Nurse Educator
Nurse Educator Vol. 40, No. 4, pp. 169-173 Copyright * 2015 Wolters Kluwer Health, Inc. All rights reserved.
Cultivating a Culture of Medication Safety in Prelicensure Nursing Students Peggy A. Bush, PhD, RPh & Re´mi M. Hueckel, DNP, RN, CPNP-AC & Dana Robinson, BSN, RN Terry A. Seelinger, MHA & Margory A. Molloy, MSN, RN, CNE Safety education in nursing has traditionally focused at the level of individual nurse-patient interactions. Students and novice clinicians lack clinical experience to create context and understand the complexity of the health care system and safety science. Using the Quality and Safety Education for Nurses quality and safety competency as a framework, the objective of this education project was to design comprehensive, engaging, learner-centered, online modules that increase knowledge, skills, and attitudes about medication safety. Keywords: medication errors; medication safety; nursing education; online modules; patient safety; Quality and Safety Education for Nurses
M
edical errors remain a significant concern despite concerted efforts to mitigate for more than a decade. Recent estimates suggest that more than 400 000 deaths result annually due to preventable medical error, equating to 1 of the leading causes of death in the United States.1 Medication errors represent a common subset of medical errors, associated with significant harm as well as financial costs. Estimates suggest that medication errors occur at a rate of more than 1 per day per hospitalized patient. At least 1.5 million serious, preventable medication errors resulting in injury (ie, adverse drug events) occur annually.2 Of the major steps in the medication process (prescribing, transcription, dispensing, administration, and monitoring), the administration step is generally associated with higher rates of medication errors.3 Staff nurses are typically responsible for medication administration and therefore are in a position to play a key role in medication safety. Historically, the practice of medication safety has focused on specific activities or knowledge to enhance error-free performance by individuals. Consistent with clinical practice, safety educaAuthor Affiliations: Assistant Professors (Drs Bush and Hueckel) and Coordinator (Ms Molloy), Center for Nursing Discovery, School of Nursing, Duke University; and Clinical Nurse (Ms Robinson) and eLearning Specialist (Mr Seelinger), Duke University Health System, Durham, North Carolina. This project was funded in part by Catalyst, a Duke School of Nursing grant to support innovation in technology and nursing education. The authors declare no conflicts of interest. Correspondence: Dr Bush, School of Nursing, Duke University, 307 Trent Dr, Durham, NC 27710 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.nurseeducatoronline.com). Accepted for publication: December 19, 2014 Published ahead of print: February 25, 2015 DOI: 10.1097/NNE.0000000000000148
Nurse Educator
tion for prelicensure nursing students has traditionally focused at the level of individual nurse-patient interactions. Examples of specific areas of focus include calculation skills,4 knowledge of high-alert medications,5 informatics tools and skills,6 and fostering interprofessional collaboration as a method to improve safety.7 More recently, health care systems have adopted broader concepts of safety science that address a systems approach and development of processes to reduce errors. Focusing on systems and processes to reduce errors contrasts with the previous individual-centered approach. A systems safety approach has been used effectively to reduce accidents in high-stakes industries such as aviation and nuclear energy. The Quality and Safety Education for Nurses (QSEN) initiative8 and others9,10 have called for a broader educational approach that is grounded in concepts of safety science. A competency for safety was developed by QSEN for prelicensure nursing education identifying specific knowledge, skills, and attitudes (KSA).8 In addition to the need for knowledge and skills, evidence suggests that attitudes about safety have an important role in reduction of medical errors. QSEN addresses attitudes explicitly in the safety competency.8 A favorable safety climate has been associated with reduced medical error rates and may be a more powerful factor than safety tools, such as systems and procedures.11,12 In our prelicensure nursing program, safety education is currently embedded throughout various courses in the curriculum, within the context of providing safe patient care. The goal of this project was to provide dedicated medication safety instruction congruent with the QSEN safety competency to enhance students’ KSAs. Introduction of this content early in the prelicensure curriculum should enhance formation of a knowledge base and attitudes consistent with a culture of safety. Volume 40 & Number 4 & July/August 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
169
Our focused medication safety course includes 4 Webbased modules using engaging, learner-centered instructional strategies. Learning outcomes address 4 major topics: recognition of the context within which medication errors occur, common causes and types of medication errors, prevention strategies, and the impact of medication errors on patients, families, and the health care system. The modules supplement existing instruction on the knowledge and skills necessary to avoid medication errors at the time of administration. The dimension of attitude toward safety is increasingly recognized as a factor that directly relates to medical and medication error rates,11
Nurse Educator Vol. 40, No. 4, pp. 169-173 Copyright * 2015 Wolters Kluwer Health, Inc. All rights reserved.
