RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA BANGALORE.
ANNEXURE –II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the candidate and Address / Mrs. SHERLY VARGHESEIST YEAR M.Sc. NURSING
S.C.S COLLEGE OF NURSING SCIENCES
KECT TOWER
ASHOKNAGAR
MANGALORE.
2 / Name of the Institution / S.C.S. COLLEGE OF NURSING SCIENCES
ASHOKNAGAR,
MANGALORE.
3 / Course of Study and Subject / M.SC. NURSING
MEDICAL SURGICAL NURSING
4 / Date of admission to the course / 15-06-2009
5 / TITLE OF THE STUDY:
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON MEDICATION ERROR AMONG STAFF NURSES WORKING IN A SELECTED HOSPITAL AT MANGALORE.
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7 / Brief Resume of the Intended Work
Introduction:
Patient safety is very important in the provision of quality care. The patient who is to be cured or cared for is to be at the centre of the care process without which the objective of care will not be achieved. As care givers attempt caring the sick, they inadvertently make mistakes that either worsen the situation of the patient or result in death. These errors are inevitable but with acknowledgement of the possibility of the incidence of errors in the care process, it could be reduced to the minimum.1
Medication error is any preventable error in the medication administration process starting from prescribing including preparing, dispensing, administrating and transcribing. . Medication errors are not only significant clinically but may also have serious economic and legal consequence like extended hospital stay, additional treatment and diagnostic evaluation. 2
Nurses are frequently recognized as the “last line of defense” in the prevention of medication errors. The nurse provides the final check prior to the patient receiving medication. Therefore to have knowledge about common medication errors and its prevention is very important for the nurses in their professional practice.3
6.1 Need for the study
Safe nursing practice includes an understanding of the legal boundaries in which nurses must function. In 1986 the Government of India passed the Consumer Protection Act (CPA) to protect the consumer against unreasonable practices which create risk or harm. One of the common sources of negligence that have resulted in lawsuits against hospital and nurses is medication error. Therefore nursing students, during their training period should be made aware of the CPA.Continuing education programme through workshops, conferences and in service education will refresh the knowledge and create awareness among nurses about safe nursing practice.4
In India, the statistical figure shows 400,000 deaths due to adverse drug reactions and 720,000 adverse events per annum. Several suggestions are made for reducing medication error. One of the suggestions is to give training to doctors, nurses and other staff in safe practice. In the United States annually, medication errors responsible for 180,000 deaths – the equivalent of three jumbo –jet crashes every 2 days. Adverse drug reactions are the fourth most common cause of death in US accounting for more than 100, 000 deaths per year.5
With medical errors continuing to pose 100 times greater risk to human lives than encounters in the nuclear power industry , India now woke up to urgency of patient safety. By launching the National Patient Safety Policy, India took the first step towards making hospitals safer.6
A study was conducted in a general hospital in Delhi over a period of six months to analyze the medication errors because of the look alike and sound-alike brand names confusion. Results of the study shows most commonly brand name confusion is seen with almost identical brand names for combination drugs (84.01%). Such type of errors could be dangerous and also increase the cost of therapy and unnecessary exposure of the patient to more drugs and their side effects. Brand name confusion could be prevented by strict adherence to the hospital drug formulary.7
A medication safety education programme was developed and implemented in California to reduce the harm caused to patients by medication errors. Participants completed two 30-minute computer modules focusing patient safety. Changes in the nurse’s knowledge and behavior were evaluated before and after completion of the education programme.A statistically significant change in knowledge regarding medication errors occurred. It was concluded that there was a need for strong administrative support and follow up to foster changes in behaviour, which can lead to reduction in harm caused by medication errors.8
With the growing reliance on medication therapy as the primary intervention for the most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits. With inadequate nursing education about patient safety and quality, excessive workloads, illegible provider handwriting, flawed dispensing systems and problems with the labeling of drugs, nurses are continually challenged to ensure that their patients receive the right medication at the right time.9
Even though much care is taken by nurses for administration of medication still medication errors challenge patient’s safety during their stay in the hospital. Many studies reveal that education programmes can help the nurses to increase their awareness regarding mediation error. Thus the investigator feels that a self instructional module on medication error could be useful in providing knowledge to the staff nurses to prevent medication errors in their working conditions.
