Download 6.2.1 Reviews related to nurses knowledge on pediatric

A STUDY TO ASSESS THE KNOWLEDGE ON PAEDIATRIC
EMERGENCY DRUGS AND CALCULATION OF DOSAGE AMONG
STAFF NURSES IN SELECTED HOSPITALS AT BANGALORE, IN A
VIEW OF PREPARING AN INFORMATION BOOKLET.
M.Sc Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Science, Karnataka, Bangalore
By
Mr. AJESH JOSE
M.Sc NURSING I ST YEAR 2011-2012
Under the guidance of
HOD, Department of CHILD HEALTH NURSING
Nightingale college of Nursing
Guruvanna Devara Mutt, Near Binnyston Garden,
Magadi Road, Bangalore-560023
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,KARNATAKA,
BANGALORE
ANNEXURE-II
PERORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. AJESH JOSE
I YEAR M.Sc NURSING
1.
NAME OF THE CANDIDATE
NIGHTINGALE COLLEGE OF NURSING,
AND ADDRESS
GURUVANNA DEVARA MUTT,
NEAR BINNIYSTON GARDEN,
MAGADI ROAD ,BANGALORE-23.
NIGHTINGALE COLLEGE OF NURSING,
2.
GURUVANNA DEVARA MUTTU,NEAR
NAME OF THE INSTITUTE
BINNIYSTON GARDEN,
MAGADI ROAD, BANGALORE-23.
3.
COURSE OF STUDY AND SUBJECT
4.
DATE OF ADMISSION
M.Sc NURSING IN
CHILD HEALTH NURSING .
12-5-2011
“A
STUDY
KNOWLEDGE
EMERGENCY
TO
ASSESS
ON
THE
PAEDIATRIC
DRUG’S
AND
CALCULATION OF DOSAGE AMONG
5.
TITLE OF THE TOPIC
STAFF
NURSES
IN
A
SELECTED
HOSPITALS AT BANGALORE, IN A VIEW
TO PREPARING
BOOKLET”
2
AN INFORMATION
3
6.
BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Medicines are nothing in themselves if not properly used, but the very hands
of God if employed with reason and prudence”.
- Herophilus
“ Medicine sometime snatches away heath, and sometimes gives it”.
- Ovid.
Administration of medication is the most important nursing responsibility.
The need for accuracy in preparing and giving medications to children is greater than that of
adult. Since the pediatric dose is often relatively small in comparison with the adult dose ,a
slight mistake in the amount of a administration drug represents a greater error.1
Each child has five ‘rights’ during administration of medication ,which will
prevent most dosage error. A sixth right has been added to this listing because it also will
provide for a measure of safety when parents give medication to their children. The rights
include the following, the right patient, the right drug, the right dose, the right route, the
right time, and the right of parents and the child “to known”. The right of parent and child to
know indicates the right to ask and the right to receive an answer to their questions
prescribed drug ,its action and side effects. The nurse or the doctor is responsible for sharing
this information to use the drug safely.2
A medication is a substance used in the diagnosis, treatment, cure,
relief or prevention of health alterations. In fact, medications are the primary treatment client
associate with restoration of health. Too much of a medicine may cause severe unwanted
effects.3 Separate medicines can have unnecessary interactions when used together. An
expired medicine or one that is stored wrongly can be ineffective or even dangerous. An
inappropriate route can cause unnecessary pain and ineffectiveness of a medication. Taking
the wrong medicine can be as dangerous as being poisoned. The list goes on and these errors
can add up to weigh down on the health, becoming very costly in the process. Without care,
medications can end up on the path to hurting lifestyle, time, and worse of all health.
It is the physician’s responsibility to prescribe drugs in the correct dosage
to achieve the desired effect without endangering the health of the child. However, nurses
4
must have an understanding of the safe dosage of medication, administration to children, as
well as the expected action, possible side-effects and signs of toxicity. Unlike with the adult
medication, there are few standardized, pediatric drug dosage ranges and with a few
exceptions drugs are prepared and packaged in average adult dose strength.3
The most
important aspect for selection of a drug and
establishment of the proper pediatric dosage is the acknowledgment that the pediatric patient
is not just a small adult. Newborns, children and adolescents have different physiological,
pharmacokinetic and pharmacodynamic parameters compared to adults. The differences are
mainly related to the changes occurring during growth and maturation and require individual
dosages. Thus, guidelines of specific dosages and useful means for calculation of pediatric
dosages must be developed in order to enhance the effectiveness and therapeutic limit and
prevent serious adverse effects.