Cultivating a Culture of Medication Safety in Prelicensure Nursing Students Peggy A. Bush, PhD, RPh & Re´mi M. Hueckel, DNP, RN, CPNP-AC & Dana Robinson, BSN, RN Terry A. Seelinger, MHA & Margory A. Molloy, MSN, RN, CNE Safety education in nursing has traditionally focused at the level of individual nurse-patient interactions. Students and novice clinicians lack clinical experience to create context and understand the complexity of the health care system and safety science. Using the Quality and Safety Education for Nurses quality and safety competency as a framework, the objective of this education project was to design comprehensive, engaging, learner-centered, online modules that increase knowledge, skills, and attitudes about medication safety. Keywords: medication errors; medication safety; nursing education; online modules; patient safety; Quality and Safety Education for Nurses
M
edical errors remain a significant concern despite concerted efforts to mitigate for more than a decade. Recent estimates suggest that more than 400 000 deaths result annually due to preventable medical error, equating to 1 of the leading causes of death in the United States.1 Medication errors represent a common subset of medical errors, associated with significant harm as well as financial costs. Estimates suggest that medication errors occur at a rate of more than 1 per day per hospitalized patient. At least 1.5 million serious, preventable medication errors resulting in injury (ie, adverse drug events) occur annually.2 Of the major steps in the medication process (prescribing, transcription, dispensing, administration, and monitoring), the administration step is generally associated with higher rates of medication errors.3 Staff nurses are typically responsible for medication administration and therefore are in a position to play a key role in medication safety. Historically, the practice of medication safety has focused on specific activities or knowledge to enhance error-free performance by individuals. Consistent with clinical practice, safety educaAuthor Affiliations: Assistant Professors (Drs Bush and Hueckel) and Coordinator (Ms Molloy), Center for Nursing Discovery, School of Nursing, Duke University; and Clinical Nurse (Ms Robinson) and eLearning Specialist (Mr Seelinger), Duke University Health System, Durham, North Carolina. This project was funded in part by Catalyst, a Duke School of Nursing grant to support innovation in technology and nursing education. The authors declare no conflicts of interest. Correspondence: Dr Bush, School of Nursing, Duke University, 307 Trent Dr, Durham, NC 27710 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.nurseeducatoronline.com). Accepted for publication: December 19, 2014 Published ahead of print: February 25, 2015 DOI: 10.1097/NNE.0000000000000148
Nurse Educator
tion for prelicensure nursing students has traditionally focused at the level of individual nurse-patient interactions. Examples of specific areas of focus include calculation skills,4 knowledge of high-alert medications,5 informatics tools and skills,6 and fostering interprofessional collaboration as a method to improve safety.7 More recently, health care systems have adopted broader concepts of safety science that address a systems approach and development of processes to reduce errors. Focusing on systems and processes to reduce errors contrasts with the previous individual-centered approach. A systems safety approach has been used effectively to reduce accidents in high-stakes industries such as aviation and nuclear energy. The Quality and Safety Education for Nurses (QSEN) initiative8 and others9,10 have called for a broader educational approach that is grounded in concepts of safety science. A competency for safety was developed by QSEN for prelicensure nursing education identifying specific knowledge, skills, and attitudes (KSA).8 In addition to the need for knowledge and skills, evidence suggests that attitudes about safety have an important role in reduction of medical errors. QSEN addresses attitudes explicitly in the safety competency.8 A favorable safety climate has been associated with reduced medical error rates and may be a more powerful factor than safety tools, such as systems and procedures.11,12 In our prelicensure nursing program, safety education is currently embedded throughout various courses in the curriculum, within the context of providing safe patient care. The goal of this project was to provide dedicated medication safety instruction congruent with the QSEN safety competency to enhance students’ KSAs. Introduction of this content early in the prelicensure curriculum should enhance formation of a knowledge base and attitudes consistent with a culture of safety. Volume 40 & Number 4 & July/August 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
169
Our focused medication safety course includes 4 Webbased modules using engaging, learner-centered instructional strategies. Learning outcomes address 4 major topics: recognition of the context within which medication errors occur, common causes and types of medication errors, prevention strategies, and the impact of medication errors on patients, families, and the health care system. The modules supplement existing instruction on the knowledge and skills necessary to avoid medication errors at the time of administration. The dimension of attitude toward safety is increasingly recognized as a factor that directly relates to medical and medication error rates,11
