping student nurses deal with mathematical problem solving.

The clinical skills laboratory is extremely important and can provide simulated practical sessions without the use of a calculator. Research supports the use of clinical skills area as useful in enhancing student nurses’ knowledge by applying mathematical knowledge to clinical practice. Drug calculation workshops should be an integrated part of the nursing curriculum, with summative assessments at the end of each academic year, and during clinical placements.

Experienced nurses are expected to provide dedicated support to student nurses, to support learning and to impart their knowledge, as well as creating an environment that is conducive to learning. However, there is evidence that qualified nurses do not necessarily have the appropriate knowledge and skills required to accurately calculate drugs.

It is important to ensure that qualified nurses receive some sort of formal education to ensure they continue to develop their skills and competency in numeracy and the administration of medication. There needs to be a clear competency framework that includes written evidence demonstrating how nurses’ numeracy and drug administration skills have been developed over a period of time. Annual mandatory updates should be held with an examination at the end. For competencies to be successfully implemented they should be developed by the NHS and higher education institutes.

These measures would help nurses to better fulfil their roles and to be clear, consistent and focused on the multi-faceted aspects of drug administration. This ongoing education would also improve the quality of care for patients and result in a reduction in medication errors.

Medication administration is a complex process involving a large number of specific decisions and actions. Therefore pre and post registration nurses must receive the necessary support to meet these challenges and be equipped in light of the changing and complexity of medication now available as technology advances.

MAXINE PRYCE-MILLER is a senior lecturer (child division) and VERNEL EMANUEL is a senior lecturer (adult division); both are at University of Wolverhampton School of Health and Well Being


Readers' comments (8)

  • Ongoing education should be in place to firstly be considered a profession and secondly is mandatory knowledge to mentor others. Also self esteem and confidence would increase and as result the NHS would save lots more money in more ways than one. Updates on medications, and ways to help colleagues should also be included in education.

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    one solution would be ,that each patient have a medicine box at the bottom of their bed accessible by the nurse in charge of medication. the pharmacy with be in control of of its contents,, each prescription will be filled out by the pharmacy to strict controls adhering to the accurate drug calculation specific to that patient. This will also stop the problem of drugs sounding the same,and the boxes looking the same. So the will need to be a team if pharmacy staff in overall charge.
    On admission the patient will have an interview with the pharmacist and things will go from there. a simplistic idea that i feel would work.

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  • Doesn't get round the problem of lack of numeracy skills though. Pharmacy staff wouldn't be involved in calculations for IV medicines etc. As the pharmacy nurse I am often asked by ward staff to help work out doses & the biiggest problem I find is a lot of people just can't count. Plus in this financial climate even pharmacy are having to tighten their belts with posts being frozen so, their staffing levels are going down too just the same as in nursing

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  • Sandra is working from a risk averse point of view. Pharmacies will be overrun with extra workloads such as this so in my humble opinion this is a non-starter. The management of the risk is simple - reinforce the importance of numeracy. It isn't difficult, it just needs to become part of a culture of care and diligence. Checking calculations with a calculator or with a pen and paper might not look particularly professional, but they certainly get the job done.

    The higher education system is not entirely blameless in this situation. I remember sitting in a presentation by the recruiting team for one relatively local University who stated that they would accept a 50% score in level 2 numeracy as sufficient to gain entry to a nursing course. To put that into context, my twelve and a half year old son scored 77% on an equivalent level test - without a calculator!

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  • It seems amazing that we are talking about nurses having degrees, who cannot do relatively simple arithmetic!

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  • I think many are lossing the point here, as a student nurse in both the general field and also mental health field of Nursing in the 1980's it was a requirement that we passed a drug assessment during our Nurse training.
    Both of the assessments I undertook included the need to calculate dosages of medication. Now as a more senior Nurse I constantly struggle when I speak to student Nurses who have problems with calculating doses but also a lack of understanding regarding the medications they are involved in administering.
    The concept that a Nurse can now obtain NMC registration without any formal assessment of their skill, knowledge and competence to safetly administer medication should be of concern to many
    Surely staff would do better with regard to calculating the dose if they also understood the way the drug is likely to effect the patient.

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  • Being a newly qualified nurse, I can safely say that every placement I had as a student nurse required me to complete a drug calculations element. I also had drug calculations exam in university every year, and since going into practice I am correcting older more senior nurses who were giving medication ' how they have given it for years',

    The more senior nurses are not always as perfect as they would have us newly qualified believe

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  • The university of the West of Scotland nursing course has a drug calculation exam. The only pass rate is 100% correct. Any less than 100% even 99% is considered a fail

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