Two methods are commonly reported as being favorable for
definition of the proper pediatric dosage, namely per weight and per Body Surface Area.
However, such methods not always yield the same drug dosage, leading to the need of
proper evaluation to determine the ideal situation for each individual. Utilization of body
weight as a criterion for evaluation of therapeutic dosages should be employed just for mean
dosages, usually calculated for antibiotics, since the blood concentrations of the drugs are
not proportional to weight. Dosages based on the body weight are believed to be insufficient
for the achievement of proper serum concentration of most drugs, being the body surface the
most valid basis for dosage, since it is related to some physiological functions that account
for the differences in pharmacokinetics in patients of different ages. The effect of drugs is
directly related to the blood volume and metabolism, being the Body Surface area better for
calculation of the pediatric dosage. Measurements of the volume of the fluid compartment
and investigations on the blood concentrations of drugs have good correlation with the Body
Surface Area.4
6.1 NEED FOR THE STUDY
Healthy children the wealth of nation .The National Policy for children
(1947) says that :
“A Nation’s children are its asset, their nature and solicitude are our
responsibility”5
Children and adults respond to drugs differently. There are
5
important difference in the absorption, distribution, metabolism and excretion. Children’s
body systems are less developed, their gastrointestinal transit time varies and their body
composition changes with development. The limited scope of current research in
pharmacokinetics and the effects on the developing child creates the need for more studies
on drug therapy in the pediatric client.6
To administer medication safely to clients certain cognitive skills are
essential. The nurse accepts full accountability and responsibility for all actions that are
taken, this includes the administration of medication. Demonstrating accountability and
acting responsibly in professional practice occur. Most of the errors that are made by nurses
are medication errors. A medication error is any event that could cause or lead to a client
receiving inappropriate medication therapy or failing to receive appropriate medication
therapy. Most medication errors occur when a nurse become distracted or fails to follow
routine procedures such as checking dose calculations, deciphering illegible handwriting or
administering medications with which the nurse is unfamiliar.7
’’
Health care professionals and government agencies have openly and heatedly
discussed the topic of medication error in recent years in an attempt to improve patient care
quality and safety. In 1999, the US Institute of medicine alarmed health care professionals
by publishing a book entitled “To err is human – Building a safer health system.” It claimed
that one million medical mishaps happened each year, causing 100,000 patient deaths.
Deaths caused by the medical errors were between 44,000 and 98,000.8
A prospective study was conducted to assess the evaluation of nurses errors
associated in the preparation and administration of medication in a pediatric intensive care
unit (PICU) at the university hospital in Switzerland. In this study, based on the observation
of nurses activities, the data were collected over a period of 10 weeks. The frequency of
errors was calculated as the sum of all noted errors, plus the sum of all omitted drugs,
multiplied by 100. The sum of all given doses, plus all omitted doses gives the ‘Total
opportunity for errors’. This total was 275 and the total frequency of errors was 26.9%. The
most frequent errors were wrong time errors (32.4%), wrong administration technique errors
(32.4%) and preparation errors (23.0%). In relation with other studies conducted under
comparable conditions, a lesser number of omissions and wrong time errors were observed
and more administration technique and dose preparation errors were observed. A program of
systematic assistance and survey by professional pharmacists could improve the quality of
the preparation and administration of medication in the pediatric intensive care unit (PICU).9
6
A cross-sectional study was conducted (2006) in Taiwan to evaluate nurses’
knowledge of high-alert medications and section. Snowball sampling and descriptive
statistics were used. A total of 305 nurses participated, giving a 79·2% response rate
(305/385). The correct answer rate for section 1 was 56·5%, and nurses’ working experience
contributed to scores. Only 3·6% of nurses considered themselves to have sufficient
knowledge about high-alert medications, 84·6% hoped to gain more training, and the leading
obstacle reported was insufficient knowledge (75·4%). A total of 184 known administration
errors were identified, including wrong drug (33·7%) and wrong dose (32·6%); 4·9% (nine
cases; 9/184) resulted in serious consequences. It was concluded that insufficient knowledge
is a factor in nurses’ drug administration errors. Most errors do not harm patients, but
incorrect administration of high-alert medications can result in serious consequences.
