Introduction:
Medication administration is a complex multistep process that includes prescribing, dispensing, administering drugs and monitoring patient response. Errors can occur at any stage. Although many errors arise at the prescribing stage, some can occur due to pharmacists, nurses, or other staff.
Administration of medicines by nurses is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner.(1) The appropriateness of a medication requires the basic knowledge of actions, interactions, side effects, dose, route and approved use of the drug being administered.(2) Medication errors are a serious threat to patient safety in all settings.
The 5 R’s of administration of drugs (right patient, right drug, right dose, right route and right time) are principles that nurses are taught as part of their education. Nurses may not always adhere to the 5 R’s. They may also lack the knowledge about the pharmacology of the medication, which may lead to medication errors.(3) It is a well-known fact that no drug is entirely safe and therefore, nurses who administer medications need to have a thorough and broad knowledge of the drugs and its mode of administration in the effective treatment of patients.(4)
Nurses need to maintain the adequacy of their knowledge in clinical pharmacology and therapeutics in order to prevent errors that involve medications with complex pharmacokinetic and pharmacodynamic properties.(5)
Research has documented the widespread use of analgesics by nursing staff, although less is known about the knowledge that nurses actually have about these drugs.The frequency of analgesic drug errors in hospitals is nearly 3 per 1,000 prescriptions.(6) It has been found that knowledge has been lacking in the fields of dosing of analgesics, the pharmacological and non-pharmacological treatment of pain, and the assessment of pain in patients.(7)
Our study investigated the knowledge of nurses about the pharmacology of various analgesics prescribed in our hospital.
Methodology
Study design: Prospective questionnaire based study
Place of study: The study was conducted at Father Muller medical college of Nursing, Kankanady, Mangalore
Duration of study: The study was conducted over a period of one month
Study population: All registered nurses working in various wards in Father Muller medical hospital and students belonging to GNM, BSc Nursing and PCBSc, who were actively involved in administering medications in the hospital were included in the study. A total of 102 nurses including staff and students took part in the study.
Method of Collection of Data: Following approval from the institutional ethics committee, questionnaires were given to the nurses coming under the inclusion criteria. The questionnaires included multiple choice questions on the basic knowledge of various common analgesics prescribed (Diclofenac, Butorphanol, Morphine and Tramadol).
The questions included were based on the dosage forms, mechanism of action, route of administration, adverse effects and the nurses’ educational qualifications, and their working experience in the field of nursing.(8)
The participants were asked to answer the questionnaire the in front of the researcher, so that the study was done under supervision. A few of the questions asked are given in Table 1.
| Table 1: Some Samples from the Questionnaire |
Analgesic |
Question |
| Butrum |
What does it contain |
Which group of analgesics does it belong to |
| Morphine |
Dose of acute toxicity |
Can it be administered in a patient with bronchial asthma |
| Voveran |
What does it contain |
Which group of analgesics does it belong to |
| Tramazac |
What does it contain |
What is the most common side effect |
Their answers were given a score out of 20 (100%). A score of 15 and above was considered adequate knowledge, 10-15 inadequate and < 10 was considered poor knowledge.
Statistics: Data was evaluated using frequency, percentage, Mann Whitneys test and Kruskal Wallis test.
