Top 10 Reasons to Change How You Are Teaching Medication Admininistration...Now

Medication administration errors across all health care settings continue to occur. The statistics are quite alarming:

• More than 7 million patients in the U.S. are impacted by medication administration errors every year (Journal of Community Hospital Internal Medicine Perspectives, 2016). 
• Ten percent of hospital patients will be subject to a medication error (NCBI, 2019).  
• During medication administration, there is about an 8%-25% median medication error rate (Patient Safety Network, 2018). 
• Improper dispensing of medications results in medication error rates between 0.014%-55% (BMJ Open Quality, 2018).

Nurses play a role in both committing and preventing these medication administration errors. Are nursing programs doing the best they can to lower these numbers? Is the “old way” the “right way”? Given the statistics, our answer is a resounding “NO”.

The reasons why you should change your educational strategies around teaching medication administration to nursing students fall into one of two categories 1.) nursing program challenges or 2.) clinical site challenges. 

MEDICATION ADMINISTRATION CHALLENGES IN NURSING PROGRAMS

1. Learning it once isn’t enough.

Medication administration is most often taught in the first semester of a nursing program but not revisited or reinforced after that. It is assumed that if a student is “checked off” on the skill, then a safe and competent practice has been established.

2. Memorizing steps doesn’t work.

Medication administration is typically presented as a series of steps that students are told to memorize and replicate. Cognitively, this is at the lowest level on both Bloom’s Taxonomy and Miller’s Assessment Pyramid. When higher order learning is not part of the process, the steps are easily forgotten or the importance of each step is minimized by the student. This opens the door to potential medication errors. 

3. Deliberate practice not emphasized enough.

The laboratory curriculum in a nursing program is jam packed with skills that must be taught and learned by a large group of students over a short period of time. Once students move through one skill, it’s on to the next, without considering the need for deliberate, repeated practice to firmly establish the correct process. Skill decay is a real phenomenon that is especially problematic with a skill that is as high-risk as med admin.

3. The skill is often taught in a vacuum.

Without a patient or patient-care scenario embedded in medication administration skill practice, students don’t make the connection between what they are doing and the significance it has on actual patients. It’s hard to understand the importance of getting it right every time when it is seen as a “to do” list.

4. Clinical judgment may be missing.

Students need to understand there is clinical judgment in every aspect of patient care. This is not emphasized enough (or at all) in med admin teaching. The focus is on the process, not the thinking. Should a patient even be getting the med that is ordered? Why or why not? What should the nurse expect to happen or be concerned about happening? When this aspect of med admin is not paid attention to at the earliest stages of teaching, it’s hard to build it in later. Memorizing the psychomotor skill is not the end game, it’s the kickoff.

5. Out of date training tools don’t translate.

Teaching med admin using tools, equipment or “props” that don’t look, feel or act like the tools and equipment that will be used in clinical practice is a big miss. The experience in the nursing lab needs to replicate as closely as possible what a nursing student will see and do in the clinical site, or the skill will not translate accurately. End the pretend.

MEDICATION ADMINISTRATION CHALLENGES IN CLINICAL SITES

6. Prohibitive institutional restrictions.

More and more, clinical sites are limiting the number of nursing students allowed on a patient-care unit, the activities the students can engage in and student access to the patient’s health record. These restrictions reduce clinical learning of all types, but can especially impact medication administration.

7. Opportunities are limited.

Specific to med admin, there are several factors that limit a student’s opportunity to practice the skill. Routine medication administration times may occur either before or after the students are on the unit. The patient’s need for a medication may be too urgent to allow for a student to administer it under the guidance of faculty. The nurse assigned to the patient (or the patient themselves) may not be comfortable with a student administering medications.

8. Student to clinical faculty ratio is too big.

Nursing students are routinely placed in clinical experiences where the ratio of students to faculty is 6:1 or 8:1. Given how long it takes to guide a student through a medication pass for even a moderately complex patient, it is easy to see that very few students will have an opportunity to practice on any given clinical day. Frequently the clinical faculty will assign med admin to one or two students a day, so by the end of a clinical semester each student will be lucky to have had more than three opportunities to pass meds.

9. Learning from mistakes is not an option.

Everyone can agree that people learn from their mistakes. But when students administer medications in clinical, they are not allowed to fail. This makes perfect sense from the perspective of patient safety, but without an opportunity to make a mistake and remediate, the impact of the learning experience is lessened.

10. Learning from mistakes is not an option.

Everyone can agree that people learn from their mistakes. But when students administer medications in clinical, they are not allowed to fail. This makes perfect sense from the perspective of patient safety, but without an opportunity to make a mistake and remediate, the impact of the learning experience is lessened.

Are You Ready to Change?

When an educational practice has been well established and considered to be “the best way”, it’s hard to be a champion for a change. Providing an alternative can go a long way in facilitating a new mindset. Download our guide “20 Ways to Thread Med Admin Throughout Your ENTIRE Curriculum” and share it with your faculty colleagues and program director today.