Sufficient knowledge about high-alert medications is vital.10
The administration of medications consists of a series of complex, problem-prone
processes. In a study of the origin of errors, 38% of preventable medication errors occurred
at the administration step. It has been claimed that nurses spend up to 40% of their time
administering medications. The frequency of administration errors ranges from 2.4% to
47.5%, depending on the drug distribution system in place. In the United Kingdom, a recent
report by the National Patient Safety Agency (NPSA) indicated that 56.5% of reported
errors associated with severe harm or death occurred at the administration step.11
Various formula involving age, weight and body surface area (BSA) as the basis
for calculations have been devised to determine children’s drug dosage from a standard adult
dose. Because the administration of medication is a nursing responsibility responsibility,
nurses need to have not only knowledge of drug action and patient responses, but also some
resources for estimating safe dosages for children.12
A number of professional organizations have established recommendations for safe
medication administration. In April 2007, the World Health Organization (WHO) identified
nine patient safety solutions developed to prevent harm. Six of the solutions are relevant to
medication administration and include avoiding or using special precautions with look-alike
and sound-alike medication names, verification of patient identity, control of concentrated
electrolyte solutions, avoiding catheter and tubing misconnections, and utilization of singleuse injection devices. In 2007, six countries signed an agreement entitled the “Action on
Patient Safety: High 5s,” an initiative of the World Alliance for Patient Safety and WHO,
which also includes management of concentrated inject able medications.13
7
Nurses are the key personnel in administering the drugs. Nurses
must administer 90- 95% drugs daily in a safe and efficient manner. The nurse should
administer drugs in with nursing standards of practice and organizational policy. The safe
storage and maintenance of an adequate supply of drugs are other responsibilities of the
nurse. Even though nurses are skilled personnel in administering drugs, still many studies
shows the high incidence of medication errors, especially in emergency setting.14
So after searching and analyzing many studies I found that there is a great need to
assess the nurses
knowledge regarding emergency drugs and calculation of dosage in
pediatric setting.
6.2 REVIEW OF LITERATURE
The purpose of literature review is to discover what has previously been done about
the problem to be studied ,what remains to done, what methods have been employed in
other research and how the result of other research in the area can be combined to develop
knowledge. According to Abdellah and Levine, ”the material gathered in the literature
review should be created as an integral part of research data, since what is found in
literature not only can have an important influence on formulation of problem and design
of research, but also provide comparative material when the data collected in research is
analyzed”15
“ The review of literature is defined as a broad, comprehensive in depth,
systematic and critical review of scholarly publications, unpublished scholarly print
materials, audiovisual material and personal communications. “ 16
This literature which is reviewed and relevant to the present study
and organized under the following headings,
6.2.1 Reviews related to nurses knowledge on pediatric emergency drugs.
6.2.2 Reviews related to pediatric medication error.
6.2.3 Reviews related to the drug calculation.
6.2.1. Reviews related to nurses knowledge on pediatric emergency drugs.
A qualitative study was conducted to explore attitudes and practice
8
related to medication administration among pediatric nurses in Royal children’s hospital,
Brisbane. They have selected 32 pediatric nurses working in eight clinical areas by using
purposive sampling technique for the study. Data was collected by using structured
interview schedule. Results of the study showed that 43% of the nurses have average
knowledge and 57% had below average knowledge. The study concluded that medication
administration is a complex area of pediatric nursing practice in an innovative attempt to
assist in understanding nursing medication practice .The study recommended that there
should be future based management strategies related to nursing medication practice.17
An Experimental study was conducted to assess the knowledge on
pediatric emergency medication among nurses in the paediatric intensive care unit at
university of Illinois, Chicago. They have selected 21 nurses for the study by using a simple
random sampling technique. Data was collected by using a questionnaire. Result of the study
showed that there was significant difference between the mean pretest score (69.5%) and the
mean posttest score (87.3%).