6.2 Review of literature
Review of literature is a systematic identification, location, scrutiny and summary of written materials that contain information on research problem. 10
A prospective study was conducted in a public hospital in India to determine the nature and types of medication prescribing errors in an Indian setting. 304 patients were included in the study. Out of the 304 cases, 103(34%) cases had at least one error. The incorrect dosing interval contributed maximum (61.8%) to the total errors. The results points to the establishment of medication error reporting at each hospital and to share the data with other hospitals.11
A study was conducted at Al Ain hospital UAE, by the department of pharmacy and department of nursing. The objective was to design and implement an educational programme to raise the awareness of nursing staff about medication errors.A sample of in-patient nursing staff(n=370) was included and a structured questionnaire was used to assess knowledge on medication errors. The study concludes that the structured educational programme has significantly improved knowledge of the in-patient nursing staff from 57.4% to 68.9% in terms of raising their awareness about medication errors.12
An exploratory study on tracking and reporting medication error was done at a tertiary care hospital at Pakistan. Important findings show that the main error rate was 5.5%. Pharmacy contributed to a higher error rate of 2.6%, followed by nursing 1.1% and physicians 1%. Recommendations of the study are to consider medication usage as a high risk area and tracking errors should be an indicator for all nursing units.13
A study was conducted on role of registered nurses in error prevention, discovery and correction of medication errors at the University of Pennsylvania USA. Daily logbooks were used to collect information about errors discovered by a random sample of 502 critical care nurses during a 28-day period. Procedure errors were common; charting and transcription errors were less frequently discovered. Results of the study revealed the importance of nurses in maintaining patient safety. Future studies should identify factors that enhance the effectiveness to prevent, intercept and correct medication errors.14
A retrospective study of mediation errors was conducted in LDS hospital Utah, USA. From a complete list of cancer chemotherapy regimens, they randomly selected 200 for review and compared written order with the records. Results shows the 21% of the reported errors resulted form incorrect orders being recorded in the physician written order and or the medication administration record. 38% of the errors resulted from incorrect pharmacy or nurse dispensing of a correctly ordered medication. 41% of the errors resulted from incorrect administration of a medication that had been correctly ordered and dispensed. 15
A prospective study on medication administration errors was conducted in a community hospital in USA. During the study period 141 medication administration errors were reported. 21% of these were order writing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. An emphasis on studying medication administration errors at institutions is likely to result in meaningful process changes and improve efficiency of medication error reporting. 16
A study was conducted in Dublin on factors contributing to medication errors. The reviewer listed the contributing factors for mediation errors as poor mathematical skills of the nurses, lack of nurse’s knowledge on medications, length of nursing shifts, workload and staffing levels, nursing care and medication delivery system, single nurse drug administration, weak policy and procedures, distraction and interruption and quality of prescription. It is important that the nurse educators provide in services education to nurses relating to medications. 17
6.3 Statement of the problem
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON MEDICATION ERROR AMONG STAFF NURSES WORKING IN A SELECTED HOSPITAL AT MANGALORE.
6.4 Objectives
1. To assess the knowledge of staff nurses regarding common medication errors.
2. To develop and administer a self instructional module on medication errors.
3. To evaluate the effectiveness of self instructional module on medication errors in terms of gain in post test knowledge scores.
4. To find the association between pretest knowledge scores with selected demographic variables.
6.5 Operational Definition
Effectiveness:
In this study, effectiveness refers to determining the extent to which the self instructional module has achieved the desired effect and is measured in terms of gains in knowledge scores.
Self Instructional Module:
In this study, self instructional module refers to self contained written material which can be used by the staff nurses for self learning on medication error.
Medication Error:
In this study, medication error refers to inappropriate medication administration due to miscommunication, name confusion and labeling.
Staff Nurses:
In this study, staff nurses refer to registered nurses who have undergone General Nursing and Midwifery course.
6.6 Assumptions
The assumption of the study is:
1. Staff nurses will have less knowledge regarding medication error.
2. Self instructional module will enhance the knowledge of staff nurses regarding medication error.
6.7 Delimitations
1. Staff nurses who are working in a selected hospital at Mangalore.
2. Staff nurses who are registered in state nursing council.
6.8 Hypothesis/Projected Outcome
All hypotheses will be tested at 0.05 level of significance.
H1: The mean post-test knowledge scores of the staff nurses will be significantly higher than their mean pre-test knowledge.
H2: There will be a significant association between pretest knowledge scores with selected demographic variables.
Materials and Methods:
7.1 Source of data collection
Data will be collected from Staff nurses working in a selected hospital at Mangalore.
7.1.1 Research design
Pre experimental study with one group pre- test post -test design.
