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Do you dread drug calculations?

  • Comments (9)

I can handle writing long and considered essays.

I relish being assessed in the heat of a practice environment.

I am resigned to the fact that I will have to endure a three hour written examination on anatomy and physiology.

However, having to demonstrate 100% competence in the preparation and administration of medication gives me shivers. I can understand the necessity for the exam and the reason why 100% is required. I mean, who wants to be a patient in that 1% failure rate?

My main problem is that I have concerns about my own competence in mathematics. I’m sure that I’m not alone in this so I will share some of the measures that I have taken to prepare myself for this exam which is now only a year away.

  • Practice: As simple as it sounds, a surprising number of students don’t regularly practice or undertake the many mock exams that are out there. My own university uses an online system called Safe Medicate (it used to be called Authentic World). This is the system that I will be using for my exam and they have an infinite amount of mock exams for students to practice with. I urge you to use it or a system like it to get familiar with the type of questions that will be asked and just as crucially, the way in which they expect you to answer those questions.
  • Ask for help: I was once a bit to proud to ask for help. Before my learning difficulty was highlighted I attributed my problem with maths down to sheer laziness at secondary school (if I’m honest, laziness certainly played a part) and because of that pride I muddled along without getting the problem sorted. If you know that you have a problem or even if you think you have a problem it is far better to ask for help at the earliest stage. Your university will have some sort of support system for students struggling with maths (and many other aspects of learning) so they would be a good place to start. You might also have friends or relatives that can help you with the concepts and practicalities of drug calculations. Finally, there a large number of resources both online and in physical form to help you improve your skills. Perhaps get a pocket maths guide which you can refer to during your breaks or on the train just to keep things fresh in your mind.
  • Don’t feel pressured: I recently completed a mock exam and while the results were just known by the university and didn’t have any bearing on my course the pressure that myself and others felt was very much real. Not least of all because it highlighted the fact that we would all have to complete this test sooner than we had thought and be expected to perform perfectly. I had practised and I had sought the help of my mother (who used to be a maths teacher) but what I struggled with was a number of my colleagues telling me how easily the exam was and how quickly they had managed to complete it. “It’s really easy, there’s nothing to worry about” they would say to me. It may well have been easy for them but for me, and others like me, it only made me feel more frustrated. As much as possible, try not to let comments from others affect you, this goes for all aspects of nursing. There are clearly going to be some sections of the course that people find a lot easier than others and to some that may be maths requirements. We all excel in different areas and when you find an area that you find difficult it helps to remain focused.

I hope my advice helps, what techniques do you use to get get a hold of drug calculations?

  • Comments (9)

Readers' comments (9)

  • Jayne Williams

    I absolutely agree with you, my only fear with my nursing degree is math. I've struggled with it all my life and am dreading my safe medicate test as I am slow at calculations. I have bought some good math calculations for nursing books and have practiced. I've taken your advice on board, thanks for posting this, I don't feel entirely on my own now.

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  • Adam Roxby

    Hello Jayne.

    You are certainly not alone and there have been times when I thought that my problems with maths could be the end of my training. However, I'm fully utilising all of the support is available to me.

    Hopefully through articles like this and getting people to respond and engage with the problem we can dispel some of the stigma. For many students it is a very real problem and the cause of a great deal of anxiety.

    So thank you for your comments I am pleased you found the article helpful.

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  • Dear Adam, I would like to reassure you that you are not the only one who feels this way. I have been qualified for over 30 years and last year where I work started annual testing for all staff. I can calculate medications on a daily basis but in a test situation I panic. I am so relieved to hear that young people also find this daunting . Like you I find it very hard when everyone says its easy! Not for me. Thank you for brining this to the fore. Good luck for your future in nursing .

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  • Anonymous

    Hi Adam

    I am a third year Mental Health Nursing Student and due to the high levels of anxiety felt during my drug calculations exam I unfortunately failed:(. Controlling the anxiety during this very stressful situation is really difficult, somehow I need to figure out how to manage this for my reassessment. I

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  • michael stone

    I am old enough to have been at university when the transition from using slide rules, or logs, to calculators happened. And working out chemistry, with logs, was awfully time-consuming.

