This experimental pilot study was aimed at the development of a quality standard to facilitate medication administration error detection, prevention, and reporting among pre-licensure baccalaureate nursing students. Based on both the literature review and peer review, sequential steps of the medication administration process were identified, bundled, and anchored in the mnemonic, C-MATCH-REASON, to form a new inquiry-based paper checklist that pairs clinical reasoning with rule adherence. The Checklist (independent variable), for nursing student utilization, was accompanied by an error tracking instrument (Observation Form) for nursing faculty (raters) to measure medication errors committed, recovered, and reported. Reason’s (1990) error theory was applied to measure errors (dependent variable).
The hypotheses examining pre-licensure nursing students’ processing of performance and system related errors included that the participants who utilized the C-MATCH-REASON checklist compared to those in a no-checklist control condition, individually and collectively would: (1) report more medication errors; (2) demonstrate greater rule adherence; (3) commit fewer skill-based errors; (4) commit fewer knowledge-based errors; (5) commit fewer confirmation bias errors; and (6) commit fewer errors in total.
A simulation environment with a 2x2 crossover design (two experimental groups and two practice periods) was utilized to conduct the study. The participants were randomly assigned to a crossover sequence AB or BA (A = checklist intervention and B = no-checklist control condition). Medication administration practice in both experimental conditions equalized the learning experience. Also, two peer-reviewed medication administration scenarios of equal difficulty were developed. Each scenario contained three embedded errors and an answer key for consistency with error tallying among the raters. To assess the reliability and validity of the Observation Form, traditional and video-recorded instruction were utilized, and interrater agreement was established among the raters. A rubric, comprised of sub-scores that made up a Global Medication Administration Error Total Score for each scenario, was used by the researcher to total the data collected. Scenario One scores ranged from 0 to 78. Scenario Two scores ranged from 0 to 73. A Just Culture was applied to the simulation setting to facilitate error reporting (Frankel, Leonard, & Denham, 2006).
Final analysis included empirical data collected from 19 participants by two raters. SPSS® V25.0 was utilized for all analyses related to the study. The Chi Square Test was conducted to analyze demographic differences among the experimental groups, which were determined to be balanced. Nonparametric tests were chosen because the sample was small (Kachigan, 1986). The Kruskal-Wallis test for independent samples and the Wilcoxin matched-pairs signed rank test were generated to analyze differences among continuous variables and assess learning across two periods. Debriefing was provided to elicit reflection.
The empirical findings, from Period One, support the use of the C-MATCH-REASON checklist for rule adherence (p = 0.005), knowledge-based error reduction (p = 0.010), confirmation bias error reduction (p = 0.014), and the reduction of Total Errors (p = 0.010). The null hypothesis was not rejected for embedded errors found (p = 0.061) nor Total Error Reporting (p = 0.254). Participant feedback from both periods identified that the C-MATCH-REASON checklist facilitated clinical reasoning, error awareness, and learning. All participants and raters endorsed the continued use of the instruments.
|Commitee:||Kelman, Glenda B., Van Patten, Rosemarie R.|
|School:||Sage Graduate School|
|Department:||School of Health Sciences|
|School Location:||United States -- New York|
|Source:||DAI-A 82/1(E), Dissertation Abstracts International|
|Subjects:||Nursing, Health education|
|Keywords:||Baccalaureate nursing students, Checklists, Medication Administration Errors|
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