Meir Medical Center MEIR MEDICAL CENTER (MMC) Background. Pharmaceutical Calculation 06/11/2012

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Cameron Wiggins
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Kfar Saba Reducing Errors in Pharmaceutical Calculations: Educating & Training Medical Staff Ronit Lahat, B.Sc.

Marina Leonenko, RN,MA Doron Netzer, MD ; Mira Maram-Edri MD Meir Medical Center, Kfar Saba, Israel 1 MEIR MEDICAL

* Total 75 beds. * Admissions 56,800 per year. * Joint Commission Accredited (008, 01).

the number of errors in medicinal treatment (McQueen, Begg & well,010 ; Wong, 010 ; Glover & Sussmane, 00).

1 Kfar Saba Reducing Errors in Pharmaceutical Calculations: Educating & Training Medical Staff Ronit Lahat, B.Sc. Pharm. M.Sc. Liliana Baitelman, M.Sc. Pharm. Marina Leonenko, RN,MA Doron Netzer, MD ; Mira Maram-Edri MD Meir Medical Center, Kfar Saba, Israel 1 MEIR MEDICAL CENTER (MMC) * Academic Medical Center. (Affiliated with Tel Aviv University) * Total,000 employees. * Total 75 beds. * Admissions 56,800 per year. * Joint Commission Accredited (008, 01). Meir Medical Center 4 3 Background There is an overall consensus that errors in drug contribute significantly to the number of errors in medicinal treatment (McQueen, Begg & well,010 ; Wong, 010 ; Glover & Sussmane, 00). These kinds of mistakes are the cause of 11% of all mistakes in hospital medicinal treatment (Glover & Sussmane, 00 ; Lesar, Briceland & Stein, 1997). Pharmaceutical Calculation Definition: The mathematical process required to accurately determine dosage, units, solution s concentrations and rate according to the clinical needs of the patient. Pharmaceutical calculation is an essential part of the daily function of pharmacists, medical doctors and nurses

questions in the government exam Every nurse has to pass an exam before administering medications Physicians No Courses - Neither in Israel or abroad - All medical interns have 1 hour workshop

2 Staff Training: Current situation in Israel Background (cont.) Courses during generic studies Knowledge exam at end of course/studies Knowledge assessment before starting work at the hospital Nurses 1 hour training program Passing grade = 100 There are questions in the government exam Every nurse has to pass an exam before administering medications Physicians No Courses - Neither in Israel or abroad - All medical interns have 1 hour workshop Calculation errors occur both while filling orders and while performing them (Wong, 010). Some of these mistakes are caused by the lack of education and training of the staff medical doctors and nurses (Glover & Sussmane 00 ; Wright 010). 8 7 THE GOAL Quality & safety improvement of the medical 10 treatment of hospitalized patients by raising the awareness and knowledge of staff regarding pharmaceutical. Courses during generic studies Knowledge exam at end of course/studies Knowledge assessment before starting to work at the hospital 9 Staff Training: What s done currently in Israel? Nurses HELP There is a training, lasting at least 1 hours Course passing grade = 100 There are questions in the government exam Every nurse has to pass an exam before administering Medications Physicians No Courses Neither in Israel or abroad All medical interns have 1 hour workshop The Project Process Defining project population: All medical interns working at MEIR MC during 011. Defining course format: 5 sessions, 1.5 hours each. Defining teaching methods: 3 frontal lectures. 1 self-training session including exercises in workbooks. 1 e-learning self-training session. Aims To study attitudes, level of knowledge and self confidence of medical interns performing pharmaceutical. To improve the skills and abilities of medical interns in performing pharmaceutical. 1 11

The Project Process (cont.) Pre-test Results Preparation of course material: Presentations, worksheet formulations, exercises with answers workbooks.

3 The Project Process (cont.) Pre-test Results Preparation of course material: Presentations, worksheet formulations, exercises with answers workbooks. Development of questionnaires: To examine attitudes & knowledge (pre- & post-test). The questionnaires were submitted at the 1 st & 5 th meetings. Evaluation & summarization of questionnaire data. Drawing of conclusions & recommendations for the future Self-assessment of Knowledge & Confidence in Performing Pharm. Calculations (Scale 1-6, 1= don t agree at all 6= totally agree) Attitudes Importance of Topic (Scale 1-6, 1= don t agree at all, 6= totally agree) I feel confident performing all pharm. At least once in my work I didn t know how to perform the Pharm. are relevant to physicians function Mistakes in pharm. can be critical to the safety of my patients Objective Knowledge Questions (pre-test n=) Attitudes Regarding Consulting with colleagues (Scale 1-6, 1= don t agree at all, 6= totally agree) I prefer consulting with my colleagues My colleagues know the subject sufficiently

Attitudes Regarding Previous Training (n=4) Received previous training Was the training sufficient? Pre-test (n=) 1 st session 11 0 Post-test (n=0) 5 th session 19 (1 didn t answer) 11 ** Pre-test vs.

0 19 Objective Knowledge Questions )Post-test n=0) Differences in Attitudes There was no significant statistical difference in other attitudes between pre- & post-tests.

4 Attitudes Regarding Previous Training (n=4) Received previous training Was the training sufficient? Pre-test (n=) 1 st session 11 0 Post-test (n=0) 5 th session 19 (1 didn t answer) 11 ** Pre-test vs. Post-test Results ** Since the questionnaires were anonymous, we were unable to connect between the answers and the number of meetings in which the intern participated Objective Knowledge Questions )Post-test n=0) Differences in Attitudes There was no significant statistical difference in other attitudes between pre- & post-tests. T-test Scale Pre-test (X) Post-test (X) p.value I feel confident performing all the <0.001 Difficulty level felt while answering objective knowledge questions < Objective Knowledge Right Answers Pre-test (n=) vs. Post-test (n=0) Comparing Objective Knowledge Results )Pre-test n=) Exercise Right answer Did not answer All questions (Total 110 questions) 46 (41.8%) 35 (31.8%) Exercise )Post-test n=0) Right answer Did not answer (Total All questions 100 questions) 50 (50%) 7 (7%) 4 ** Since the questionnaires were anonymous, we are unable to connect between the answers and the number of meetings in which the intern participated. 4

5 Current Situation in MMC and Plans for the Future * Training medical interns working at MMC. * Training new physicians starting to work at MMC. * Training pediatricians at MMC. * Teaching at the Faculty of Medicine in Tel Aviv University. * Review workshop for nurses at MMC. Summary In this project we studied the attitudes, knowledge and skills of drug among medical interns. The differences before and after the training emphasize the importance of training as well as the ability to improve knowledge & skills. 5 Conclusions Thank you for your attention. Our project has clinical significance for the quality and the safety of medical treatment. Raising awareness, knowledge and skills performing pharm. calculation of the medical staff can contribute to the reduction of errors in medicinal treatment. We strongly recommend the teaching of pharm. calculation to all relevant staff members

RESEARCH ARTICLES Medication Error Identification Rates by Pharmacy, Medical, and Nursing Students

RESEARCH ARTICLES Medication Error Identification Rates by Pharmacy, Medical, and Nursing Students Terri L. Warholak, PhD, Caryn Queiruga, PharmD,* Rebecca Roush, PharmD,* and Hanna Phan, PharmD The University