PRELICENSURE STUDENT NURSE MEDICATION ERRORS: A SYSTEMATIC REVIEW OF THE LITERATURE
Purpose: The purpose of this systematic review of the literature was to identify research and quality management articles that described and examined medication administration errors and ‘near misses’ made by prelicensure nursing students within the clinical environment.
Background: Medication errors make up a significant proportion of medical errors that create risk for patients receiving care in health care facilities and can impede optimal patient outcomes. While much attention has been directed to the study of medication errors, little is known about the experiences of prelicensure student nurses who make medication errors or have near misses related to medication therapy. Knowledge of the characteristics of these errors and near misses made by prelicensure student nurses, factors that these individuals attribute to the occurrence of the medication errors, and the resulting patient outcomes can add to our understanding of the experience.
Methods: A broad search of PubMed, CINAHL, Cochrane Library, PsycINFO, and Web of Science using the search terms nursing student and medication error was conducted for the time period of January 2004 to October 2014. The search was limited to the English language. Research, quality management, or anecdotal articles that described some aspect of the frequency, characteristics, related factors and patient outcomes of prelicensure nursing student medication administration errors or near misses in the clinical environment were included. Reference lists of the included articles were searched for additional studies that fit this same time period. The broad search identified 360 published articles which decreased to 246 articles after duplicates were removed. Upon review of title and abstract, the number of articles was reduced further. Some articles required review of the article in order to determine inclusion. A total of 10 research and quality management articles and 3 anecdote/single case articles were included in the systematic review.
Results: While the various studies addressed different outcomes and employed different methods, it is clear that student nurses are involved in medication errors and near misses. Characteristics of the medication errors primarily involved rights violations such as right patient, right medication, right dose, right time, right technique, and omission. Factors related to the occurrence of errors and near misses included inexperience, confusing medication records or instructions, lack of knowledge and understanding, and lack of appropriate supervision. While most patients experienced no harm, a few patients required prolonged hospitalization or life-sustaining interventions, and one resulted in death.
Implications: Knowledge of prelicensure student nurse medication administration errors is particularly important for nurse educators so that current teaching practices for medication therapy can be optimized to: (1) support student learning regarding appropriate medication administration, and (2) ensure patient safety while in the care of prelicensure student nurses. There is a paucity of literature that describes this experience and further research is indicated.