Background : Nursing students are at risk for committing medication administration errors (MAEs), which significantly alter the delivery of safe and effective healthcare. Purpose: To identify the medications most frequently involved in medication errors as reported by Jordanian nursing students, as well as to identify the level of nursing students’ adherence to best-practice when administering high-risk medications. Methods: A cross-sectional design was used among a convenience sample of 74 nurses. Results: A total of 74 of 110 (67.3%) questionnaires were returned. The most frequent medications subjected to MAEs were Dopamine, Dobutamine, and Insulin continuous intravenous infusion (17.2%, 16.0% and 13.5% respectively). Regarding the adherence to best-practice, nursing students adhered the most to the following best-practices: checking the patient armband prior to medication administration with a mean of 3.81 (±0.6) and bringing the MAR sheet with them when preparing a medication with a mean of 3.46 (±1.1). Conclusion: Developing an effective medication training programs in all undergraduate nursing programs in Jordanis is vital to ensure patient safety. Nursing educators in clinical and academic settings need to reinforce the importance of adherence to medication management best-practice in all courses. Close and effective supervision of students needs to be maintained throughout nursing students’ clinical training, especially during medication preparation and administration.
Medication management is a high-risk, high-frequency nursing task in everyday practice [
Medications are part of the patient treatment plan, and appropriate management is critical to ensure patient safety [
Many international studies have been conducted to measure the incidences, causes and contributing factors to Medication Administration Errors (MAEs) among nursing students. These studies have concluded that the incidence of MAEs among nursing students was surprisingly high and frequently occurred [
In their fourth year of education, undergraduate nursing students at the University of Jordan become more independent in their clinical training and practice without constant supervision from their clinical preceptors. In their last semester, students work 52 shifts in their preferred clinical area shadowing the bedside registered nurses. The transition from directly supervised clinical training to independent self-directed bedside training exposes patients to medication errors committed by nursing students.
Therefore, the aim of this study was to identify the medications most frequently involved in MAEs as reported by Jordanian nursing students. In addition, a secondary objective of this study was to identify the level of nursing students’ adherence to best-practice when administering high-risk medications.
This cross-sectional study was conducted from December 2016 to December 2017 after approval by The University of Jordan―School of Nursing Institutional Review Board. Based on a G × Power analysis [
The first section of the used questionnaire collected demographic data from nursing students, which included the following information: student age, gender, hospital type, clinical training unit, and type of high school diploma earned. The second section asked nurses to list the most frequent medications they have difficulties with during medication management (preparing, calculating, mixing or administrating). The third section asked for nurses to use a 5-point Likert scale format from 1 = never to 5 = always to rank their adherence to best-practice when administering high-risk medications, factors that promoted compliance with the protocol, factors that could increase the risk of medication error, the extent of their familiarity with the protocol, and confidence with the protocol [
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. (SPSS Inc., Chicago, IL, USA). Data were presented using mean, percentage, standard deviation, and proportion for categorical variables.
1) Sociodemographic characteristics
A total of 110 questionnaires were disseminated and 74 of those were returned (67.3% response rate).
2) The most frequent medication involved in MAEs as reported by Jordanian nursing students:
Nursing students reported that the medications most frequently subjected to MAEs during medication management (preparing, calculating, mixing, or
Sociodemographic variable | Number (%) | Mean (SD) |
---|---|---|
Age (in years) | 22.4 (±0.66) Range (22 - 24) | |
Gender | ||
Female | 59 (79.7%) | |
Male | 15 (20.3%) | |
Clinical training Hospital type: | ||
Governmental | 34 (45.9%) | |
Private | 19 (25.7%) | |
Teaching | 21 (28.4%) | |
Clinical training unit: | ||
Medical floor | 11 (14.9%) | |
Surgical floor | 16 (21.6%) | |
Intensive Care Unit (ICU) | 25 (33.8%) | |
Emergency Department (ER) | 8 (10.8%) | |
Maternity | 4 (5.4%) | |
Pediatric floor | 2 (2.7%) | |
Others | 6 (8.1%) | |
2 (2.7%) | ||
Type of high school | ||
Scientific | 67 (90.5%) | |
Health | 7 (9.5%) |
administering) were Dopamine, Dobutamine, I.V. Insulin, Potassium chloride, Heparin I.V. infusion, S.Q. insulin, Morphine, Amiodarone, Gentamicin and Chemotheray, in respective order of frequency. More details can be found in (
3) Adherence to best-practice when administering high-risk medications:
Nursing students adhered the most to the following aspects of best-practice: checking the patient armband prior to medication administration with a mean of 3.81 (±0.6) and bringing the MAR sheet with them when preparing a medication (mean 3.46 (±1.1)). One of the primary areas of interest in this study was examining the level to which nursing students adhered to best-practice during the medication management process. However, students also reported participating in practices that increased the risk for medication errors such as: preparing and carrying medications for more than one patient at the same time with a mean of 3.66 (±0.8), and administering medication that another nurse has prepared with a mean of 3.22 (±1.4) (
This study is the first study conducted on nursing students’ MAEs in Jordan.
Medications most frequently involved in MAEs (n = 74 ) | Number | Percentage (%)* |
---|---|---|
Dopamine (Intropin) | 28 | 17.2% |
Dobutamine (Dobutrex) | 26 | 16.0% |
Insulin Intravenous (IV) continuous infusion | 22 | 13.5% |
Potassium chloride (KCL) | 20 | 12.3% |
Heparin I.V. continuous infusion | 18 | 11.0% |
Insulin Subcutaneous (S.Q) injection | 16 | 9.8% |
Morphine | 12 | 7.4% |
Amiodarone (Cordarone) | 9 | 5.5% |
Gentamicin (Gentamicin) | 8 | 4.9% |
Chemotherapy | 4 | 2.4% |
*The number of medications most frequently involved in MAEs exceeds the sample size number since each nurse had the chance to report up to 10 medications.
