Opioid Room of Horrors: a simulation approach to strengthen drug administration safety

Medication administration errors (MAEs) are frequent and preventable. While the five rights (5R) rule and the double-check are standard practices for safe drug administration, incidents still occur. MAEs involving high-risk drugs such as opioids are a major concern, especially in older patients. To address this, a practical, error-driven training was developed through an opioid Room of Horrors (RoH) to reinforce the 5R rule and the double-check procedure and map risks within the opioid medication-use process, thereby improving the safety of opioid administration. The secondary objective was to evaluate participant satisfaction with the training.

The opioid RoH integrates four errors and four hazards hidden in the opioid medication-use process. Participants, working in pairs, were asked to prepare and administer an opioid to a fictitious patient. Two assessors recorded the number of errors detected and hazards avoided. During the debriefing, assessors reviewed and explained these items to the pair of trainees combined with a refresh on the 5R rule and the double-check process. Detection and avoidance rates were analysed using descriptive statistics. Participants assessed the training through a satisfaction questionnaire.

A total of 86 sessions were conducted, involving 172 participants including nurses, nurse assistants and physicians from a geriatric department. Participants detected errors such as wrong patient (60%), expired drugs (63%), incorrect strength or galenic form (55%) and documented allergy (55%), while most hazards were avoided, except for the correct device, which was used in only 65% of cases. Double-check performance was inefficient mainly focusing on the dose check. Satisfaction was high (9.2/10), and 73% of participants reported a knowledge gain.

The opioid RoH is an effective training to refresh and emphasise the rigorous application of the 5R rules and the double-check procedure to reduce MAEs. Additionally, this simulation showed persistent gaps such as patient identification and double-check failures, highlighting the need to strengthen safety practices through continuous training and institutional-level system improvements in medication administration safety.