Teaching Activity
Contents
Introduction
Literature review
Pulmonary Unit teaching
Pretest
Final results
Posttest
Nursing Practice Guideline
Attendance record
Handoff Communication Champions meeting presentation
Introduction
The final approval of the Nursing Practice Guideline was an integral component in standardizing the procedure for high risk medications in the Medical-Surgical areas of the hospital. The next step was to educate nursing staff of these changes to create a consistent practice throughout the organization. My initial responsibility was to educate the Pulmonary Unit of the expectations the Nursing Practice Guideline has set in place. The next logical step was to present the revised guideline at the Handoff Communication Champions Meeting, for a large component on the revision addressed the hospital wide implementation of care handoff occurring at the bedside of the patient. The final component of sharing the guideline in actual practice, would be to access it on the hospital's website known at the "HUB" by simply utilizing the search engine and entering one of the medications listed in the guideline.
Literature review
Dickinson, A., McCall, E., Twomey, B., & James, N. (2010). Paediatric nurses’ understanding of the process and procedure of double-checking medications. Journal of Clinical Nursing. 19: 728-735. (LOE VI)
Hodgkinson, B., Koch, S., Nay, R., & Nichols, K. (2006). Strategies to reduce medication errors with reference to older adults. International Journal
of Evidence Based Healthcare. 4: 2-41. (LOE V)
The Joint Commission. (2008). Preventing errors related to commonly used anticoagulants. Sentinel Event Alert. 41: 1-3. (LOE VI)
Just, S., Schepers, G., Piotrowski, M., Saint, S., & Kauffman, C. (2006). Improving safety of intravenous admixtures: Lessons learned from a Pentostam overdose. Journal on Quality and Patient Safety. 32(7): 366-372. (LOE V)
Sheu, S., Wei, I., Chen, C., Yu, S., & Tang, F. (2008). Using snowball sampling method with nurses to understand medication administration errors.
Journal of Clinical Nursing. 18: 559-569. (LOE V)
Smetzer, J. L., & Cohen, M. R. (2007). Preventing drug administration errors.
Medication Errors. 2nd ed., 421-423. (LOE VI)
Starkey, S., & Walden, P. (2010). How do we prevent medication errors?
Nursing Made Incredibly Easy. 8 (6): 18-22. (LOE VI)
Pulmonary Unit Teaching
The Pulmonary Unit education began with a pretest. The pretest would evaluate the nurse's knowledge of the specific medications and their familiarity with the previous guideline. Education would be performed on the medications that were unknown and refine the understanding of the updates that the guideline provides. The teaching would involve highlighting the specific aspects of each medication that required an independent double check, the actual process involved with an independent double check, and the documentation expectations. The evaluation of the level of learning that had occurred was appraised by posttest. The entire teaching event was performed with both small groups of staff and individual staff members.
Pretest
Contents
Introduction
Literature review
Pulmonary Unit teaching
Pretest
Final results
Posttest
Nursing Practice Guideline
Attendance record
Handoff Communication Champions meeting presentation
Introduction
The final approval of the Nursing Practice Guideline was an integral component in standardizing the procedure for high risk medications in the Medical-Surgical areas of the hospital. The next step was to educate nursing staff of these changes to create a consistent practice throughout the organization. My initial responsibility was to educate the Pulmonary Unit of the expectations the Nursing Practice Guideline has set in place. The next logical step was to present the revised guideline at the Handoff Communication Champions Meeting, for a large component on the revision addressed the hospital wide implementation of care handoff occurring at the bedside of the patient. The final component of sharing the guideline in actual practice, would be to access it on the hospital's website known at the "HUB" by simply utilizing the search engine and entering one of the medications listed in the guideline.
Literature review
Dickinson, A., McCall, E., Twomey, B., & James, N. (2010). Paediatric nurses’ understanding of the process and procedure of double-checking medications. Journal of Clinical Nursing. 19: 728-735. (LOE VI)
Hodgkinson, B., Koch, S., Nay, R., & Nichols, K. (2006). Strategies to reduce medication errors with reference to older adults. International Journal
of Evidence Based Healthcare. 4: 2-41. (LOE V)
The Joint Commission. (2008). Preventing errors related to commonly used anticoagulants. Sentinel Event Alert. 41: 1-3. (LOE VI)
Just, S., Schepers, G., Piotrowski, M., Saint, S., & Kauffman, C. (2006). Improving safety of intravenous admixtures: Lessons learned from a Pentostam overdose. Journal on Quality and Patient Safety. 32(7): 366-372. (LOE V)
Sheu, S., Wei, I., Chen, C., Yu, S., & Tang, F. (2008). Using snowball sampling method with nurses to understand medication administration errors.
