1 Scholarly PAPER. Medication calculation competencies for registered nurses: a literature review AUTHORS Abstract Ms Karen Sherriff Objective RN, BN, MN (Hons), Cert Crit Care, Cert Coronary Care, To describe the literature that focuses on safe JP(Qual) administration of medications, Medication calculation Clinical nurse Research, Gold Coast Health Services skills development and maintenance of ongoing District, QLD, c/ Nursing Education and Research Unit, competence in nurses. Gold Coast Hospital, 108 Nerang Street, Southport, QLD, Australia. Setting University and hospital nurse education departments. Professor Marianne Wallis Subjects RN, BSc(Hons), Cert CardioThor Nursing, PhD Theoretical and empirical literature focusing on nurse Chair, Clinical Nursing Research, Griffith Health mediated Medication administration errors Institute and Gold Coast Health Services District, QLD, Primary argument c/ Nursing Education and Research Unit, Gold Coast nurse education departments devote a high proportion Hospital, 108 Nerang Street, Southport, QLD, Australia.
2 Of time to Medication calculation skill development and testing. Annual testing is time consuming for Ms Sarah Burston both nurse educators and nurses, and the validity, RN, BSc(Hons), MSc, Cert Burns & Plastics, Cert frequency, acceptable pass mark, self efficacy and Teaching & Assessing in Nursing Practice, Cert maintenance of skills related to Medication calculation Understanding & Application of Research testing is largely unclear. Assistant Director of Nursing, Education Programs, Conclusion Gold Coast Health Services District, QLD, c/ Nursing The theoretical literature focuses on drug Education and Research Unit, Gold Coast Hospital, 108. administration errors, development of tools and Nerang Street, Southport, QLD, Australia.
3 Techniques to improve nurses' Medication calculation skills and guidelines. There is considerable debate as to nurses' self perception of their arithmetical skills, their educational needs in this area and the KEY WORDS relationship between skill level and patient outcomes. Empirical literature focuses on the incidence of dosage calculation , patient safety, nursing, education, errors, evaluation of Medication calculation skills;. professional knowledge. the relationship between test results and errors, effectiveness of strategies to improve Medication calculation skills and Medication calculation testing and policy. Course content and delivery are thought to influence safe Medication administration.
4 However, there has been a lack of rigorous research demonstrating the efficacy of educational models. Several studies report low levels of calculation proficiency in nurses; however, it is unclear whether Medication calculation testing affects Medication administration error rates. Further research is required to determine the robustness of the current processes to assess nurses' Medication calculation competence and ensure optimal patient safety. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 28 Number 4 75. Scholarly PAPER. Introduction ameliorated is dosage error caused by calculation error (Leape et al 1995; Lesar et al 1997; Balas et al Promoting a culture of safety is a priority for healthcare 2004; Kopp et al 2006; Haw et al 2007).
5 Consequently providers today. International literature suggests nurse educators have assigned a significant amount Medication errors occur in all health care settings. of time and effort to assessing Medication calculation Adverse events, defined as incidents in which harm skills. In order to improve nursing competence in this resulted to a person receiving health care (AIHW. area clear evidence of the effectiveness of different 2007), include Medication errors. Medication errors educational or systems interventions is required. are defined as any preventable event that may cause or lead to inappropriate Medication use or AIMS. patient harm while the Medication is in the control of health professional, patient or consumer (National The aims of this review are to describe the literature, Coordinating Council for Medication Error Reporting both theoretical and empirical, that focuses on and Prevention 2008).
6 Of all hospital adverse factors affecting safe administration of medications, events, Medication errors are considered the most Medication calculation skills development and preventable (Williams 2007). Not only do they have maintenance of ongoing competence in registered an effect on patients and clinicians, they impact nurses. This review discusses the validity, frequency, significantly on patient length of stay and financial acceptable pass mark, self efficacy and maintenance cost to the health service. of skills related to Medication calculation testing. In Australia it is estimated that Medication errors METHODS. are responsible for 27% of adverse event deaths The literature was accessed through the online (Runciman et al 2003), and hospital studies bibliographic databases CINAHL and Medline using demonstrate that harmful Medication errors are the MeSH headings: Medication errors, registered reported in approximately 1% of all admissions nurses, dosage calculation , and mathematics.
7 (Wilson et al 1999; Runciman et al 2003). This Cochrane and Joanna Briggs Institute databases problem is not unique to Australia, Medication error were accessed to search for the existence of rates have similarly escalated in the United States systematic reviews related to Medication competency of America (USA) and United Kingdom (UK). In the and Medication error reduction. Articles were also USA over 7,000 deaths occur annually as a result sourced from citations in the reference lists of of Medication errors (Kohn et al 2000) with more retrieved articles. Articles selected included primary than 17% of these due to miscalculation of dosages research, academic reviews of literature, systematic (Bayne and Bindler 1988; Bayne and Bindler 1997.)
8 Reviews and papers containing current government Phillips et al 1998; Kohn et al 2000; Capriotti 2004;. statistics. Articles related to the performance of Greenfield et al 2006; Harne Britner et al 2006). Medication calculations were excluded. All articles There are limited data available from the UK, though were published in English and, with the exception it is broadly reported that Medication errors account of two research papers considered pertinent to for 10 20% of all adverse events, many of which are the topic, were no older than 13 years owing to the preventable (Smith 2004). fact that the focus on Medication safety has come The causes of Medication errors or Medication to the forefront since the mid 1990s (World Health adverse events can be grouped into system, Organization 2002).
9 One systematic review, one best environmental and human factors (Wilson et al practice sheet, 38 research articles, 20 theoretical 1999; Deans 2005). Whilst adverse events such articles (reviews, guidelines, discussion papers and as Medication allergy and anaphylaxis are largely opinion papers), three reports, two electronic sources unavoidable, one cause of Medication adverse and one book were included in this review. events, mediated by nurses, that may be able to be AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 28 Number 4 76. Scholarly PAPER. DISCUSSION reported nurses and student nurses found maths interesting and self rated their mathematical skills as Nurses' Medication calculation skills sufficient (Grandell Niemi et al 2003; Grandell Niemi Research studies have indicated that mathematical et al 2005).
10 Anxiety, negative attitudes and poor numeracy skills are evident in the nursing population at both Teaching Medication skills undergraduate (Bayne and Bindler 1988; Brown Basic Medication calculation education and testing 2002; Glaister 2005; Greenfield et al 2006; Jukes and have been included in undergraduate nursing Gilchrist 2006; Sredl 2006) and postgraduate levels programs since their inception, however, it has been (Bayne and Bindler 1988; Calliari 1995; Harne Britner suggested that differences in students' baseline et al 2006). A substantial number of articles have mathematical abilities, and not requiring mastery identified that many nurses lack sufficient skill to of calculation tests prior to graduation (Bayne and calculate drug dosages correctly (Bayne and Bindler Bindler 1988), have resulted in inconsistencies in 1988; Polifroni et al 2003; King 2004; Ferri and the Medication calculation skills of graduate nurses.)