This study concluded that there was improve in nurses
knowledge regarding the use of emergency medication in pediatric intensive care unit .The
study recommended that an educational programme developed co-operatively improved
specific measures of pediatric intensive care unit nurses knowledge of emergency drugs.18
A cross sectional survey was conducted on staff nurses to explore the
impact of pre-identified contextual themes on nursing medication practice. The study was
conducted with a sample size of 278 pediatric nurses from the emergency department,
intensive care unit and medical and surgical wards of an Australian tertiary pediatric hospital
and the response rate was 67%. The study results concluded that organizations need to
employ multidisciplinary education programmes to promote universal understanding of, and
adherence to, medication policies.19
A descriptive study was conducted to develop and test a method for
assessing nursing effort and workflow in the medication administration process. The study
was conducted with a sample of 151 nurses and 980 unique medication observations in
medical-surgical units at a rural hospital, an urban community hospital, and an academic
medical center was conducted. The background of the study was to reduce medication error
as thousands of patients die each year from medication errors, and hospitals strive for error
reduction. Bar-coding medication administration systems have been proposed as a solution,
however, many hospitals lack the necessary pre-implementation workflow process data on
medication administration processes to evaluate the effectiveness of their current system.
9
The results revealed that nurses averaged more than 15 minutes on each medication pass and
were at risk of an interruption or distraction with every medication pass. They concluded
that system challenges faced by nurses during the medication administration process lead to
threats to patient safety, work-around, and workflow inefficiencies, and distractions during a
time when focus is most needed to prevent error.20
A descriptive study was conducted to document characteristics of
nurses work interruptions during medication administration. The study was conducted with a
sample of 102 medication administration rounds in a single medical unit using a dose
distribution system and the following work interruption characteristics were recorded.
Source, secondary task, location, management strategies, and duration and the results
revealed that 374 work interruptions were observed over 59 hours 2 minutes of medication
administration time (6.3 WI/hr). During the preparation phase, nurse colleagues (n= 36;
29.3%) followed by system failures such as missing medication or equipment (n= 28;
22.8%) were the most frequent source of work interruptions. Nurses were interrupted during
the preparation phase mostly to solve system failures (n= 33; 26.8%) or for care coordination
(n= 30; 24.4%). During the administration phase, the most frequent sources of work
interruptions were self-initiation (n= 41; 16.9%) and patients (n= 39; 16.0%). The most
frequent secondary task undertaken during the administration phase was direct patient care
(n= 105; 43.9%). Work interruptions lasted 1 min 32 s on average, and were mostly handled
immediately (n= 357; 98.3%). It was concluded that the process of medication
administration is not protected against work interruptions, which poses significant risks
.Interventions to reduce work interruptions during the medication administration process
should target nurses and system failures to maximize medication administration safety.21
6.2.2. Reviews related to medication error.
A study was conducted on Drug administration errors and their
determinants in pediatric in-patients. It was a prospective direct-observation study of drug
administration errors from April 2002 to March 2003 in four clinical units in a pediatric
teaching hospital. Twelve observers accompanied nurses giving medications and witnessed
the preparation and administration of all drugs to all patients on all weekday mornings. The
results showed that of the 1719 observed administrations to 336 patients by 485 nurses, 538
administration errors were detected, involving timing (36%), route (19%), dosage (15%),
unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719
10
administrations. Thus the study emphasizes to sensitize the nurses to the importance of
medication errors.22
A descriptive study on Reporting of Medication Errors by Pediatric Nurses
surveyed a convenience sample of 57 pediatric and 227 adult hospital nurses regarding their
perceptions of the proportion of medication errors reported on their units, why medication
errors occur, and why medication errors are not always reported. In this study, which focuses
on pediatric data, pediatric nurses indicated that a higher proportion of errors were reported
(67%) than adult nurses indicated (56%). The medication error rates per 1,000 patient-days
computed from actual occurrence reports were also higher on pediatric (14.80) as compared
with adult units (5.66). Pediatric nurses selected distractions/interruptions and RN-to-patient
ratios as major reasons medication errors occurred. The results of this study indicate the
need to improve the accuracy of medication error reporting by nurses and to provide a
hospital environment conducive to preventing medication errors from occurring .23