Journal of Clinical Nursing. 18: 559-569. (LOE V)
Smetzer, J. L., & Cohen, M. R. (2007). Preventing drug administration errors.
Medication Errors. 2nd ed., 421-423. (LOE VI)
Starkey, S., & Walden, P. (2010). How do we prevent medication errors?
Nursing Made Incredibly Easy. 8 (6): 18-22. (LOE VI)
Pulmonary Unit Teaching
The Pulmonary Unit education began with a pretest. The pretest would evaluate the nurse's knowledge of the specific medications and their familiarity with the previous guideline. Education would be performed on the medications that were unknown and refine the understanding of the updates that the guideline provides. The teaching would involve highlighting the specific aspects of each medication that required an independent double check, the actual process involved with an independent double check, and the documentation expectations. The evaluation of the level of learning that had occurred was appraised by posttest. The entire teaching event was performed with both small groups of staff and individual staff members.
Pretest
After the pretest was completed, an evaluation of the familiarity of the high risk medications was performed. Those medications that were not fully understood were reviewed with each staff member. The medications that are deemed high risk by senior leadership are as follows:
Chemotherapy - comprehensive term for a group of medications that treat various types of cancer and the majority of these medication are administered only by a Chemotherapy Certified Nurse
Epoprostenol (Flolan) - treats pulmonary hypertension by decreasing the blood pressure in the lungs
Heparin, Argatroban, and Bivalirudin - group of medications that thin the blood, also know as anticoagulants
Insulin - causes cells in the body to store glucose and regulates the essential amino acid uptake by body cells
Magnesium Sulfate (20gm) - this high dose in grams, treats preterm labor by slowing uterine contractions; the normal dose for Medical-Surgical areas is only 1-2gm
Rituximab (Rituxan) - interferes with the growth and spread of cancer cells in the body to treat non-Hodgkin's lymphoma and chronic lymphocytic leukemia
Treprostinil (Remodulin) - treats pulmonary hypertension by decreasing the blood pressure in the lungs
PCA - abbreviation for Patient Controlled Anesthesia that is a device that infuses pain medication into a vein and the patient can control the infusion amount based on their pain level
PCEA - abbreviation for Patient Controlled Epidural Anesthesia that is a device that infuses near the cerebral spinal fluid, that the patient can control the infusion amount based on their pain levels
Intrathecal - variety of specialized medications injected into the cerebral spinal fluid
Final results
The next educational component was to review the pretest and how that test directly correlated to the actual guideline. The questions that were answered correctly were highlighted to ensure comprehension. The incorrect questions were clarified by locating the correct answers in the actual guideline. The effectiveness of the entire teaching activity was evaluated with the same exam utilized as a posttest. The questions were the same on both tests to minimize extraneous variables that could jeopardize the results of the experiment. Every question answered incorrectly on the posttest was reviewed with the individual personally. The actual exam questions are listed below in italic with the percentage of correct answers on the pretest and posttest. "X" indicates the correct answer(s) for each question.
1. True or false? Care handoff is defined as any situation where another Healthcare Personnel assumes the care of the patient for the remainder of the shift, accepting a patient transferred from another area of the organization, or at the change of shift.
_X_True ___False
Pretest 97% correct Posttest 100% correct
This is care handoff as defined in the guideline.
2. True or false? All IV medications that are deemed high risk may be documented under the EPIC care handoff communication tab of “IV lines & drips reviewed”.
___True _X_False
Pretest 62% correct Posttest 100% correct
All medications may be documented in this fashion except high risk medications. High risk medications must be documented in the Medication Administration Record (MAR) with the dual signoff format.
3. True or false? An independent double check of a medication is defined as two RN’s separately verify the medication, volume, concentration, and rate, then authenticate all the information with the Medication Administration Record (MAR) to reach the same conclusion.
_X_True ___False
Pretest 97% correct Posttest 100% correct
This is defined in the guideline and highlights the actual expectation of an independent double check.
4. Which of the following IV medications would require an independent
double check and EPIC cosign when care handoff has taken place?
Check all that apply.
___Cytogam _X_Insulin ___Synagist
_X_Argatroban _X_Rituximab ___Thymoglobulin
___Lasix ___Solumedrol _X_Magnesium (20gm)
_X_Bivalirudin _X_Remodulin _X_PCA/PCEA
_X_Chemotherapy _X_Flolan ___Magnesium (1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 88% correct
This question emphasizes which medications are deemed high risk and the care handoff expectation.
5. Which of the following IV medications would require an independent
double check and EPIC cosign when a bolus dose is given?
Check all that apply.
