Identification of Systems Improvement for Medication Administration During Pediatric Emergencies

2.50
Hdl Handle:
http://hdl.handle.net/10755/162702
Type:
Presentation
Title:
Identification of Systems Improvement for Medication Administration During Pediatric Emergencies
Abstract:
Identification of Systems Improvement for Medication Administration During Pediatric Emergencies
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Hohenhaus, Susan, MA, RN, FAEN
P.I. Institution Name:Hohenhaus & Associates, Inc.
Title:President
Contact Address:, Wellsboro, PA, 16901-, USA
Co-Authors:Sue Cadwell, BSN, RN; Nancy Sears-Russell, RN, MS
Purpose: To identify and characterize areas for improvement in the clinical performance of nurses in relation to pediatric medication administration.

Design: Prospective, randomized controlled trial.

Setting: Four geographically distinct hospitals of a corporate healthcare system in four regions of the U.S including one urban children?s hospital and three community hospitals.

Participants/Subjects: Registered nurses were randomized to control or study group. Human subject protection was obtained through institutional review board approval at the corporate level as well as at each individual hospital.

Methods: Emergency Nurses participated in a videotaped low-fidelity simulated pediatric resuscitation/stabilization event in their emergency clinical unit. Clinical performance was evaluated at each of the following steps: (1) methods used to calculate/convert medication dose; (2) selection of correct medications; (3) proper preparation of the medication; and (4) measurement of medication doses. Nurses were allowed to use any resources they wished (drug books, calculators, other clinicians).

Results: A total of 53 nurses were each given five pediatric emergency medication orders (dextrose, fosphenytoin, phenytoin, lorazepam, and ceftriaxone). Calculation methods noted included: 94% used some type of handwritten method to derive medication calculations; 91% chose to write on a paper towel; 96% used a common calculator for at least one calculation. Most common errors observed were: 40% error rate for reconstitution of ceftriaxone; 23% chose one wrong medication (sound alike drugs); 42% of dextrose was incorrectly calculated. 42% of medication orders that were drawn up in a syringe had amounts measured not consistent with the stated dose. In addition, pediatric emergency "carts" were noted to lack standardization as well as common pediatric medications.

Recommendations: By observing the clinical performance of nurses in a simulated videotaped pediatric stabilization event, we have identified some important areas in need of improvement in each step of the medication administration process. These findings indicate a need for improved systems that assist the nurse in preparing and administering pediatric medications, including standardized ordering and safe medication packaging, enhanced pediatric medication delivery education and training, revision and standardization of pediatric resuscitation medication "drawers" and use of clinical aids or adjuncts for nurses caring for emergency pediatric patients.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleIdentification of Systems Improvement for Medication Administration During Pediatric Emergenciesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162702-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Identification of Systems Improvement for Medication Administration During Pediatric Emergencies</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hohenhaus, Susan, MA, RN, FAEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Hohenhaus &amp; Associates, Inc.</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">President</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Wellsboro, PA, 16901-, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">shohenha@ptd.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Sue Cadwell, BSN, RN; Nancy Sears-Russell, RN, MS</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To identify and characterize areas for improvement in the clinical performance of nurses in relation to pediatric medication administration.<br/><br/>Design: Prospective, randomized controlled trial. <br/><br/>Setting: Four geographically distinct hospitals of a corporate healthcare system in four regions of the U.S including one urban children?s hospital and three community hospitals.<br/><br/>Participants/Subjects: Registered nurses were randomized to control or study group. Human subject protection was obtained through institutional review board approval at the corporate level as well as at each individual hospital.<br/><br/>Methods: Emergency Nurses participated in a videotaped low-fidelity simulated pediatric resuscitation/stabilization event in their emergency clinical unit. Clinical performance was evaluated at each of the following steps: (1) methods used to calculate/convert medication dose; (2) selection of correct medications; (3) proper preparation of the medication; and (4) measurement of medication doses. Nurses were allowed to use any resources they wished (drug books, calculators, other clinicians). <br/><br/>Results: A total of 53 nurses were each given five pediatric emergency medication orders (dextrose, fosphenytoin, phenytoin, lorazepam, and ceftriaxone). Calculation methods noted included: 94% used some type of handwritten method to derive medication calculations; 91% chose to write on a paper towel; 96% used a common calculator for at least one calculation. Most common errors observed were: 40% error rate for reconstitution of ceftriaxone; 23% chose one wrong medication (sound alike drugs); 42% of dextrose was incorrectly calculated. 42% of medication orders that were drawn up in a syringe had amounts measured not consistent with the stated dose. In addition, pediatric emergency &quot;carts&quot; were noted to lack standardization as well as common pediatric medications.<br/><br/>Recommendations: By observing the clinical performance of nurses in a simulated videotaped pediatric stabilization event, we have identified some important areas in need of improvement in each step of the medication administration process. These findings indicate a need for improved systems that assist the nurse in preparing and administering pediatric medications, including standardized ordering and safe medication packaging, enhanced pediatric medication delivery education and training, revision and standardization of pediatric resuscitation medication &quot;drawers&quot; and use of clinical aids or adjuncts for nurses caring for emergency pediatric patients.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:41Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:41Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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