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