A prospective study was conducted in a teaching hospital to identify and
analyze medical errors in pediatric practice. All admitted children underwent surveillance
for medical errors. Of 457 errors identified in 1286 children, medication errors were 313
(68.5%), those related to treatment procedures were 62 (13.6%) and to clerical procedures
82 (17.9%). Physiological factors accounted for 125 (27.3%) of errors, equipment failures in
68 (14.9%), clerical mistakes 118 (25.8%), carelessness 98(21.4%) and lack of training for
48 (10.5%). Morbidity was nil in 375 (82%), mild in 49 (10.7%), moderate in 22 (4.8%) and
severe in 11 (2.4%) errors. The study concluded that a non-punitive systems analysis
approach will help to identify and rectify potential sources of iatrogenic morbidity and
mortality in children.24
A prospective observational cohort study was conducted to evaluate the
frequency and characteristics of preventable medication-related events in hospitalized
children, to determine the yield of several methods for identifying them and to recommend
priorities for prevention. over a 12-week period on the pediatric wards at a universityaffiliated urban general hospital in New Zealand. For all admissions of greater than 24
hours, medication-related events were identified and there were 495 eligible study patients,
who had 520 admissions and 3037 patient days of admission, during which 3160 medication
orders were written. Of 761 medication-related events reported during the study period, 630
(83.3%) were identified by chart review; 111 (14.6%) by a voluntary staff quality
11
improvement reporting system; 16 (2.1%) by interview of parents; and 4 (0.53%) events via
the concurrent routine hospital-incident reporting system. It was concluded that preventable
medication-related events occur commonly in the pediatric inpatient setting, and importantly
over half of the events that caused patient harm were deemed preventable, and hence the
best targets for prevention are dosing errors, particularly during the prescribing stage of the
medication use process, and use of antibacterial agents, particularly when administered by
the intravenous route.25
A study was conducted on Opportunities for performance
improvement in relation to medication administration during pediatric stabilization. The
nurses participated in a simulated pediatric stabilization event which was videotaped. Their
clinical performance was evaluated at each of the following steps: (1) communicating and
confirming the dose of medication; (2) converting the dose; (3) selecting the correct
medications; (4) properly preparing the medication formulation; and (5) measuring
medication doses. The time required to convert and draw up the medications was also
evaluated. A total of 150 medication orders for five medications were given by the
physician. Results showed that only 55% of the orders were verbally repeated back by the
nurses. Of the 120 orders in which the doses were converted from milligrams to milliliters
by nurses, 17 (14.2%) were converted incorrectly and the maximum dose deviation reached
400%. Selection of the wrong medication occurred in 11 of the 150 orders. Dextrose (which
requires dilution before being administered to children) was not diluted in 17% of the
medication orders and in 12% it was diluted improperly. About 40% of the orders for
ceftriaxone (which requires reconstitution) were not properly reconstituted. In 49 (32.7%) of
the 150 medication orders that were drawn up in a syringe, the amount measured was not
consistent with the stated dose. For some medications, a prolonged time was required by
nurses to convert the doses and draw up the medications. The study concluded that
complexities of the process set up many opportunities for nurses to make errors. Future
investigations should examine how to simplify the whole process and standardize many of
the steps.26
6.2.3 Reviews related to the drug calculation.
An observational survey was conducted (2008) on pediatric health care
professionals, to identify educational interventions to reduce dose calculation errors and the
literature review identified one paper describing an in-service test for medical trainees.
12
319/559 questionnaires were returned (57%). 34 mentioned educational interventions, 15
centers provided further information on teaching and assessment methods and 13 provided
presentations, usually at doctors' induction. Many interventions had a similar format,
including describing differences from adult prescribing, common errors and how to calculate
doses. Pediatric clinical pharmacists play a significant role in delivering training and
competency assessment. It was concluded that teaching of pediatric prescribing takes place
mostly in the format of lectures during doctors' induction. Few centers assess competency
and no validated tool exists. There has been little evaluation of the impact of teaching on
competency to prescribe.27
Several studies and reports demonstrate the need to make mathematical
calculations a priority focus area. More than 1 in 6 medication errors involve a calculation
error. A simulated study in a pediatric stabilization unit in England found that 14.2% of 150
orders were converted from milligrams to milliliters incorrectly, with a maximum dose
deviation of 400%. Furthermore, 32.7% of drug doses drawn up in a syringe were incorrect.