Best-practice behavior: | Mean (SD) |
---|---|
Do you check the patient’s armband prior to administer medication? | 3.81 (±0.6) |
*Do you prepare and carry medications for more than 1 patient with you at a time? | 3.66 (±0.8) |
Do you label the medication cup with the patient’s name & room number? | 2.94 (±1.2) |
Do you bring the Medication Administration Record (MAR) sheet with you when you prepare a medication? | 3.46 (±1.1) |
Do you label syringes and infusions with the medication, name, patient name, and room number? | 3.15 (±1.2) |
*Do you administer medication that another nurse has prepared? | 3.22 (±1.4) |
Do you have unusual doses independently-double checked by another nurse? (e.g: heparin) | 3.06 (±1.1) |
Do you have insulin doses independently-checked by another nurse? | 3.16 (±1.0) |
Do you check the patient allergies before administering medication? | 3.38 (±1.4) |
Do you have a direct supervision from the bedside Registered Nurse (RN) while preparing and administering medications? | 2.84 (±0.6) |
*Negatively stated behaviors, reverse coded in the analysis.
Among the 74 students who participated in this study, 48 (64.9%) declared to have committed at least one MAE during their undergraduate education period. The relatively moderate rate of reported MAEs among nursing students in this study could be even higher. Underreporting may be caused by students’ unwillingness to admit error due to a fear of receiving a low grade [
In Jordan there are no systems or policies for reporting MAEs, and hospitals do not usually disclose the actual rate of MAEs for fear of affecting their reputations. The Jordanian healthcare system is composed of 65 private hospitals, 15 military hospitals, 32 governmental hospitals, and two university-affiliated teaching hospitals [
1) Adherence to best-practice when administering high-risk medications:
a) Checking patient ID
There are variations in the literature regarding the compliance with checking patient ID among bedside registered nurses. Gill et al. [
b) Bringing the medication sheet (MAR) when preparing the medication
The second highest reported practice prior to administering medications was bringing the medication sheet (MAR) when preparing the medication. Even though this practice is an essential part of medication administration protocol, there are still a significant portion of nursing students who are noncompliant with this best-practice protocol. The significance of bringing the MAR sheet to the medication room or patient room prior to medication administration was not investigated in any previous studies.
c) Double checking
There are very few studies that have investigated the issue of double checking prior to medication administration, and no studies investigated that issue as it relates to nursing students. In this study, there were two items asking nursing students about the practice of double checking: “Do you have unusual doses independently-double checked by another nurse?” and “Do you have insulin doses independently-checked by another nurse?” The level of adherence to these two practices was on the average level of mean 3.06 ± 1 and 3.16 ± 1.0 consecutively.
Again, there are controversies in the literature on the significance of double checking. Armitage [
d) The availability of direct bedside nursing supervision
The majority of nursing students in this study reported the absence of a bedside nurse’s direct supervision during medication management. This could be explained because nursing instructors from the schools of nursing have a large number of students in the same clinical area or in different scattered areas. Therefore, students may be administering medications on their own, or they may have been given the authority to do so by the bedside registered nurse.
This result was not surprising, Reid-Searl et al. [
2) The most frequent medication involved in MAEs as reported by Jordanian nursing students.
All research studies that have investigated the levels of medication knowledge and MAEs have been conducted on bedside nurses with a wide variety of experiences. No studies were found that have assessed the medications most frequently subjected to MAEs among nursing students. Therefore, the discussion of our results will be compared to results from studies conducted on bedside RNs.
In an investigation of intravenous medication (I.V.) medication error events among critical care nurses, Bagheri-Nesami et al. [
Based on the researcher literature search this is the first study to investigate the medication error among Jordanian nursing students. Keeping in consideration that this study was conducted on students studying at the University of Jordan - School of nursing only, other students at other nursing programs in different Jordanian universities were not included in this study. In addition, fear of receiving a low grades may have been contributing to non-reporting the MAEs in some students. Subsequently, the issue of MAEs among Jordanian nursing students may be greater than reported in this study. Finally, the findings must be considered in the context of self-reported recalled medication error during clinical training period, which extends over three years. Therefore, it may not be appropriate to generalize the findings to different educational settings.
The findings of this study suggested that Jordanian nursing students are at high risk of committing MAEs. In addition, it found that noncompliance with medication administration best-practice was widely prevalent among nursing students.
This study provides nursing educators in both academic and clinical settings with a better understanding of the weaknesses that nursing students have in medication management. This study also provides invaluable knowledge about the level of nursing students’ adherence to medication management best-practice. Moreover, the results of this study should guide nursing educators to reinforce students’ clinical training on pharmacology, policy, and procedures of medication management.
Having a well-organized clinical training program on medication management as well as reinforcing a high level of supervision in all Jordanian undergraduate nursing programs is paramount to ensure high quality nursing preparation that maintains patients’ safety.
This research was supported and sponsored by The University of Jordan.
Salami, I. (2018) Nursing Students’ Medication Errors and Adherence to Medication Best-Practice. Open Journal of Nursing, 8, 281-291. https://doi.org/10.4236/ojn.2018.85024
Section I. Medication Administration Practice Questionnaire.
Section II. Medication Administration practice.