    But while some drug dosages need to be very accurate, I think that quite often it is largeish errors which would be really problematic. So, here is something I always do where possible, for any maths.

    First, work out an approximate answer. So if you need to work out 41.2 x 134, that will be somewhere close to 50 x 100, so it must be fairly close to 5000. If you know that, then when you do it properly you know you have made a mistake if you answer is 257, or 9588, etc.

    An approximation of 4 x 1300 would actually give you 5200, which I feel pretty certain would normally be good enough for clinical purposes, bearing in mind how uncertain the actual effect of most drugs is, etc.

    If you have trouble muliplying 4 by 1300, you really should not be involved in such calculations, on safety grounds.

    With long sets of numbers, you approximate by 'pairing numbers' as you go along (look for things such as 2 and 5 in a multiplication, then cross the 2 and the 5 out and write 10, etc).

    But always use a simplification of the maths, to make sure you know roughly what the correct answer must be, so that you can immediately see if you have missed a factor of 10, etc.

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  • Adam Roxby

    Hello once again.

    Marian - I still don't think that I practice enough and that’s more of a routine mindset. However, I do think there is a big difference between the ward environment and sitting in front of a pc.

    Many thanks for your comment.

    Anonymous - Thank you very much for sharing this, I understand it can’t be easy. I think too many people are quick to dismiss the anxiety of failure and of exams. I share your emotion.

    Let me know how you get on and I, of course, wish you all the very best.

    Michael - I have to say I think I prefer the modern method (with the electronic aids). I have to say that it’s a great tip. All students should always have a rough idea of what the end result will be. I suppose we are being trained to seek the perfection that is required when administering medication.

    Thanks for you tip and to all that has commented.

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  • Anonymous

    "I suppose we are being trained to seek the perfection that is required when administering medication."

    and 100% accuracy!

    it is not always easy on the wards with constant interruption and so many distractions. the only way is to try and find a quiet space and moment to yourself and keep calm and if there are any problems just take a deep breath and start over.

    after 30 years of practice, I found that many of the calculations were similar and once one got the hang it was OK and if in doubt I always got a colleague to help or check my own calculation. I like to have go first otherwise you never learn. most were very amenable to helping as they understood the dangers of not although they were always rather surprised when I asked. the French are very self sufficient and less humble. they don't like admitting they don't know something or ask for help. once qualified you are supposed to be fully autonomous and know everything, in their view. However, I knew which colleagues were approachable and would genuinely help and not judge and the rarer ones to avoid, unless they were the only ones around, who would make some snide remark to make one feel small. but again I'd rather feel tiny than make an error.

    My biggest fear was preparing chemos as their doses and dilutions were often extremely complicated. new drugs kept appearing and the dosages seemed to become more and more complex. this was a greater problem on nights when one was entirely alone and no one to ask and not always much spare time to indulge in complicated reflections but we still had to administer the occasional treatment for continuity, I was often petrified but once again made sure I had enough time and remained calm and if interrupted just started over again.

    Often one was under time pressure when preparing drugs or had others putting pressure on you but again I managed not to panic and make matters worse.

    Good luck with the exams which are
    probably an invaluable test for the future!
    when preparing injectibles in the drug cupboard we were often competing for the small space so couldn't always linger there.

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  • michael stone

    Adam, I definitely prefer the modern method of using a calculator - and my 'mental maths' wasn't fantastic, anyway.

    But being certain of the approximate answer, is a great guard against having made a mistake somewhere when you used the calculator.

    Of course, the calculation of the figures, is different from knowing what figures to use in the first place (ie the clinical expertise). And some types of drug, need much closer dose control than others - but I think a combination of experience, and not being SCARED of 'doing numbers' should work.

    I admire your 'enquiring attitude' - you ask, so you will find things out !

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  • I'm so glad I've found this, I'm a first year nursing student so not had the exam yet. I've got it after Christmas and I'm worried already as I'm terrified it'll hold me back.

    Thank you so much for the tips in your article. It's been a great help and I'm so relieved I'm not alone in this.

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