Reducing Medication Administration Errors in Acute and Critical Care: Multifaceted Pilot Program Targeting RN Awareness and Behaviors.

OBJECTIVE: The aim of this medication safety pilot program was to increase RN sensitivity to potential error risk, improve behaviors, and reduce observed medication administration errors (MAEs). BACKGROUND: MAEs are common and preventable and may lead to adverse drug events, costing the patient and organization. MAEs are low visibility, rarely intercepted, and underreported. METHODS: An interprofessional team used process improvement methodology to develop a human factors-based medication safety pilot program to address identified issues. An observational time-series design study monitored the effect of the program. RESULTS: After the program, error interception practices during administration increased, and some nurses reported using a mindfulness strategy to gain situational awareness before administration. Process behaviors were performed more consistently, and the risk of MAE decreased. Familiarity and complexity were identified as additional variables affecting MAE outcome. CONCLUSIONS: Strategies to support safe medication administration may reduce error and be of interest to nurse leaders.

Outcomes Achieved Through Implementation of Interdisciplinary Plans of Care.

The process used to implement interdisciplinary plans of care on a pilot 32-bed stroke unit to meet Joint Commission requirements is described. Outcomes achieved as a result of the change also are reviewed.

Case-based online modules to teach graduate-level nursing students about complementary and alternative medical therapies.

We integrated complementary and alternative medicine (CAM)-related content into selected core courses in our master's-level curriculum. To facilitate students' application of the content, we developed evidence-based online case studies and evaluated their effectiveness by comparing students' pretest and posttest scores on multiple-choice quizzes. Findings suggest that evidence-based online case studies are an effective strategy for teaching graduate nursing students about the clinical issues surrounding patients' use of CAM therapies.

Knowledge of palliative and end-of-life care by student registered nurse anesthetists.

As part of a 5-year study funded by the National Cancer Institute, all graduate nursing students, including student registered nurse anesthetists (SRNAs) participated in a 2-credit-hour course called Interdisciplinary Palliative Care. Medical and health science students also participated in the course, with more than 800 students completing the course to date. The sample consisted of 62 master's-level students enrolled in either the first or second year of the nurse anesthesia program. A pretest-posttest design was used to determine changes in palliative care knowledge and perceived effectiveness in palliative care skills. There was an overall improvement in knowledge and attitudes related to course content. Students reported that, through the development of new knowledge, they felt better able to care for and advocate for their patients. Further research is needed into the appropriate roles that Certified Registered Nurse Anesthetists (CRNAs) can play in palliative and end-of-life care.

A decision algorithm for admitting students to advanced practice programs in nursing.

The academic records of 738 master's-level nursing students were reviewed to develop an optimal compound decision rule for selecting candidates who would be successful in advanced practice programs. Chi-square analysis was used to establish the association between various combinations of independent variables and dismissal status. Independent variables included cumulative grade point average (CUMGPA), undergraduate nursing grade point average (NSGGPA), and Graduate Record Examination (GRE) scores (quantitative and verbal). Results indicated that the combination of any two independent variables was as predictive of success as was any combination of three independent variables and that the combination of a CUMGPA of 3.25 and NSGGPA of 3.0 predicted success in 99% of the cases. The addition of the GRE scores added no additional predictive value. On the basis of these analyses, we waived the GRE requirement for applicants who met the GPA criteria and developed decision rules for admitting those who did not.

Optimizing evaluation of nursing education programs.

Program evaluation data must be meaningful, credible, objective, and responsive. The content, inputs, process, and product model provides an effective and useful framework for organizing the evaluation process. The model is a decision/accountability-oriented approach that emphasizes both proactive and retroactive evaluation to assess program improvement and quality. The authors describe the steps used in developing an evaluation plan to address undergraduate, graduate, and specialty standards and to serve as a framework for data collection, decision-making, continuous quality improvement, and demonstration of outcomes.

Preventing and managing dehydration.

Sufficient body water and electrolyte homeostasis are essential for healthy physiologic functioning. Nurses are key to preventing, detecting early, and treating fluid and electrolyte imbalances. Dehydration significantly alters both physical and psychological functioning, and older adults are at increased risk. Identifying fluid disorders early can prevent complications and reduce hospital stays. Understanding the mechanisms of fluid homeostasis enables nurses to assess, prevent, and collaborate in managing isotonic, hypertonic, and hypotonic dehydration.