___Cytogam _X_Insulin ___Synagist
_X_Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol ___Magnesium (20gm)
_X_Bivalirudin ___Remodulin _X_PCA/PCEA
___Chemotherapy ___Flolan ___Magnesium(1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 94% correct
This question highlights the importance of double checking before a bolus dose is given and which medications the bolus function is performed. A bolus is large dose of the medication infused rapidly.
6. Which of the following IV medications would require an independent
double check and EPIC cosign when a rate change is performed?
Check all that apply.
___Cytogam ___Insulin ___Synagist
_X_Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol _X_Magnesium(20gm)
_X_Bivalirudin _X_Remodulin _X_PCA/PCEA
_X_Chemotherapy _X_Flolan ___Magnesium(1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 56% correct
This question differentiates which medications require an independent double check when the rate is changed. Many nurses also selected insulin, for this practice is routinely performed on the Pulmonary Unit even though it is not a component of the Nursing Practice Guideline.
7. Which of the following IV medications would require an independent
double check and EPIC cosign when a dosage change is performed?
Check all that apply.
___Cytogam ___Insulin ___Synagist
___Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol ___Magnesium(20gm)
___Bivalirudin _X_Remodulin _X_PCA/PCEA
___Chemotherapy _X_Flolan ___Magnesium(1-2gm)
___Heparin ___Potassium ___IVIG
Pretest 94% correct Posttest 100% correct
These medications emphasize the importance of an independent double check to ensure the infusion dosage matches what is listed in the MAR. Most medications have only one standard dose in the hospital setting.
8. Where would you find the policy/procedure/guideline on the administration of high risk IV medications?__________________________________________________
Everyone answered this question correctly on the pretest and posttest. The hospital's website known as the HUB is the place everyone goes to for the most recent information on policies, procedures, and guidelines.
Posttest
Below is the posttest that evaluated the level of comprehension from the teaching activity.
Chemotherapy - comprehensive term for a group of medications that treat various types of cancer and the majority of these medication are administered only by a Chemotherapy Certified Nurse
Epoprostenol (Flolan) - treats pulmonary hypertension by decreasing the blood pressure in the lungs
Heparin, Argatroban, and Bivalirudin - group of medications that thin the blood, also know as anticoagulants
Insulin - causes cells in the body to store glucose and regulates the essential amino acid uptake by body cells
Magnesium Sulfate (20gm) - this high dose in grams, treats preterm labor by slowing uterine contractions; the normal dose for Medical-Surgical areas is only 1-2gm
Rituximab (Rituxan) - interferes with the growth and spread of cancer cells in the body to treat non-Hodgkin's lymphoma and chronic lymphocytic leukemia
Treprostinil (Remodulin) - treats pulmonary hypertension by decreasing the blood pressure in the lungs
PCA - abbreviation for Patient Controlled Anesthesia that is a device that infuses pain medication into a vein and the patient can control the infusion amount based on their pain level
PCEA - abbreviation for Patient Controlled Epidural Anesthesia that is a device that infuses near the cerebral spinal fluid, that the patient can control the infusion amount based on their pain levels
Intrathecal - variety of specialized medications injected into the cerebral spinal fluid
Final results
The next educational component was to review the pretest and how that test directly correlated to the actual guideline. The questions that were answered correctly were highlighted to ensure comprehension. The incorrect questions were clarified by locating the correct answers in the actual guideline. The effectiveness of the entire teaching activity was evaluated with the same exam utilized as a posttest. The questions were the same on both tests to minimize extraneous variables that could jeopardize the results of the experiment. Every question answered incorrectly on the posttest was reviewed with the individual personally. The actual exam questions are listed below in italic with the percentage of correct answers on the pretest and posttest. "X" indicates the correct answer(s) for each question.
1. True or false? Care handoff is defined as any situation where another Healthcare Personnel assumes the care of the patient for the remainder of the shift, accepting a patient transferred from another area of the organization, or at the change of shift.
_X_True ___False
Pretest 97% correct Posttest 100% correct
This is care handoff as defined in the guideline.
2. True or false? All IV medications that are deemed high risk may be documented under the EPIC care handoff communication tab of “IV lines & drips reviewed”.
___True _X_False
Pretest 62% correct Posttest 100% correct
All medications may be documented in this fashion except high risk medications. High risk medications must be documented in the Medication Administration Record (MAR) with the dual signoff format.
3. True or false? An independent double check of a medication is defined as two RN’s separately verify the medication, volume, concentration, and rate, then authenticate all the information with the Medication Administration Record (MAR) to reach the same conclusion.
_X_True ___False
Pretest 97% correct Posttest 100% correct
This is defined in the guideline and highlights the actual expectation of an independent double check.
