Coleen Kumar

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Coleen Kumar
Exploring the Relationships between
Practicing Registered Nurses (RNs)
Pharmacology Knowledge and Medication
Error Occurrence
Coleen Kumar , PhD, RN, CNE
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My Seton Hall University Dissertation Committee :
Dr. Debra DeLuca
Dr. Terrence Cahill
Dr. Lee Cabell
Background
The Problem: The Epidemic of Medication Errors
­ Medication errors are the most common type of error
affecting the safety of patients (Kohn, Corrigan& Donaldson, 2000; US FDA,2012 )
­ More than 100,000 people die each year because of
preventable medical errors(Kohn,Corrigan,Donaldson,1999)
­ Medications are administered by RNs and account for almost
40% of all medication errors ( Ulanimo , O’Leary-Kelley, Connolly, 2007)
­ Pharmacology
knowledge is essential for medication
competence and for safe drug administration
­ Registered nurses lack pharmacological knowledge and
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calculation skills required for safe
practice
Consequences of Medication Errors
For the Patient:
­ Prolonged hospital stay ; Additional discomfort ;Death
For the RN:
­ Low of Morale ; Disciplinary Action ; Loss of Life
For the System:
­ Annual cost of errors per year in US hospitals is between
$17 billion and $29 billion per year (AHRQ, 2008).
­ 1.5 million preventable medication errors occur within the
health system annually(IOM,2006).
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The Medication Process: A Fault in the System
(FDA,2001;Simonsen, Johansson, Daehlin, Osvik,Farup,2011)
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Factors Contributing to Medication Errors: The RN
l Assessment and Evaluation
l Preparation
l Administering
(Bates,Cullen,Laird,1995;FDA,2001;Taxis&Barber,2003;Ulanimo,O’Leary-Kelley &
Connolly,2007)
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Summary: Medication Errors: Contributing Factors
and Consequences
­The factors that contribute to medication errors can be
divided into individual healthcare professionals’ and
systems factors
­ No agreement on the definition of a medication error
­ A complex medication process
­ Nurses most often blamed for errors
­ Medication errors are costly to patients, healthcare
professionals and the healthcare system.
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Significance
­Nursing research lacks a definition of medication competence which
integrates pharmacology knowledge- thus there are varied approaches
and determinants of medication competence in nursing education and
little or no research studies exploring all knowledge categories of
medication competence.
­The Nursing Scope and Standards of Practice and Accrediting Nursing
Bodies such and the American Association of Colleges of Nursing (AACN)
and the National League for Nursing (NLN) do not address medication
competence or outline specific standards and guidelines for pharmacology
curriculum in nursing programs nationwide (AACN,2008;ANA,2010).
­THERE IS LITTLE OR NO RESEARCH EXPLORING THE ROLE OF RNS
PHARMACOLOGY KNOWLEDGE AND THE OCCURRENCE OF A
MEDICATION ERROR .
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Research Questions
This study aimed to test the hypotheses related to the following
research questions:
1: Is there a relationship between practicing RNs composite (both
pharmacology and math calculations) knowledge , as measured
by the MCS test, and the occurrence of a medication error, as
determined from an RN’s self-report?
2: Is it possible to predict the occurrence of a medication error (as
determined from an RN’s self-report) if the RN’s pharmacology
knowledge is known (as measured by the MCS test)?
3: In addition to practicing RNs’ composite (pharmacology and
calculation) knowledge do their demographic characteristics
influence the occurrence of medication errors ?
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Conceptual Framework
How knowledge develops in RNs
(Benner,2001)
How errors happen
(Reason,1990)
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Methods
­ Descriptive and correlational and cross-sectional design
­ Setting: 2 healthcare facilities in the Northeastern region
of the U.S.
­ Convenience sample
­ Datacollection:TheMedicationCalculationsSkillstest(GrandellNiemi,etal,2005)
­ 3partsurvey(administeredinpaperorelectronicformat)
­ Demographics&characteristicsoftheparticipants
­ Perceivedandactualpharmacologyknowledge(
includingcalculationsability)
­ Selfreportofamedicationerrorexperience
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Variables
Independent Variables
­ RQ1: RNs composite (pharmacology and
math calculation) knowledge
­ RQ2: RNs pharmacology knowledge only
­ RQ3 will also employ the demographic
variables
Dependent variable
­Medication error occurrence
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RESULTS
SAMPLE
80
212Practicing
RNs
Femalesn =167
Malesn =45
70
70
61
60
50
40
27
30
20
16
5
10
0
Participant Ages
13
<25 years
25-30 years
31-40 years
41-50 years
>61 years
RESULTS
MCS Composite Score
MCS Pharmacology
Score
60
50
40
30
20
10
0
MCS Calculations Score
Medication Calculation Skills Test Scores
Actual Mean
Perceived Mean
RESULTS
Research Question 1 Relationship between knowledge
and error and Research Question 2 Prediction of error if
knowledge is known
RQ 1
Knowledge
Point Estimate
95% Wald
Confidence Interval
P-value
1.03
1.00
1.07
.053
.99
.99
1.00
.27
Error
RQ 2
Prediction of error if
knowledge is known
RESULTS: Research Question #3 Relationship of demographic variables to medication
error occurrence
Predictor Variables:
p-value for demographic
variable
Composite test score only
Overall p-value for
logistic regression model
--
.053
Age
.250
.135
Specialty
.067
.027
Experience
.386
.160
Education
.043
.023
Certification
.016
.010
Hours (FT/PT)
.247
.070
Setting
.060
.040
Shift length(12h/8h)
.739
.151
Shift time (days/eve/night)
.009
.005
Composite test score and:
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RESULTS
RNs Self Report of a Medication Error
RESULTS
Medication Error Experience
Distractions and
Interruptions
Patient off unit
3%
4% 1%
11%
Unfamiliar with Drug
Unfamiliar with route of
administration
Lack of staffing
Unfamiliar with the
unit/patients (floated)
high acuity of patients on
the Unit
Working overtime
43%
17%
12%
8%
RESULTS
Nature of the Error
N=28
N=57
n=32
n
=
3
3
Wrong Pt.
Wrong Drug
Wrong Route
Wrong Amount
Wrong Time
Discussion
Research Q 1: Relationship between RNs
knowledge and error occurrence
­ Composite knowledge has an impact predicting
medication errors.
­ RNs with high MCS test scores had a slightly higher
incidence of medication errors than those with low test
scores.
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Discussion
Research Q2: Prediction of error if
knowledge is known
­ Pharmacology knowledge/scores was
not related to the incidence of
medication errors.
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Discussion
RQ3 Medication error rate predicted by certain
RN characteristics + knowledge
Composite
test score +
specialty
p=.027
Composite
test score +
shift time
(p=.005)
Composite
test score
+education
p=.023
Medication
error rate
Composite
test score +
setting
(p=.040)
Composite
test score +
certification
(p=.010)
Summary
­ Medication errors are a tremendous problem.
­ Most medication errors are attributed to the
administration of medications
­ Most common medication error : the wrong patient.
­ Most common cause of a medication error : distractions
and interruptions.
­ There is a relationship between knowledge and
medication errors.
­ Characteristics of the RNs have a significant effect on
medication error rate.
­ Certified RNs make less errors.
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How to reduce medication errors:
Implications for Educators
­ Modify basic and continuing education
­ Develop curricula to enhance medication
competencies
­ Recognize the complex nature of the problem
THANK YOU

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