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Identification of medication errors by nurses during simulated situations
KELBLOVÁ, Kateřina
Current status: Medication errors within the context of safe and high quality health care are one of the most frequently discussed topics of recent years. They are part of the medical process, occur in different forms, affect patients of all ages and decrease the quality of provided health care. Prescriptions of medication in medical documentation have to be clearly legible and include all the required information. Nurses' role within the medicaiton process could be described as an ultimate "safeguard" that can prevent medication errors. Goals: The objectives of this research are to assess nurses' awareness of medication errors, ssess their ability to detect medication errors and find out the level of their knowledge regarding the correct procedures and measures following medication error detection.Methodology: The research was conducted using a qualitative research method. The in-depth interviews with nurses were carried out at a surgical critical care unit at the hospital in Jindrichuv Hradec. Following the collection of a sufficient amount of data the interviews were coded using the "pen and pencil" technique and then divided into categories.Research file: In order to achieve the highest level of objectivity the research was carried out with a group of nurses who work at the same unit of a hospital department. The research file included nurses who had varied levels of education and numbers of years of experience. Results: Surgical critical care unit nurses are not aware of the exact definition of medication errors. Only one nurse was able to discuss adverse events with related consequences. The remaining nurses' awareness of medication errors corresponded to the classification described in the relevant foreign and Czech academic literature. None of the interviewed nurses detected all the errors included in the simulated scenarios. Only one nurse, who is currently completing her qualification in this specialty, detected a wrongly prescribed antidote. The simulated scenarios also included a group of high-risk medications that is commonly used at the unit. The first medication included in this group was a 7.45% solution of potassium (KCl). A majority of the participants detected the high concentration of this high-risk medication. Another high-risk medication was a 10% concentrate of NaCl in an infusion; this error was also detected by the majority of the nurses. The third high-risk medication was a wrongly prescribed insulin (it lacked the detailed description of units, time and route). This prescription error was not detected by the majority of participating nurses. Another type of medication error included in the simulated scenarios was a group of medications used specifically in critical care. Only half of the participating nurses successfully detected the errors related to the prescription of this group of medications. The last type or medication errors focused on incomplete prescription by doctors. The most frequently detected error was a prescription of an opiate that lacked the route and the least frequently detected error was a wrong prescription of an infusion administration. It is evident that the nurses always inform the doctor when they detect a medication error. They are more willing to inform the ward sister in cases of incidents caused by somebody else. Only a small group of nurses are willing to inform the senior consultant, the head nurse or the hospital management. Only one nurse associated medication error reporting with an audit. However the majority of nurses agrees that it is important to report any medication errors.Conclusion: The analysed data suggested that the nurses were aware of medication errors. The analysis of the results of the simulated scenarios suggested that nurses' ability to detect medication errors in prescriptions was related to the number of years of experience and the level of education.
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The issue of life-threatening conditions in emergency medicine
KELBLOVÁ, Kateřina
Issues relating to life-threatening conditions in emergency medicine The purpose of this bachelor?s thesis was to determine how nurses in Intensive Care Units cope with common emergency situations. The theoretical part explains acute care, its three stages, staff/bed rate, and education and skills of the nurses. It also contains descriptions of possible acute life-threatening conditions, which may result in sudden cardiac arrest. It also describes specifics of cardiopulmonary resuscitation, and stress the nurses experience in intensive care. The target was achieved through four sub-goals: To determine the level of preparedness of nurses to work in such departments. To determine whether specialized study program can influence preparedness for crisis situations. To determine whether nurses change their attitudes to crisis situations after a period of practice. To determine how nurses in this field experience and cope with crisis situations. The practical part contains a qualitative research based on semi-standardized interviews held with eight nurses, and consequent content analysis accomplished through open coding. There were determined 23 categories and other sub-categories. For better clarity, data in categories 2,3,7,9,10 and 19 were put into categorization tables. The conclusion is: half of the nurses that claimed secondary school of nursing had been their only completed study program said this education prepared them inadequately for real situations. Only one nurse who had completed the specialized program felt ready for ICU. Partial preparedness was found in the nurse who had completed a higher vocational school. Preparedness can also be assessed from feelings the nurses experienced soon after they started their careers at ICU. Only one nurse felt all right; the others felt anxiety and stress. This means, nurses are not sufficiently prepared on theoretical level when they start their careers; and it results in negative feelings, eg. stress. The hypothesis No. 1 is: Nurses are insufficiently prepared on theoretical level when they start their careers. The survey showed that 6 nurses had completed specialized study program; one before she joined ICU, and one is currently in the program. All nurses who finished the study program find it helpful; only the nurse with no program completed feels she is not ready for crisis situations now. Therefore, the hypothesis No. 2 is: Specialized study program has a positive impact on how nurses handle crisis situations. Reaching the third objective, the survey looked at how nurses dealt with crisis situations at the start of their careers and at the time of the survey. Three nurses had identical answers. Two found no situation critical, and one still finds the fight for patient?s life burdensome. Two nurses replaced ?resuscitation? with ?no crisis situation?; one mentioned ?conflicts in the workplace?, and two remaining nurses described insignificant changes. Yet, all nurses but one responded that the length of their practice has positive impact on how they handle crisis situations. Even though the length brings safety and peace, it does not necessarily improve the care provided. Objective No. 4: What feelings do nurses have when they handle crisis situations? Most frequent answer was staying balanced and composed, rational thinking, and speed in decision-making process; also a certain form of stress. Interestingly, if asked about possible reasons for leaving the department, nurses mentioned general management, problems in the team and in relationships; only two nurses were fully happy with their jobs. The results and conclusions of this bachelor?s thesis may serve as inspiration to managers in nursing.
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