How to Use Nursing Simulation to Decrease Medication Errors
Healthcare simulation has been used by Associate Degree Nursing Program nursing students to increase safety and proficiency with medication administration. Pharmacology faculty of the program designed weekly nursing simulations to help learners apply and practice in the clinical simulation lab what was learnt in the classroom. Student nurses are often eager to give medications while on clinical rotation. Roman Jones et al. (2022) studied risk perception of student nurses and found learners fear medication administration errors. The students also expressed a desire for more opportunity to practice medication administration. Many clinical environments restrict some forms of medication administration, such as intravenous routes, for student nurses. This HealthySimulation.com article written by Kathy Sokol, MSN, RN, CHSE, discusses how to incorporate nursing simulation to improve medication administration safety.
The Classroom is Not Enough to Teach Nursing Students Medication Administration
Mandatory completion of a nursing pharmacology course alone does not guarantee the learner will be able to safely give drugs in the clinical environment. Classroom based education of the most common classifications of prescribed drugs provides a knowledge of actions, implications, adverse effects and nursing interventions. However, without hands-on administration practice prior to arrival at the healthcare facility, student nurses are more likely to perform more common medication errors. These include: dose omission, inaccurate time of the drug administration, incorrect dosage preparation, failure to monitor patient liver and renal function and incorrect IV push/drip rates. (Tariq et al., 2023).
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The Food and Drug Administration (FDA) estimates at least 100,000 medication errors are reported annually just in the United States (The Food and Drug Administration, 2019). Underreported near misses and incidents without patient complications can drive this number up. These errors can result in hospitalization, death, disability or birth defects. The FDA has extensive processes to insure drug safety. However, proper drug labels, adequate tests, provision of accurate prescriptions and patient information are only one piece of the medication safety puzzle. Providers, pharmacists and nurses share the heavy responsibility for safe, conscientious drug administration.
Student nurses learn under sometimes very stressful clinical conditions. A bad case of the nerves can lead to unintentional medication errors. In addition, if the learner is disorganized, careless, has poor focus or rushes through their medication pass the patient may suffer negative outcomes. Tariq et.al (2023) found two of the most common system failures for medication administration were a failure to obtain an accurate patient drug history and incomplete order checks. Both healthcare providers and nurses review the patient’s list of prescribed and over the counter drugs to check for accuracy, duplication of prescriptions and inconsistencies. Each time the nurse administers a drug, the current order is verified through the six rights of medication administration: right patient, right drug, right dose, right route, right time and right documentation.
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Healthcare Simulation to Teach Student Nurses Medication Administration
Recognition of the risk of student nurses progression into clinical practice without adequate preparation to safely administer medications is vital. A pharmacology clinical simulation lab component was added to an Associate Degree nursing curriculum. For thirteen weeks, learners participated in nursing simulations designed to help them gain experience and skill at medication administration.
The lab was set up with six practice stations. Each of twelve students worked with a partner to practice administration of medications to one another. Student nurses took turns to be the nurse or the standardized patient in the clinical simulation scenario. All learners were required to play both roles of student and patient in each session. One student nurse would practice as a student nurse that administered medications and the other would be in the role of standardized patient. Those in the standardized patient role did not actually swallow oral medications but were handed the tablets and capsules in a medication cup to simulate the live patient experience.
In the clinical simulation scenarios, injections and intravenous administration were performed on peripheral task trainers placed alongside the learner standardized patients body. The student nurse was expected to perform identification of the standardized patient with use of two patient identifiers. The student nurse provided patient education in the clinical simulation of medication administration.
In the pre brief for the clinical simulation, all learners reviewed the drug to be administered that day with the faculty facilitator. After the pre brief, learners went to their assigned station which was supplied with an assortment of medications and supplies. Examples of supplies included: paper cups, syringes, needles, alcohol wipes, cotton balls and various intravenous tube consumables. The student nurse selected appropriate medications and supplies dependant on the prescriber’s order. Each student nurse documents on a medication administration record (MAR).
If in the clinical simulation scenario the prescribed drug impacted the standardized patient’s lab values, a lab report was included for review. The learner patient wore an ID band with the patient’s name and date of birth. An allergy band was applied only if in the premedication assessment, the nurse discovered an allergy. Any required assessment such as pulse, blood pressure or check of a lab value was completed before any drugs were administered. If for any reason the standardized patient learner actually had abnormal vital signs, the student nurse recorded that information on the MAR and stated what they would do to follow-up.
At the end of each simulation day, a debrief was done with all the student nurses who participated as well as their faculty facilitator. At least two faculty were present throughout the clinical simulation to observe the students.
The semester weekly scenarios progressed from oral medication dose administration through subcutaneous and intramuscular injections, and included administration of intravenous push and piggyback drugs. Intravenous push is not a skill many healthcare facilities allow student nurses to perform even with a preceptor. Addition of this skill to the pharmacology course enables student nurses to have at least one experience with this method before they are expected to perform medication administration as a graduate nurse.
A summative final nursing simulation was given for a pass/fail grade. In the evaluation each learner administered an oral drug, subcutaneous injection, intramuscular injection, intravenous push and intravenous piggyback. The summative evaluation was timed to simulate real-world conditions. Learners who were not successful on their first attempt, performed remediation and were permitted one additional attempt.
Healthcare Simulation Faculty Noted Student Nurse Improvements
Clinical faculty were surveyed at the end of the term after the learners administered medications in a healthcare facility for the first time. Anecdotal comments were all positive. Faculty remarked how much better prepared the student nurses were. The group who participated in nursing simulation correctly gave medications with less prompts than was required by previous clinical groups.
Learners consistently performed pre-medication assessments without reminders. The learners who participated in pharmacology simulation, demonstrated greater proficiency with subcutaneous and intramuscular injections and intravenous pushes and piggybacks. Learners self-reported greater confidence in their medication knowledge and medical administration skills.
Most nursing simulation scenarios include the administration of medications. The downside is only one learner has the opportunity to perform the drug administration. The addition of weekly pharmacology simulation scenarios to the curriculum gives all learners a chance to practice safe, accurate medication medication in both the nursing administrator and patient role before they step to the bedside in a clinical environment.
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Kathy Sokol lived most of her adult life in Florida before “retiring” to Las Vegas. She has been a registered nurse for over 30 years and a nurse educator since 2005. Kathy has a masters degree in nursing education and earned Master Instruction certification from Chamberlain University College of Nursing.
She set up and managed simulation labs on several campuses throughout the country. Kathy collaborated on a course called Sim 101 to educate faculty on how to enrich student learning through simulation. In 2016, Kathy and her team did a presentation at IMSH on how to efficiently open a sim lab while saving time and money.
Kathy was initiated into Sigma Theta Tau International Honor Society. She was a nominee for the Daisy Faculty Nurse Award. She has been published in RN Magazine, is a regular contributor on LinkedIn and has an adult learning page on Facebook. She is currently working on a book about change.
Kathy lives in Las Vegas with her husband. She is a visiting professor at Chamberlain University College of Nursing.
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