One study demonstrated that 81% of nurses were unable to correctly calculate medications
90% of the time and that 43.5% of test scores requiring calculations were below 70%
accuracy. In the United States, a nationwide study conducted to assess practices to validate
mathematical skills indicated a required passing rate of 80%; no respondent institutions
required 100% accuracy. The authors recommended a call for 100% accuracy on
mathematical tests for medication administration in order to reduce medication errors.28
6.3 STATEMENT OF PROBLEM :“ A STUDY TO ASSESS THE KNOWLEDGE ON PAEDIATRIC EMERGENCY
DRUGS AND CALCULATION OF DOSAGE AMONG STAFF NURSES IN A
SELECTED HOSPITALS AT BANGALORE ,IN A VIEW
TO PREPARING AN
INFORMATION BOOKLET.”
6.4 OBJECTIVES OF THE STUDY
 To assess the level of knowledge among staff nurses on pediatric emergency drugs
and calculation of dosage.
 To associate the level of knowledge among staff nurses with selected sociodemographic variables such as age, education, areas of experience, marital status etc.
 To prepare an informational booklet regarding pediatric emergency drugs and
calculation of dosage.
13
6.5 HYPOTHESIS
 H1-- There will be a significant difference in knowledge regarding the pediatric
emergency drugs and calculation of dosage among staff nurses.
 H2-- There will be a significant association between knowledge and sociodemographic variables such as age ,education ,areas of experience, marital status etc.
6.6
OPERATIONAL DEFINITION :-
ASSESS
 It refers to the way of finding the level of knowledge of staff nurses regarding
pediatric emergency medication and calculation of dosage.
KNOWLEDGE
 In this study it refers to level of under standing of staff nurses regarding pediatric
emergency medication and calculation of dosage.
EMERGENCY DRUGS
 Medication required for the emergency first-aid treatment of medical conditions. The
drugs include Adenosine, Adrenaline, Aminophylline, Calcium gluconate, Dextrose,
Diazepam, Digoxin, Dobutamine hydrochloride, Dopamine, Frusemide,
Hydrocortisone, Lidocaine hydrochloride, Naloxone hydrochloride, Phenobarbital
sodium, Sodium bicarbonate.

CALCULATION
 It is the procedure of calculating the medicine,determining something by
mathematically or logical method.
DOSAGE
 It is the administration of a therapeutic agent in prescribed amounts.
STAFF NURSE
14
 It refers to the trained nursing personnel’s who have completed their, GNM, B.Sc,
P.C.B.Sc and working at selected hospitals at Bangalore .
INFORMATIONAL BOOKLET
 It refers to a concise and comprehensive, information
material
regarding
pediatric emergency medication and calculation of dosage.
6.7 ASSUMPTIONS
It is assumed that:
6.7.1
Staff nurses may have inadequate knowledge regarding pediatric emergency
medication and calculation of dosage.
6.7.2
The information booklet on pediatric emergency medication and calculation
of dosage will promote the nurses to prescribe the correct dosage.
6.8 DELIMITATIONS
The study is delimited to
 Staff nurses working in a selected hospitals at Bangalore.
 Staff nurses who knows English or Kannada.
 Staff nurses who are willing to participate.
6.9 PROJECTED OUTCOME
 This help the staff nurses to understand about the pediatric emergency medication
and calculation of dosage and hence it will help to prescribe the correct dosage to the
child.
MATERIALS AND METHODS
7.1. SOURCE OF DATA
Data will be collected from staff nurses working in a selected hospitals at Bangalore .
15
7
7.1.1 RESEARCH DESIGN
The research design adopted for this study is descriptive study..
7.1.2 RESEARCH APPORACH
The research approach for this study is Survey approach.
7.1.3 RESEARCH SETTING
This study will be conducted in selected hospitals at Bangalore.
