175CHAPTER 17
Medication Administration
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
Medical and medication errors lead to more than 400,000 deaths per year (Makary & Daniel, 2016). Between 49% and 53% of new nurses (less than 1 year of experience) will make a medication error (Zimmerman & House, 2016). Causes for medication errors include miscommunication among health care providers, workload issues, lack of knowledge about the medication, failure to complete medication administration safety checks, look-alike/sound-alike medication names, rights, transcription errors, poor mathematical skills, distractions during medication administration, and dispensing errors from pharmacy (Leufer & Cleary-Holdforth, 2013). Nursing students report not feeling adequately prepared in the area of medication administration and safety due to lack of practice in the lab setting, limited opportunities to administer medication in the clinical setting, and lack of confidence in linking theoretical to practical learning (Vaismoradi, Jordan, Turunen, & Bondas, 2014). All of these factors attest to the importance of educating our students on safe medication practices to promote patient safety.
In an effort to provide students with additional practice of this essential nursing skill, the Clinical Simulation Learning Center (CSLC) required completion of one medication scenario for each student during their second, third, and fourth semester. These scenarios were developed in collaboration with the faculty teaching the course and the simulation staff. The scenarios are synchronized with lecture content and each semester the simulations increase in complexity. Students must successfully demonstrate selected critical criteria during the scenario in order to successfully pass the simulation. If students miss any of the critical criteria, they are required to attend a 1-hour remediation session.
The scenario presented in this chapter was based on a recommendation by the pharmacology professor to develop a scenario involving a patient having an allergic reaction to a prescribed medication.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALTY
New York University (NYU) Meyers College of Nursing’s CSLC is designed to simulate the hospital and outpatient environment for both undergraduate and graduate students. The CSLC allows students to enhance their clinical skills and nursing knowledge in a safe learning environment. Our cutting-edge simulation center is larger than 10,000 square feet and consists of 21 simulation rooms to simulate medical–surgical rooms, outpatient examination rooms, and the 176home environment—all with video-recording capability. The CSLC is currently equipped with close to 30 human patient simulators (HPSs), including SimMan® 3G, Birthing Noelle, mid-fidelity manikins, and five pediatric manikins. In addition to the HPSs, the CSLC has a database of more than 20 diverse standardized patients (SPs) who are used for almost all graduate simulations and selected undergraduate simulation sessions. Each week more than 100 simulations sessions are conducted at the CSLC for more than 1,200 undergraduate BSN and graduate MSN students.
This scenario takes place in a simulation room with six beds, each of which has an over-the-bed table and bedside cabinet, with a diagnostic station above each bed. There are three workstations on wheels that contain patient mediations and a laptop computer for patient charting. In addition, there is a laptop and patient monitor at each bedside. Tablets are used for viewing of a video report on the patient and also used to evaluate each student.
C. SPECIFIC OBJECTIVES FOR SIMULATION WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
Specific course outcomes met with this scenario:
1. Prioritize increasingly complex evidence-based plans of care to achieve identified patient outcomes and set priorities
2. Reflect on client responses to nursing interventions in order to evaluate patient outcomes and care delivery
3. Advocate for high-quality safe and culturally competent patient-centered care for adults and older adults with common, increasingly complex, acute, and chronic health problems
Undergraduate program objectives:
1. Provide safe, high-quality nursing care using principles of leadership, quality improvement, and patient safety to improve patient outcomes
2. Integrate health-promotion and disease-prevention strategies across diverse settings and vulnerable populations to address health disparities and population health
3. Implement realistic patient-centered plans of care reflecting the variations and complexity of patients across the life span in all environments
4. Manage data and influence information technology to support the delivery of high-quality and safe patient care
Student Learning Activities
This postop orthopedic medication simulation was created for second semester upper division nursing students. During this orthopedic medication simulation the student is responsible for:
1. Reviewing the patient’s chart using an electronic health record (EHR) system
2. Performing a focused physical assessment
3. Reviewing each medication using an appropriate drug resource guide
4. Performing appropriate nursing interventions based on the medication to be administered
5. Preparing the medication
6. Performing a three-way check
7. Charting the administration of the medication
8. Reassessing the patient after medication administration as needed
177D. INTRODUCTION OF THE SCENARIO
Setting the Scene
The simulation takes place in the simulation center. The patient is currently on an orthopedic floor. The student receives the patient’s report by viewing a videotaped report that is watched on a tablet and is expected to write down the report using a shift change report form provided in the room.
Technology Used
Each simulation is recorded using a simulation capture system. Tablets are used to complete an electronic evaluation tool that is later emailed to students after completion of the simulation. A simulated EHR system is used to create a chart for the patient. A workstation on wheels is used to store patient medication and includes a laptop to access the EHR system. A smart intravenous (IV) pump is used to administer antibiotics and IV fluids.
Objectives
The overall objective of the simulation is for students to safely administer medication by doing the following:
1. Perform focused assessment before medication administration
2. Demonstrate accurate medication administration skills using the six (rights) and three medication checks
3. Evaluate the patient response to treatment
4. Report any abnormal findings to the health care provider
5. Document administration of medication using the EHR system
Description of Participants
Implementation of our medication simulation involves two SPs and one faculty member to oversee the process. Mid- or high-fidelity manikins can be used in place of an SP. The SP will play the role of the patient, evaluator, and provide feedback to the student as part of the debriefing process. The faculty member’s role is to orient the student to the simulation, ensure the SP is evaluating the student accurately, and provide final results (pass or fail) at the end of the session. The simulation staff prepare all necessary documentation for each scenario, create the patient’s chart, and provide SP training for all medication simulations before the start of the semester.
E. RUNNING OF THE SCENARIO
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