Pre-test / Administration of self instructional module / Post-test
01 / X / 02
01 = Administration of structured knowledge questionnaire on medication error.
X = Administration of self instructional module on medication error on 1st day.
O2 = Reassess the knowledge using the same structured knowledge questionnaire on the 7th day.
7.1.2 Setting
The study will be conducted in a selected hospital at Mangalore.
7.1.3 Population
In this study population consists of staff nurses working in a selected hospital at Mangalore.
7.2 Method of Data Collection
7.2.1 Sampling Procedure
Samples will be selected by convenient sampling technique.
7.2.2 Sample Size
Sample size will be 30 staff nurses working in a selected hospital at Mangalore.
7.2.3 Inclusion Criteria
1. Staff nurses who are registered in state nursing council.
2. Staff nurses who are willing to participate in the study.
7.2.4. Exclusion Criteria
1. Staff nurses who are not available at the time of data collection.
2. Staff nurses who are not registered in state nursing council.
7.2.5 Instrument intended to be used.
Structured knowledge questionnaire developed by the researcher.
7.2.6 Data collection method
Prior to data collection permission will be obtained from the concerned hospital authority for conducting the study. Consent will be taken from the subjects selected for study. Pre-test knowledge will be assessed by using structured knowledge questionnaire. Then a self instructional module will be administered. After seven days post-test knowledge will be assessed by the same structured knowledge questionnaire.
7.2.7 Data analysis plan
The Data will be analyzed by using descriptive and inferential statistics.
7.3. Does the study require any investigation or interventions to be conducted on patients or animals or humans? It so please describe briefly.
Yes. The study will be conducted on staff nurses to assess the knowledge on medication error.
7.4. Has ethical clearance has been obtained from your institution in case of 7.3
Yes, ethical clearance will be obtained from the ethical committee of the institution.
List of references
1. Kwame A. The occurrence of medication errors and the occurrence of risk factors for medication errors ;( online) available from: http: // www.mb.utwente.nl.
2. Neeta R. Medication error and their prevention. Journal of Neonatology. 2008; 22: 112 –14.
3. Hurley AC, Duffy ME, Eric G, et al. Nurses satisfaction with medication administration point of care technology. Journal of nursing administration 2007; 37: 343- 49.
4. Saini K, Toppo KJ, Seema M, et al. Consumer protection Act 1986: A challenge to the nursing profession; (online) available from: http:// www.tnaionline.org/nov-09.
5. Bhatt AD. Medication errors: malpractice, implications and prevention. Express healthcare management (editorial) 16th-30th Jun 2002.
6. Tandon A. India wakes up to patient safety norms. The Tribune (online edn) Sep 15, 2009.
7. Joshi MC, Joshi HS, Taniq K, et al. A prospective study of medication errors arising out of look-alike and soud-alike brand names confusion. The International Journal of risk and safety in medicine.2007; 19(4): 195-01.
8. Dennison RD.A Medication safety education program to reduce the risk of harm caused by medication error. The Journal of continuing education in nursing .2007; 38 (4):176-83.
9. Huges RG, Blegen MA. Patient safety and quality: An evidence based hand book for nurses. Medication administration safety.
10. Polit DF, Hungler BP. Nursing Research: Principles and Methods, 6th Edn. Philadelphia: Lippincott;1999.
11. Pote S, Tiwari P, D’Cruz S. Medicaton prescribing errors in a public teaching hospital in India. Pharmacy Practce.2007;5:17-20.
12. Elnour AA, Ellahham NH, Al Qassas HI. Raising the awareness of inpatient nursing staff about medication errors. Pharmacy world and science .2008; 30: 182-190.
13. Khurhid K, Rozmin N, Rashida JM, et al. A systematic approach of tracking and reporting medication error. Ther Clin Risk Manag.2008 Aug; 4(4): 673-79.
14. Rogers AE, Dean GE, Hwang WT, et al. Role of registered nurses in error prevention discovery and correction. Quality and safety in health care.2008; 17: 117-21.
15. Nelson NC, Scott ER, Samore MH, et al. Detection and prevention of medication errors using real-time bedside nurse charting. The Journal of the American Informatics Association.2005 Jul;12(4):390-97.
16. Clyde DF, Julie K, Penelope F, et al. Study of medication errors in a community hospital oncology ward. Journal of oncology practice. 2006 Jul; 2:149-54.
17. O, Shea E. Factors contributing to medication errors. Journal of clinical nursing. 1999; 8: 496-04.
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