Results
The response rate was 100%. The sample comprised of a total of 102 participants, of which 17(16.6%) were senior staff nurses, 38(37%) were junior staff nurses and 47(46%) were student nurses. (Table 2)
| Table 2: Designation of the nurses in the study |
Designation |
Number |
Percentage (%) |
Senior staff nurses |
17 |
16.6 |
Junior staff nurses |
38 |
37 |
Student nurses |
47 |
46 |
Total |
102 |
100 |
Of the staff, 10.8 % were BSc and MSc nurses, 43.1% were GNM staff. (Figure 1)
 |
 |
Figure 1: Designation of the Nurses |
Figure 2: Overall Knowledge and Designation |
The mean knowledge score of BSc & MSc staff was 12.18, GNM staff was 11.7 and of student nurses was 13.38. None of the groups scored more than 15, suggesting their knowledge was inadequate. The scores also showed that there was a significant difference in knowledge based on their designation. (BSc /MSc staff 60.91%, GNM staff58.98% and final year BSc nursing students 66.91%, p<0.13) (Figure 2)
Of the staff nurses, 5.9% had a working experience of less than one year, 11.8 % had 1-3 years, 9.8% had 3-5 years, 9.8% had 5-10 years and 12.7% had more than 10 years working experience. There was a correlation between knowledge and experience in the staff nurses. (p<0.13). (Figure 3)
 |
Figure 3: Overall Knowledge with Experience in Years |
Discussion
Medication administration is a daily basic activity in nursing practice and nurses need to have sufficient knowledge, attitude and competency to perform these tasks. 10 to 18% of all reported hospital injuries have been said to be caused due to medication errors and nurses can be involved in the occurrence of these errors.(9)
Our study assessed the knowledge of the pharmacology of analgesics among 102 nurses. Of them, 10.8% were MSc and BSc staff nurses, 43.1% were GNM staff and 46.1% were final year BSc Nursing students.
The staff had a median experience of 5 years post registration.
None of the nurses answered all the questions correctly. The highest score obtained was 14.
Our study showed that the knowledge of pharmacology was related to the experience of the staff in the field of nursing. The BSc and MSc nurses had a better knowledge level that the GNM nurses, suggesting a correlation of knowledge with the level of education.
A similar study done by Ndosi and Newell in a sample of 42 nurses showed that knowledge on pharmacology of commonly administered drugs was more in nurses with higher experience and education level.(10)
A study done by Leesa Niekrek and Frances Martin in Tasmania among 2768 nurses revealed that they had very low knowledge in the use of analgesics.(11)
The final scores of all groups of nurses was inadequate suggesting that they do not have sufficient pharmacological knowledge of the commonly prescribed analgesics in our hospital.
There is a need for additional pharmacology education for nurses in order increase the currency of their knowledge in the field and to prevent medication errors.
References
- Nursing and midwifery council. Standards for medicines management. 2007;3. Available at www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf
- Saskatchewan Registered Nurses’ Association: Medication Administration: Guidelines for Registered nurses. 2007;4. Available at www.srna.org/images/stories/pdfs/nurse_resources/medication_admin.pdf
- Hsaio GY, Chen IJ, Yu S, Wei IL, Fang YY, Tang FI. Nurses' knowledge of high-alert medications: instrument development and validation. J Adv Nurs. 2010 Jan;66(1):177-190.
- Copping C. Preventing drug administration errors. Nursing Practice. 2005;101(33):32. Available at http://www.nursingtimes.net/nursing-practice/clinical-zones/prescribing/preventing-and-reporting-drug-administration-errors/203718.article
- Banning M. Medication errors:considerations for nurse prescribers. Nurse Prescribing. Mar 2005;3(2):68-72.
- Smith HS, Lesar TS. Analgesic Prescribing Errors and Associated Medication Characteristics The Journal of Pain January 2011;12(1):29-40.
- Ferrell BR, McGuire DB, Donovan MI. Knowledge and beliefs regarding pain in a sample of nursing faculty. Journal of Professional Nursing March–April 1993;9(2):79–88.
- Simonsen BO, Johansson I, Daehlin GK, Osvik LM, Farup PG. Medication knowledge, certainty, and risk of errors in health care: a cross-sectional study. BMC Health Serv Res. 2011;11:175.
- Fontan J, Maneglier V, Nguyen VX, Loirat C, Brion F. Medication errors in hospitals: computerized unit drug dispensing systems versus ward stock distribution system. Pharm World Sci. 2003;25(3):112-117.
- Ndosi ME, Newell R. Nurses' knowledge of pharmacology behind drugs they commonly administer. Journal of Clinical Nursing. Feb 2009;18(4):570-80.
- Van Niekerk LM, Tasmanian FM. Nurses’ knowledge of pain management International Journal of Nursing Studies April 2001;38(2):141–152.
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