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Call for Decision Support for High-Alert Medication Administration Among Pediatric Nurses: Findings From a Large,
Mengxue He1,2,3, Qin Huang4, Hong Lu3
1School of Nursing, Fudan University, Shanghai, China.
Insights
Pediatric nurses in China show insufficient knowledge of high-alert medications (HAMs), impacting safe medication administration. Enhanced training and technological support are crucial for improving patient safety and reducing medication errors.
Area of Science:
- Pediatric Nursing
- Medication Safety
- Clinical Pharmacy
Background:
- Children face a higher risk of medication errors (MEs) compared to adults.
- High-alert medications (HAMs) are defined by the Institute for Safe Medication Practice (ISMP) as drugs that pose a significant risk of patient harm if misused.
- Nurses play a critical role in medication administration and patient care.
Purpose of the Study:
- To assess pediatric nurses' knowledge of HAMs in China.
- To evaluate the basis and confidence levels in decision-making regarding HAMs.
- To identify decision support needs for pediatric nurses handling HAMs.
Main Methods:
- A web-based, cross-sectional survey was conducted among 966 pediatric nurses across 14 hospitals in China.
- Data were collected using a self-administered instrument covering demographics, HAM knowledge, decision-making confidence, and support needs.
- Statistical analysis was performed using SPSS 20.0.
Main Results:
- Nurses demonstrated insufficient knowledge of HAMs (median score 75.0/100), with lower scores in HAM regulation compared to administration.
- Most nurses relied on drug instructions and handbooks for decision-making and reported high confidence (84.6%).
- Decision-making difficulties occurred across administration stages, and 92.0% of nurses deemed decision support necessary, favoring computerized systems and pharmacist communication.
Conclusions:
- Chinese pediatric nurses exhibit knowledge gaps regarding HAMs, affecting decision-making.
- Enhanced support, including training, technology, interprofessional collaboration, and a supportive institutional culture, is essential for safe HAM administration.
- Addressing these inadequacies is vital for improving pediatric patient safety.
Abstract:
Background: Children have a higher risk of medication errors (MEs) than adults. The Institute for Safe Medication Practice (ISMP) defined high-alert medications (HAMs) as a group of medications that could cause significant patient harm or even death when they are used in error. Nurses are actively involved in and responsible for patient care, especially in medication administration. This study aimed to estimate the knowledge, decision-making basis and confidence and decision support needs related to HAMs among pediatric nurses in China. Methods: A web-based, cross-sectional survey was conducted among pediatric nurses who were recruited from 14 member hospitals of the Pediatric Nursing Alliance of National Children's Medical Center in China using a convenient sampling technique. Data were collected using a self-administered instrument composed of four parts: the demographic characteristics of participants, participants' knowledge about HAMs, participants' self-evaluation of the basis of and confidence in decision-making, and decision support needs regarding HAMs. Among the participants, the maximum score for HAM knowledge was 100. All data were entered and analyzed using SPSS 20.0. Results: A total of 966 nurses participated in this study. Nurses were found to have insufficient knowledge about HAMs, with a median (IQR) of 75.0 (70.0, 80.0), out of a maximum score of 100. Knowledge about HAM administration was significantly higher than that about HAM regulation, with a p value < 0.001. The three lowest-scoring items concerned HAM regulation, and the "Treat fentanyl skin patches as a regulated narcotic" item obtained the lowest score, with only 1/5 of respondents answering it correctly. Most participants reported that their basis for decision-making about HAMs was drug instructions (90.0%) or drug handbooks (81.9%) and evaluated their confidence in decision-making about HAMs as high or relatively high (84.6%). The decision-making difficulties when encountering HAMs focused on most stages of HAM administration, especially the appropriateness of prescriptions, checks, preparation and administration. The vast majority of participants assessed decision support as necessary or very necessary (92.0%), and the most popular options for decision support were computerized clinical decision support systems (46.4%) and real-time online communication with pharmacists (23.9%). Conclusion: Our study demonstrated the inadequacies in HAM knowledge, the basis and difficulty of decision-making, and decision support needs regarding HAMs in Chinese pediatric nurses. Nurses need greater support in HAM administration, including not only training but also adequate technology, mutually beneficial interprofessional collaboration, and a positive institutional culture.
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