DRUG CALCULATION SKILLS AND ASSOCIATED FACTORS AMONG NURSES IN FEDERAL MEDICAL CENTER UMUAHIA, NIGERIA
CHAPTER ONE
INTRODUCTION
Background to the study: Drug calculation skills are an important part of nursing care (Paa-Kofi-Tawiah et al., 2022). Nurses must be able to accurately calculate dosages of medication, as well as understand the ramifications of giving a patient the wrong dosage (Joseph et al., 2022). Nurses need to be familiar with different measurement systems, such as metric and imperial systems as well as keep up with the latest trends in drug calculation to ensure patient safety (Guido et al., 2019).
Patient safety is a vital aspect of nursing, which nurses ensure by following patients' medication instructions (de-Oliveira et al., 2018; Smith 2019; take-Nilsson et al., 2022). One of the most prevalent issues in modern medicine is drug calculation (Williams & Davis, 2016). Many of the mistakes are preventable and pose a danger to patient safety (Yousef & Yousef, 2017). These mistakes can have a wide range of implications for patients, from the loss of a medication's good benefits to death. Apart from ethical concerns, medication calculation mistakes can lead to increased healthcare costs (Gustafson & Karen-Mercereau, 2016). Medication calculation mistakes cost at least 20 billion dollars each year.
Medication mistakes occur in one out of every five doses in a normal hospital and have been recognized as the most prevalent form of error influencing patient safety as well as the most common single avoidable cause of adverse outcomes (Soon et al., 2021). Mathematical mistakes have been linked to 11-14% of pharmaceutical errors (Mulac et al., 2021). While drug administration is primarily the job of nurses, both doctors and nurses have been found to make mistakes when calculating drug dosages (Wennberg-Capellades et al., 2022). Given that the administration of some pharmaceuticals necessitates a lot of difficult calculations, mathematical competence and proficiency are required (Khasawneh et al., 2020). To acquire correct medicine doses, two mathematical abilities are required: the capacity to compute mathematically and the ability to extract important information from accessible clinical information to frame a mathematical calculation to be solved (Collins & Duffy, 2022). The inability to effectively calculate medicine doses has been found to significantly increase the likelihood of making a medication mistake (Kuitunen et al., 2021).
Medication errors that occur in healthcare have been reported to be the seventh most common cause of death globally (Strbova et al., 2015). It accounts for more than seven thousand deaths annually (Fekadu et al., 2017). Intravenously administered medicines and infusions show the highest risk of medication error (Vijaykumar et al., 2014). Medication error is any preventable event that could potentially result in inappropriate medicine use or cause harm to a consumer of healthcare, while the medicine is under the control of a care giver (Bagheri-nesami et al., 2015). More so, these errors may not entirely be due to negligence of practice by the care provider but may also be due to the complicated administration process of intravenous infusions.
Intravenous infusions are frequently given for hospital inpatients, particularly for hydration maintenance. It is necessary for fluid volume replacement and as a medium for parenteral medication transfusion (Patel et al., 2019). It is thus a beneficial medico-nursing intervention for patients with insufficient oral fluid intake and significant fluid loss as shown in vomiting and diarrhoea. Although intravenous infusion is one of the pharmaceutical delivery techniques utilized in hospitals, there is a danger of life-threatening complications when provided in (Fekadu et al., 2017). Intravenous fluid administration is complicated, and current research indicates that mistakes occur at least 55.2% of the time (Lyons et al., 2018). Administration of intravenous infusions must be done as prescribed as too slow or too fast dose delivery rate can be deleterious to the patient. Most of the time, intravenous infusion prescription order is not written in drops per minute (gtts/min). The required drops per minute rate of prescribed infusion are often left for the attending clinician (physician and nurse-midwife) and intern to calculate using the formula: drop rate per minute = ((volume of infusion X drop factor)/(Time duration in minutes)) (Patel et al., 2019). This complexity can prove difficult for clinicians and interns with little mathematical abilities, especially during clinical emergencies. Concerns about patient safety have led to the introduction of error-reducing smart pumps with pre-set drips per minute calibration for controlling intravenous infusion dosage distribution in more sophisticated nations. Moreover, the adoption of error-reduction smart pump technologies with pre-set drips per minute calibration is not popular in underdeveloped nations. Many types of macro drip systems for controlling intravenous infusions are available in European and American literature for use in maternal health clinics (Potter et al., 2017).
The drop factor of the equipment varies depending on the manufacturer and will be indicated on the exterior box of the different varieties of macro drip sets available. There is a possibility of excess or under-delivery of recommended infusion dosage in countries where sources and manufacturer labelling of macro drip sets are not properly monitored. Summa-sorgini et al. (2012) discovered inconsistencies between prescription and observed administration in terms of infusion rate among critical care clinical personnel in this regard (physicians and nurses).
