Assessment of undergraduate nursing students' medication administration competency: A systematic review

Nursing students must be well-prepared and competent in medication administration (MA) and be able to apply pharmacology knowledge as registered nurses. MA is integral to ensuring patient safety, but nursing students find it challenging to acquire competency in MA. Little is known about assessing medication administration competency in various clinical practice settings.

To conduct a systematic review of how undergraduate nursing students' medication administration competency is assessed in clinical practice settings.

Original research studies were identified using PubMed, Web of Science, CINAHL, PsycINFO, Scopus, ScienceDirect, and ERIC. This systematic literature review included primary research studies using objective competency measures of MA assessment of undergraduate nursing students in a clinical practice setting, published in English between 1990 and 2023. Data was extracted and synthesised using the Preferred Reporting Items for Systematic Reviews.

32 original research papers were included in the review. Studies came from 12 countries. A quasi-experimental design was used by 75 % of studies to examine MA competency assessment. Medication assessments were conducted primarily in simulation labs. Simulation was found to have positive outcomes on MA competency on clinical placement. Studies were grouped into three categories: 'Using technology', 'Educational Strategies', and 'Focus on Safety skills'. Studies reported error rates associated with patient identification and hand hygiene, including those of senior nursing students. Quality appraisal was conducted using the Medical Education Research Study Quality Instrument (MERSQI). The MERSQI Mean score was 12.92/18. Several studies failed to report the sample size calculation and the validity of instruments.

A whole-curriculum approach with MA content and skills mapped and scaffolded across the undergraduate nursing program is required to enable students to achieve MA competency. Attention to the design of studies is required to ensure the reliability of results. Further research is required to understand the cognitive and affective behaviours contributing to the ongoing errors, focusing on assessing competency in clinical placement.