7.1.4 POPULATION
Population in this study includes staff nurses working in selected pediatric hospitals
at Bangalore
7.2 METHODS OF DATA COLLECTION
7.2.1 SAMPLE SIZE
Total sample of the study consists of 60 nurses working in a selected hospitals at
Bangalore .
7.2.2 SAMPLING TECHNIQUE
The sampling technique adopted for this study is simple random sampling method.
7.2.3 INCLUSION CRITERIA
 Staff nurses willing to participate in the study.
 Staff nurses who are available during the study .
 Staff nurses who are completed GNM, B.Sc, PC.BSc and working in selected
hospitals at bangalore.
 Staff nurses who knows Kannada or English.
7.2.4 EXCLUSION CRITERIA
 Staff nurses who are not willing to participate in the study.
 Students nurses who are not present during the time of duty.
7.2.5 INSTRUMENT INTENDED TO BE USED SELECTION OF
16
TOOL
This consist of three parts;
 PART-1 : It consist of socio-demographic variables such as age, education, areas of
experience, marital status etc.
 PART-2 : Questionnaire will be used to assess the knowledge,30 questions will be
used.
 PART 3 :Information booklet will be given regarding pediatric emergency
medication and dosage calculation.
SCORING PROCEDURE:
 For knowledge assessment total score is -30
 If the answer is correct the score is -1
 If the answer is wrong the score is -0
SCORING INTERPITATION:
 Good
: 25 to 30.
 Average :20 to 25
 Poor
: Below 20
7.3 METHODS OF DATA ANALYSIS
Data analysis will be done using descriptive and inferential statistics:
1. Descriptive statistics: mean, median, mode and standard deviation is used for
assessing knowledge scores.
2. Inferential statistics: Chi-square will be used to find the association between
knowledge score and selected demographic variables.
7.4 HAS THE ETHICAL CLEARANE BEEN OBTAINED FROM YOUR
INSTITUTION?
All the subjects will be explained, about the purpose ,the objectives & the
procedure of the study. YES ,Ethical clearance will be obtained from the research
committee of the Nightingale College of nursing . Permission will be obtained from
17
the concerned authority of selected pediatric hospitals at Bangalore .
18
8.
REFERENCES
1. Marlow R.D ,Redding A.B; “Text Book of Pediatric Nursing”; 6th edition; W.B Saunders
company; Philadelphia; 2003; 800, 1149-1150,1172,1185.
2.Parul Data,” A text book for pediatric nursing”1ST edition, Jayapee brothers medical
publishers(p) ltd New Delhi;2009; p 157-165.
3.Perry P. Fundamentals of nursing. 1St ed. Elsevier publications; 2005. p. 821-82.
4. Gracieli Prado, Ronaldo Célio “comparative study of rules employed for calculation of
pediatric dosage” A journal of applied oral science; 2005; 13(2): 114-9. Available from
:www.fob.usp.br/revista or www.scielo.br/jaos
5. K.Park ; “Text book of preventive and social medicine”; 19th edition; Banarsidas Bhanot ;
Jabalpur ;2007; 442.
6. Niederhauser V.P;“Prescribing for children:Issues in pediatric Pharmacology”; Nurse
Practitioner; 1997 March;22(3); 16-18,23,26-28
7.Perry P. Fundamentals of nursing. 1St ed. Elsevier publications; 2005. p. 887-90.
8.Kohn LT, Corrigan JM, Donaldson MS. To error is human: Building a safer health
system. Institute of medicine of the national academy of sciences. Washington, DC. R from:
http://www.providersedge.com/ehdocs/ehr_articles/To_Err_Is_Human_%20Building_a_Saf
er_Health_System-exec_summary.pdf .Accessed on December 1,2011.
9. Schneider M.P, Cotting J; “ Evaluation of nurses errors associated in the preparation and
administration of medication in a pediatric intensive care unit”;Journal of Pharmacy World
Science;1998 Aug;20(4);178-182.
