Surprise findings from pediatric medication administration OSCE research: It's not only about the 5 rights!

Abstract

<p>One in ten patients is harmed while receiving health care in hospital settings (World Health Organization [WHO], 2008). The WHO has highlighted patient safety research as essential toward identifying major modifiable factors leading to unsafe care and patient harm globally. The Objective Structured Clinical Evaluation (OSCE) allows nurse educators an opportunity to evaluate skills important to patient safety, teamwork, and communication. Nursing literature discusses problems seen when nursing students administer medications: incorrect calculations, poor hand hygiene, not checking patient identification, and not completely addressing the 5 rights of medication administration. Not all pediatric hospitals allow nursing students to administer medications during clinical experiences. The purpose is to evaluate undergraduate nursing students' skills and competencies in pediatric medication administration during an OSCE performance. Upon completion of a 7-hour pediatric medication administration simulation lab and within the first four weeks of pediatrics, all Senior 1 nursing students completed a videotaped solo OSCE performance of medication administration to an infant manikin (two oral and one intravenous medication). This study analyzes data from two semesters (N = 210). Quantitative data was obtained from performance rubric scores (0-not done; 1-done) while viewing OSCE videos; lists of common psychomotor errors were compiled. Data collection will be completed by May, 2011; data analysis by August, 2011. Data from one semester (N=105) shows that most students checked patient ID and allergies, performed accurate calculations, communicated well to parent and infant, and administered oral meds appropriately. Common student errors/omissions were: poor hand hygiene and/or gloving, poor cleansing of IV port with alcohol, administration of heparin as pre-med flush, giving IV infusion med as IV push, giving an oral med IV. Implications for nursing and patient safety include: repetition of foundational nursing skills throughout curriculum, early use of OSCEs in nursing programs, and use of reflective writing immediately following OSCE.</p>