Exploring the Relationships between Practicing Registered Nurses (RNs) Pharmacology Knowledge and Medication Error Occurrence Coleen Kumar, PhD, RN, CNE 1
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 calculation skills required for safe 3 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). 4
The Medication Process: A Fault in the System (FDA,2001;Simonsen, Johansson, Daehlin, Osvik,Farup,2011) 5
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) 6
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. 7
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. 8
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? 9
Conceptual Framework How errors happen (Reason,1990) How knowledge develops in RNs (Benner,2001) 10
Methods Descriptive and correlational and cross-sectional design Setting: 2 healthcare facilities in the Northeastern region of the U.S. Convenience sample Data collection: The Medication Calculations Skills test(grandell- Niemi,etal,2005) 3 part survey (administered in paper or electronic format) Demographics & characteristics of the participants Perceived and actual pharmacology knowledge ( including calculations ability) Self report of a medication error experience 11
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 12
RESULTS SAMPLE 80 70 60 70 61 212 Practicing RNs Females n =167 Males n = 45 50 <25 years 40 25-30 years 30 20 10 16 27 5 31-40 years 41-50 years >61 years 0 Participant Ages 13
RESULTS Medication Calculation Skills Test Scores 60 50 40 30 20 10 0 MCS Calculations Score MCS Pharmacology Score MCS Composite Score Actual Mean Perceived Mean
RESULTS Research Question 1 Relationship between knowledge and error and Research Question 2 Prediction of error if knowledge is known Point Estimate 95% Wald Confidence Interval P-value RQ 1 Knowledge Error 1.03 1.00 1.07.053 RQ 2 Prediction of error if knowledge is known.99.99 1.00.27
RESULTS: Research Question #3 Relationship of demographic variables to medication error occurrence Predictor Variables: p-value for demographic variable Overall p-value for logistic regression model Composite test score only --.053 Composite test score and: 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 16
RESULTS RNs Self Report of a Medication Error
RESULTS Medication Error Experience Distractions and Interruptions Patient off unit Unfamiliar with Drug Unfamiliar with route of administration Lack of staffing 17% 11% 3% 4% 1% 43% Unfamiliar with the unit/patients (floated) high acuity of patients on the Unit Working overtime 12% 8%
RESULTS Nature of the Error N=28 N=57 Wrong Pt. Wrong Drug Wrong Route Wrong Amount Wrong Time n=32 n = 3 3
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. 20
Discussion Research Q2: Prediction of error if knowledge is known Pharmacology knowledge/scores was not related to the incidence of medication errors. 21
Discussion RQ3 Medication error rate predicted by certain RN characteristics + knowledge Composite test score + shift time (p=.005) Composite test score + specialty p=.027 Medication error rate Composite test score +education p=.023 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. 23
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
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