10.Hsaio GY, Chen IJ, Yu S, Wei IL, Fang YY, Tang FI. Nurses' knowledge of high-alert
medications: instrument development and validation. J Advanced nursing. Jan 2010. p. 117
Avilable from: http://www.ncbi.nlm.nih.gov/pubmed/20423443. Accessed on December 2,2011
11.Ritha shane: “Current status of administration of medication”:American Journal of
Health-System Pharmacy; March 1, 2009 vol. 66 no. 5 Supplement 3 s42-s48.
12. Wong L.D, Hockenberry J.M; “Nursing care of infants and children”;7th edition ; Mosby
; Philadelphia; 2003 ; 1149-1150,1172,1179,1185.
13.Ritha shane: “Current status of administration of medication”:American Journal of
Health-System Pharmacy; March 1, 2009 vol. 66 no. 5 Supplement 3 s42-s48.
14.Ritha shane: “Current status of administration of medication”:American Journal of
Health-System Pharmacy; March 1, 2009 vol. 66 no. 5 Supplement 3 s77-s88.
19
15. Neelam Makhija,”Introduction to nursing research”:1st edition :A.P Jain & co.
New delhi:2005:30-35.
16. B T Basavanthappa :”Text book of Nursing research”:2nd edition; , Jayapee brothers
medical publishers(p) ltd New Delhi;2009; p 92-115.
17. Davis L,Keogh K; “A qualitative study to explore pediatrics nurses attitudes and
practices related to medication administration”; Collegian Journal;2005 Oct; 12(4); 15-20.
18. Kraus D.M, Stifter J ;“Program to improve nurses knowledge of pediatric emergency
medications”; AM Journal;1991 April; 81(4); 97-101.
19.Davis L, Ware R, McCann D, Keogh S, Watson K. Evaluation of contextual influences
on the medication administration practice of pediatric nurses. J Advanced Nsg. Jun 2009. P.
1293-9.Avialable
from:
http://www.ncbi.nlm.nih.gov/pubmed/19374672.
Accessed
on
December 1,2011
20.Elganzouri ES, Standish CA, Androwich I. Medication Administration Time Study
(MATS): nursing
staff performance of medication administration. Journal of Nursing
Administration. May 2009. Accessed on December 4,2011.
P. 204-10. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed
21. Biron AD, Lavoie TM, Loiselle CG. Characteristics of work interruptions during
medication
administration JNsgScholarship. 2009. p. 330-6. Avilable from:
http://www.ncbi.nlm.nih.gov/pubmed/19941577. Accessed on December 5,2011.
22.Prot S, Fontan J E , Alberti, Bourdon, Farnoux C, Macher A M, Foureau A, Faye A,
Beaufils F , Gottot S, Brion F. Drug Administration Errors And Their Determinants In
Pediatric In-Patients. International Journal for Quality in Health Care 2005;17(5): 381-389.
23. Stratton M K, Blegen A M, Pepper G ,Vaughn T. Reporting of Medication Errors by
Pediatric Nurses .Journal of Pediatric Nursing 2004; 19 (6): 385 – 392.
24.Passi Gouri Rao, Parihar Mansi. Medical Errors in Pediatric Practice. Indian pediatrics
2008 ;587.
25. Desiree LK, David MR. Preventable medication-related events in hospitalized children
in New Zealand. Journal of New Zealand medical association.18 April 2008. Available
from: http://www.nzma.org.nz/journal/121-1272/3012/d. Accessed on December 1,2011.
26. Morgan N, Luo X, Fortner C, Frush K. Opportunities For Performance Improvement In
Relation To Medication Administration During Pediatric Stabilization. Quality Safety
Health Care 2006;15:179–183.
27. Conroy S, North C, Fox T, Haines L, Planner C, Erskine P et al. Educational
20
interventions to reduce prescribing errors. Archives of Diseases in Childhood. Apr 2008.
p. 313-5. Available from http://www.ncbi.nlm.nih.gov/pubmed/18198207. Accessed on
December 1,2011
28.Ritha shane: “Current status of administration of medication”:American Journal of
Health-System Pharmacy; March 1, 2009 vol. 66 no. 5 Supplement 3 s42-s48.
21
9
SIGNATURE OF CANDIDATE
10
REMARK OF GUIDE
11
NAME AND DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12
12.1 REMARK OF PRINCIPAL
12.2 SIGNATURE
22