Authors (including presenting author) :
Leung CSM (1), Chor YC (1), Cheng SC (1), Wong KL (1)
Affiliation :
1) Accident and Emergency Department, North District Hospital
Introduction :
Medication administration is a risky process and nurses are primarily responsible for safe medication administration. There is a positive correlation between medication incident and knowledge gap among nurses. Patient safety could be jeopardized when dealing with medications that are unfamiliar or seldom used. The risk is even higher in the Accident & Emergency Department (A&E). We frequently need to encounter different emergency situations at unsociable hours; staff rotation every few months; administrations of different drugs for different age groups and not unexpectedly, we are always push for time. Medication incidents, especially for the newcomers, are prone to happen. It is essential for A&E nurses to equip ourselves to ensure patient safety. Our team decided to implement a department based continuing education program for our nurses. The “Be smart, be safe” medication enrichment program aims to enrich our colleagues’ drug knowledge and their competencies in drug administration.
Objectives :
Our targets include three aspects: patient safety, staff development and department development.
-Patient safety: enhance patient safety through safe medication administration
-Staff development: fill up the knowledge gap of the newcomers and also continuous education for the existing staff. It was also a good learning experience for the team members on preparation of teaching materials and enhance their teaching and presentation skills.
-Department development: enhance staff engagement, team spirit and learning culture. Also promotes the mindset of “small change, big improvement” for quality improvement.
Methodology :
The "Be smart, be safe" medication enrichment program started on 1st January, 2022. We deployed a 1 nurse 1 drug strategy in which 25 senior nurses were invited and each had to prepare teaching material on 1 drug e.g. octreotide or 1 drug group e.g. drugs used in management of status epilepticus. The chosen items were relevant to our practice and endorsed by our ward manager. The teaching materials were prepared in power point format for a 5-minute talk.
Before launching the program, a paper- based questionnaire survey was done for background information and to evaluate the confidence in drug administration of our A&E nurses. 4 questions were asked in the survey: (1) Years of clinical experience (2) Number of A&E drugs familiar with (3) Confidence in administrating A&E drugs (score 1-10) and (4) Frequency that need to consult colleagues for unfamiliar drug. Small group or individual teaching was then conducted for all nurses on the 25 drug items. The information was also converted into QR codes for future reference, further self- learning and easy access during work. A post survey questionnaire was done for follow up evaluation. The questions were (1) Does the program increase your knowledge on A&E drugs? (2) Confidence in administrating A&E drugs (score 1-10). (3) Frequency that need to consult colleagues for unfamiliar drug and (4) Will you support the continuation of the program?
Result & Outcome :
In total, 64 nurses were educated through the ‘Be smart, be safe” program. Our pre-survey questionnaire found that the mean score on confidence in drug administration was only 5.89 (range 1-10). Most alarmingly, 22 of the 64 nurses gave a score ≤ 5 and 10 of these 22 nurses had ≥ 3-year clinical experience. In general, nurses with more experience have more confidence in drug administration.
Through the education program, a general increase in confidence was noted in which the mean score increased drastically from 5.89 -8.0. All 64 nurses agreed the program improved their drug knowledge and support the program to be continued in the post-program questionnaire.
It is difficult to quantify the exact improvement in medication safety through the “Be smart, be save” program. However, we believe we achieved a WIN, WIN, WIN situation. Patient safety was improved by an improvement in drug knowledge. Staff development was achieved through a quality improvement project. Department development was made through enhancement of “Small change, big improvement” quality improvement culture. Last but not the least, we also noted an improvement in team spirit and team work through staff engagement and small group teaching.
