A Quality Improvement Initiative to Enhance Paediatric Nurses' Knowledge of High-Alert Medication Administration

High-alert medications (HAMs) cause a lot of safety issues in paediatric healthcare settings, and medication errors have three times the potential to harm this group than in adults.

This quality improvement study was conducted to assess nurses' knowledge of HAMs, the barriers to safe HAM administration and the impact of targeted education.

This quality improvement project assessed the knowledge of HAM administration before and after structured training among paediatric nurses in critical care units. Barriers to safe medication administration were identified through questionnaire responses, including both knowledge-related and organisational obstacles. Knowledge gain was measured using paired t-tests and Wilcoxon signed-rank tests. An exploratory regression analysis was conducted to investigate the associations with knowledge improvement.

This study included 335 nurses. The improvement in knowledge regarding administration increased significantly after training, from an average score of 4.87 to 9.41. Main obstacles to safe medication administration identified include lack of knowledge (39.4%), unavailability of reference texts (34.6%) and ambiguous dose calculations (32.0%). Those under 25 years old, as well as those having less than 2 years of experience, recorded the absolute highest gains. Self-rated competency improved minimally, although those indicating low confidence dropped to below 10%. A great demand for additional education in HAMs was noticed, where 82% were asking for more training.

Structured training significantly improved theoretical HAM knowledge and identified critical system barriers (lack of references and ambiguous protocols). Continuous education represents an essential foundation for subsequent medication safety quality improvement initiatives.

For paediatric critical care nurses, these findings establish a knowledge foundation and identify system barriers essential for improving paediatric HAM safety.