title: Opportunities for performance improvement in relation to medication administration during pediatric stabilization.
abstract: OBJECTIVE
  To identify and characterize areas for improvement in the clinical performance of nurses in relation to medication administration.
  
  
  METHODS
  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.
  
  
  RESULTS
  A total of 150 medication orders for five medications were given by the physician. 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.
  
  
  CONCLUSIONS
  By observing the clinical performance of nurses in a simulated videotaped pediatric stabilization event, we have identified some important areas in need of improvement in each step of the medication administration process. These findings indicate a need for improved education, training, and use of clinical aids or adjuncts for pediatric emergency nurses.
authors.affiliation: School of Nursing, Duke University, Durham, NC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Morgan
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: C
authors.initials: C
authors.lastname: Fortner
authors.forename: K
authors.initials: K
authors.lastname: Frush
mesh_terms: D000046:Academic Medical Centers; D002648:Child; D004358:Drug Therapy / Q000451:nursing* / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D008348:Manikins; D008508:Medication Errors / Q000145:classification / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000592:standards*; D009731:Nursing Audit / Q000379:methods*; D009736:Nursing Process; D009741:Nursing Staff, Hospital / Q000193:education / Q000592:standards*; D019370:Observation; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011446:Prospective Studies; D012640:Seizures / Q000188:drug therapy; D015144:Southeastern United States; D014743:Videotape Recording
chemical_list: D004364:Pharmaceutical Preparations