Nurse interrupted: Development of a realistic medication administration simulation for undergraduate nurses

Abstract

Background: Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. Aim: This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. Methods: The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. Setting and Participants: Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. Outcome Mapping: To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4 weeks to extend the reflective learning process and review the impact of the experience from the student perspective. Conclusions: Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and improve deductive reasoning and analysis. The heightened awareness of interruptions and their impacts on the medication administration process, along with techniques to manage interruptions more effectively serves to better prepare nurses for practice.