4. Which of the following IV medications would require an independent
double check and EPIC cosign when care handoff has taken place?
Check all that apply.
___Cytogam _X_Insulin ___Synagist
_X_Argatroban _X_Rituximab ___Thymoglobulin
___Lasix ___Solumedrol _X_Magnesium (20gm)
_X_Bivalirudin _X_Remodulin _X_PCA/PCEA
_X_Chemotherapy _X_Flolan ___Magnesium (1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 88% correct
This question emphasizes which medications are deemed high risk and the care handoff expectation.
5. Which of the following IV medications would require an independent
double check and EPIC cosign when a bolus dose is given?
Check all that apply.
___Cytogam _X_Insulin ___Synagist
_X_Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol ___Magnesium (20gm)
_X_Bivalirudin ___Remodulin _X_PCA/PCEA
___Chemotherapy ___Flolan ___Magnesium(1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 94% correct
This question highlights the importance of double checking before a bolus dose is given and which medications the bolus function is performed. A bolus is large dose of the medication infused rapidly.
6. Which of the following IV medications would require an independent
double check and EPIC cosign when a rate change is performed?
Check all that apply.
___Cytogam ___Insulin ___Synagist
_X_Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol _X_Magnesium(20gm)
_X_Bivalirudin _X_Remodulin _X_PCA/PCEA
_X_Chemotherapy _X_Flolan ___Magnesium(1-2gm)
_X_Heparin ___Potassium ___IVIG
Pretest 1% correct Posttest 56% correct
This question differentiates which medications require an independent double check when the rate is changed. Many nurses also selected insulin, for this practice is routinely performed on the Pulmonary Unit even though it is not a component of the Nursing Practice Guideline.
7. Which of the following IV medications would require an independent
double check and EPIC cosign when a dosage change is performed?
Check all that apply.
___Cytogam ___Insulin ___Synagist
___Argatroban ___Rituximab ___Thymoglobulin
___Lasix ___Solumedrol ___Magnesium(20gm)
___Bivalirudin _X_Remodulin _X_PCA/PCEA
___Chemotherapy _X_Flolan ___Magnesium(1-2gm)
___Heparin ___Potassium ___IVIG
Pretest 94% correct Posttest 100% correct
These medications emphasize the importance of an independent double check to ensure the infusion dosage matches what is listed in the MAR. Most medications have only one standard dose in the hospital setting.
8. Where would you find the policy/procedure/guideline on the administration of high risk IV medications?__________________________________________________
Everyone answered this question correctly on the pretest and posttest. The hospital's website known as the HUB is the place everyone goes to for the most recent information on policies, procedures, and guidelines.
Posttest
Below is the posttest that evaluated the level of comprehension from the teaching activity.
Nursing Practice Guideline
Below is the Nursing Practice Guideline as is appears on the HUB. The
guideline was utilized as a quick reference for this teaching activity
Below is the Nursing Practice Guideline as is appears on the HUB. The
guideline was utilized as a quick reference for this teaching activity
Attendance record
This is the attendance record for all the Pulmonary Unit's nurses that completed the teaching activity.
This is the attendance record for all the Pulmonary Unit's nurses that completed the teaching activity.
Handoff Communication Champions meeting presentation
The Pulmonary Unit was thoroughly informed on the Nursing Practice Guideline. The next challenge was to educate the other Medical-Surgical areas of the hospital. I was approved for the agenda in the Handoff Communication Champions meeting to disseminate the guideline information. This committee has representatives from all Medical-Surgical units and the guideline information would be shared with their teams. A copy of the guideline was given to all the members of the committee present at the meeting and extras for the members that were not present at this meeting. I explained the rationale for developing the guideline and highlighted the expectations that the guideline set forth. The actual maneuvers involved with an independent double check of medication was explained. The documentation expectations were reviewed. I concluded the presentation with an open forum for questions. Below is the meeting agenda with me listed as a guest speaker, followed by the attendance record, and then the discussion points of the meeting.
The Pulmonary Unit was thoroughly informed on the Nursing Practice Guideline. The next challenge was to educate the other Medical-Surgical areas of the hospital. I was approved for the agenda in the Handoff Communication Champions meeting to disseminate the guideline information. This committee has representatives from all Medical-Surgical units and the guideline information would be shared with their teams. A copy of the guideline was given to all the members of the committee present at the meeting and extras for the members that were not present at this meeting. I explained the rationale for developing the guideline and highlighted the expectations that the guideline set forth. The actual maneuvers involved with an independent double check of medication was explained. The documentation expectations were reviewed. I concluded the presentation with an open forum for questions. Below is the meeting agenda with me listed as a guest speaker, followed by the attendance record, and then the discussion points of the meeting.