As a result, Potter et al (2017) and Strbova et al (2015) advised doctors to be aware of the kind and drop factor of macro drip sets in use in their clinics, maternity wards, and hospitals.
The drop factor of a drip set is the number of drops in the drip chamber that sum up to one millilitre (1 ml). According to Potter et al. (2017), the drop factor of the most popular macro drip sets ranges from 10gtts/ml (Travenol or Baxter brand) to 15gtts/ml (Travenol or Baxter brand) (Abbott and McGraw brands). Gage and Toney-butler (2019) agreed, adding that macro drip sets had drop factors ranging from 10 to 20gtts/ml. In the same vein, numerous additional Indian and African writers have reported values such as 16gtts/ml (Patel et al., 2019), 15gtts/ml (Diorgu & Robinson-bassey, 2018), and 20gtts/ml (Diorgu & Robinson-bassey, 2018).
Statement of Problem
Based on the assumption that the drop factor of available macro drip sets varies, this variance may provide some problem in emergency scenarios if the manufacturer does not clearly disclose the drop factor of the macro drip set.
During a clinical emergency, a practitioner who is unfamiliar with the drop factor of the most widely used macro drip set risks underdosing or overdosing the patient. This occurrence puts the patient at risk of poor treatment-related health outcomes, life-threatening illnesses, and even death (Hertig et al., 2018). Nurses are required to accurately calculate drug dosages for their patients in order to ensure the patient’s safety and well-being. However, due to the importance of this skill, researchers call for frequent drug calculation training and drills for nurse. Therefore, there is a need to examine nurses’ drug calculation skills necessary to provide safe and effective patient care.
Objectives of the study
The aim of this study is to evaluate the drug calculation skills and associated factors among nurses in Federal Medical Centre Umuahia, Nigeria.
The specific objectives for the study are to:
- assess the nurses’ ability to state the correct formula to be used in drug calculation.
- assess the ability of the nurses to state the correct macro drip set drop factor used in Federal Medical Centre, Umuahia
- assess the ability of the nurses to arrive at the correct drip flow rate.
- determine the association between drug calculation skill and the nurses’ educational qualification.
Research Questions/Hypotheses
- What is the nurse’s ability to state the correct formula used in drug calculation?
- What is the ability of the nurses to state the correct macro drip set drop factor used in Federal Medical Centre, Umuahia?
- What is the ability of the nurses to arrive at the correct drip flow rate?
- What is the association between drug calculation skill and nurses’ educational qualification?
The following null hypotheses will be tested:
- There is no significant association between the nurses’ educational qualification and drug calculation skills.
Significance of the study
Drug calculation is an essential skill for nurses, as it is a fundamental part of providing safe and effective patient care. Drug errors can have serious consequences for patients, including death, and nurses need to possess excellent drug calculation skills to protect their patients. The purpose of this study is to evaluate the drug calculation skills of nurses to identify areas in need of improvement. The results of this study will provide valuable information to help nursing educators, employers, and other healthcare professionals to ensure that nurses are receiving the necessary training and skills needed to safely administer medications. By understanding the current state of drug calculation skills among nurses, healthcare organizations can take steps to improve the quality of patient care. This study will also provide important insight into how drug calculation skills can be improved and how nurses can be better supported in their efforts to provide safe and effective patient care. Additionally, the findings of this research could also be used to inform clinical practice guidelines and to help ensure patient safety. By providing an in-depth exploration of drug calculation skills for nurses, this study will be invaluable in helping to improve patient care.
Additionally, possible findings of this study may save money for the government and hospital managements. It would do this by equipping nurses with evidence to avert the burden of litigation that could arise from infusion error.
Furthermore, possible findings from this study would on the long term protect patients, health service consumers and the public from infusion dose error as the nurse becomes more aware of the characteristics of the macro drip/adult drip sets prevalently used in south-eastern Nigeria.
Finally, this study may stimulate further studies on similar topics. It will also serve as reference to other newer empirical studies.
Scope of the study
The present study is delimited to nurses in Federal Medical Centre, Umuahia. It will focus on the assessment of drug calculation skills and will be carried out in the year 2023.
Operational definition of terms
Drug calculation skills: for the purpose of this study, drug calculation skills involve the ability of the respondents to state the correct formula for calculating infusion dosages, the correct macro drip set drop factor of 20 drops per ml and arriving at a mathematically logical drip flow rate. It will be graded as good (3 marks), moderate (2 marks), and poor (0-1 mark)
Nurses: for the purpose of this study nurses refer to licensed/registered nurses employed to practice in Federal Medical Centre Umuahia.