Nurses' knowledge of high-alert medications: A randomized controlled trial

doi:10.1016/j.nedt.2011.11.018

Nurse Education Today

Volume 33, Issue 1, January 2013, Pages 24-30

https://doi.org/10.1016/j.nedt.2011.11.018 Get rights and content

Summary

Aim

This study explores the effectiveness of an educational intervention on nurses' knowledge regarding the administration of high-alert medications.

Background

Nurses' insufficient knowledge is considered to be one of the most significant factors contributing to medication errors. Most medication errors cause no harm to patients, but the incorrect administration of high-alert medications can result in serious consequences. A previous study by the same authors validated 20 true/false questions concerning high-alert medications and suggested that the topic be taught to nurses (Hsaio, et al., 2010. Nurses' knowledge of high-alert medications: Instrument development and validation. Journal of Advanced Nursing, 66(1), 177–199.).

Methods

A randomized controlled trial was employed in 2009 in Taiwan. Twenty-one hospital wards and 232 nurses were randomized to control and intervention groups. The sixty-minute educational intervention was based on the viewing of a Powerpoint file developed for this study. The results were compared pre-intervention and six weeks post-intervention by means of a test comprising the 20 questions regarding high-alert medications.

Findings

The pre-intervention baseline data for correct answer rate was 75.8% (mean; n = 232). After the intervention, the post-test showed significant improvement in the intervention group (n = 113) (pre vs. post; 77.2 ± 15.5 vs. 94.7 ± 7.6; paired t = 10.82, p < 0.0001) but not in the control group (n = 112) (pre vs. post; 74.3 ± 14.7 vs. 75.5 ± 14.2; paired t = 0.60; p = 0.247).

Conclusions

Educational intervention appears to be effective in strengthening nurses' knowledge of high-alert medications. The Powerpoint file presented teaching material which is both suitable and feasible for hospital-based continuing education.

Introduction

Nurses' insufficient knowledge is considered to be one of the most significant factors contributing to medication administration errors (Gladstone, 1995, Wakefield et al., 1998, Phillips et al., 2001, Benner et al., 2002, Tang et al., 2007). Most medication errors cause no harm to patients, but serious injuries (e.g. coma or cardiopulmonary resuscitation) and deaths are usually due to incorrect administration of high-alert medications. A previous study by the authors of the current study validated 20 questions to evaluate nurses' knowledge, revealing a correct answer rate as low as 56.5%, demonstrating that nurses' had insufficient knowledge regarding high-alert medications, and recommended development of teaching material and educational intervention to strengthen nurses' knowledge of this topic (Hsaio et al., 2010). Also, in studies, “drug therapy” was ranked the number one learning need among 58 learning items (Glass and Todd-Atkinson, 1999), while 84.6% of nurses hoped to receive more teaching about high-alert medications (Hsaio et al., 2010). To date, few studies have focused on how to strengthen nurses' knowledge regarding high-alert medications. In this study, in an attempt to improve nurses' knowledge of high-alert medications, we developed a Powerpoint file (PPT) as the teaching material, implemented a teaching program and evaluated the effectiveness of the PPT and the teaching program.

Section snippets

Medication Errors and Administration Errors

Medication safety is a major concern and a global issue related to the quality and safety of patient care. In 1999, the US Institute of Medicine published a landmark book, To Err is Human — Building a Safer Health System, which claimed that the number of deaths caused by medical errors was between 44,000 and 98,000 each year, even greater than the number of US deaths caused by motor vehicle accidents, breast cancer and acquired immunodeficiency syndrome (AIDS) (Kohn et al., 1999). In the UK,

Aim

The aim of this study was to explore the effectiveness of an educational intervention at improving nurses' knowledge about high-alert medications.

Design

A randomized controlled trial of two-group intervention-control design was employed. The pre–post-test of 20 true/false questions was used to evaluate the effectiveness of the intervention. The study design is presented in Fig. 1.

Sampling and Participants

Stratified random sampling was applied to the recruitment of nurses from one large medical center (1520 beds) in Taiwan

Background Characteristics and Scores

A total of 232 nurses participated in this study. The majority of nurses were female (99.1%), with an average age of 29.4 ± 0.6 years and working experience of 7.0 ± 6.0 years. Nearly 70% (69.0%) had earned a bachelor's or master's degree, and 74.1% had had no training in high-alert medications (Table 1).

Data on nurses' backgrounds, such as their total working years, experience working in pediatrics and ICU, and whether or not they had received training in ER, ICU, and high-alert medications, made a

Discussion of Methods: Sampling and Instrument

The response rates were satisfactory: the control group response rate was 100%, while the intervention group's was 94.2%. Two factors may have contributed to the results. The first is that we were granted cooperation and support from the nursing administration department and the head nurses. The head nurses were the key persons encouraging nurses to participate in this research and helped us to conduct our intervention. The second is that the nurses were highly motivated to learn and fully

Conclusions

The results of this study are promising and support the notion that the knowledge of all nursing staff about high-alert medications should be improved. Without changing complex hospital systems, this type of educational intervention can be offered to strengthen nurses' knowledge and such action might help to reduce nurses' medication errors. Although nurses may gain knowledge of pharmacology through daily practice, our research demonstrated that in a six-week period the knowledge about

Conflict of Interest

No conflict of interest has been declared by the authors.

Contributions

Study design: F-IT, M-CL, SY; data analysis: I-JC, M-CL, H-FW, K-WW and manuscript preparation: F-IT, SY.

Funding

This research was supported by the National Science Council (NSC99-2314-B-010-047).

Acknowledgement

We would like to thank RN staff nurses at Tri-service General Hospital for participating in this research. We would also like to thank Mr. Mark Rawson for editing our English.

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Nurses' knowledge of high-alert medications: A randomized controlled trial

Summary

Aim

Background

Methods

Findings

Conclusions

Introduction

Section snippets

Medication Errors and Administration Errors

Aim

Design

Sampling and Participants

Background Characteristics and Scores

Discussion of Methods: Sampling and Instrument

Conclusions

Conflict of Interest

Contributions

Funding

Acknowledgement

Joint Commission Journal on Quality and Patient Safety

Nurse Education Today

Journal of Emergency Nursing

American Journal of Infection Control

Medication errors observed in 36 health care facilities

Archives of Internal Medicine

Individual, practice, and system causes of errors in nursing: a taxonomy

Journal of Nursing Administration

The educational preparation of undergraduate nursing students in pharmacology: a survey of lecturers' perceptions and experiences

Journal of Advanced Nursing

An Organization with a Memory

Essentials of Education Measurement

Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital

Journal of Advanced Nursing

Continuing education needs of nurses employed in nursing facilities

Journal of Continuing Education in Nursing

An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program

Journal of Infusion Nursing