The majority of serious mistakes that occur in hospitals are due to medication administration errors, some of which can be fatal, noted principal investigator Amy L. Seybert, Pharm.D., associate professor of pharmacy and therapeutics, University of Pittsburgh School of Pharmacy.
“Patients in intensive care units (ICUs) are at increased risk for these errors because of the number of medications they receive, as well as the complexity of the ICU environment,” she said. “This study compared the rates of medication administration errors in an ICU before and after either simulation-based training or a traditional lecture.”
The study was conducted in adult coronary critical care (CCU) and medical intensive care (MICU) units at UPMC Presbyterian. A dozen nurses in each unit were observed administering and documenting each patient’s current medications. After the initial observation, all nurses from both units, regardless of study participation, were invited to take part in an educational session that was either simulation-based or a lecture. Both sessions equally focused on the errors that were identified during the initial observation period.
The nurses who were assigned to the simulation-based session worked with a human-appearing simulator from the Peter M. Winter Institute for Simulation, Education and Research (WISER) at the University of Pittsburgh to correct errors and practice proper medication administration techniques. When errors occurred, the simulator responded with physiological changes, including shifts in blood pressure, heart rate and verbal response.
The group that attended the lecture reviewed medication administration techniques and consequences related to common errors. This session was presented in a traditional in-service setting.
To assess their knowledge, all participants were given multiple-choice quizzes along with a five-question subjective evaluation, before and after the educational sessions. The nurses also were observed administering medication twice more: one to four weeks after the educational session and again eight to 12 weeks after the session.
“After the educational sessions and the first observation period, our research found that the medication administration error rate significantly decreased to 4 percent for the CCU nurses who participated in the simulation-based training and slightly increased to 22.7 percent for the MICU nurses who participated in the lecture-style sessions,” Dr. Seybert said. “After the second and final post-education observation period, the medication error rate for the CCU nurses was 6.2 percent. The error rate for the MICU nurses increased to 36.7 percent. There was no significant difference in the quiz scores between the two groups.”
She added that this study is the first to assess simulation-based training’s effect on medication administration safety in the ICU. The researchers hope to conduct a similar analysis in other ICUs and critical care environments.
Study co-authors include Daniel G. Ford, Pharm.D., NorthBay Medical Center, Fairfield, Calif.; Pamela L. Smithburger, Pharm.D., and Sandra L. Kane-Gill, Pharm.D., M.Sc., both of UPMC and Pitt School of Pharmacy; Lawrence R. Kobulinsky, WISER; and Joseph T. Samosky, Ph.D., Simulation and Medical Technology Research and Development Center, School of Medicine and Swanson School of Engineering, all at Pitt.
About the University of Pittsburgh School of Pharmacy
Chartered in 1878, the School of Pharmacy is the oldest of the University of Pittsburgh’s Schools of the Health Sciences. The school offers a four-year doctor of pharmacy degree (Pharm.D.) as well as a postgraduate residency program. A leader in research, the School of Pharmacy is nationally known for its Clinical Pharmaceutical Scientist Program, a Ph.D. program that educates scientists to conduct translational or patient-oriented research. The school also offers a pharmaceutical science Ph.D. program and a master’s degree in pharmacy administration. The school is home to the Center for Pharmacogenetics and the Center for Education and Drug Abuse Research (CEDAR) and is a partner in the three-school Drug Discovery Institute. The Grace Lamsam Pharmacy Program for the Underserved and the Pittsburgh Poison Center/Drug Information Center and the partnership with UPMC reflect the School’s quality and excellence at the intersection of patient care, education, research and service. For more information about the School of Pharmacy, visit www.pharmacy.pitt.edu.