Drug calculations part 1: a critique of the formula used by nurses

The role of mathematics is integral to nursing practice, and careful and accurate calculations are important to help prevent medication errors. This two-part article examines different methods for solving drug calculation problems. The first part critiques the commonly taught nursing drug calculation formula. Part 2, to be published next week, explores a range of other methods that are used in practice to calculate drug dosages.

Numeracy skills for nurses: revision and review

Introduces a revision and working examples of the numeracy skills key to the role of nurses working with older people in nursing and residential homes.

Can effective teaching and learning strategies help student nurses to retain drug calculation skills?

Student nurses need to develop and retain drug calculation skills in order accurately to calculate drug dosages in clinical practice. If student nurses are to qualify and be fit to practise accurate drug calculation skills, then educational strategies need to not only show that the skills of student nurses have improved but that these skills have been retained over a period of time. A quasi-experimental approach was used to test the effectiveness of a range of strategies in improving retention of drug calculation skills. The results from an IV additive drug calculation test were used to compare the drug calculation skills of student nurses between two groups of students who had received different approaches to teaching drug calculation skills. The sample group received specific teaching and learning strategies in relation to drug calculation skills and the second group received only lectures on drug calculation skills. All test results for students were anonymous. The results from the test for both groups were statistically analysed using the Mann Whitney test to ascertain whether the range of strategies improved the results for the IV additive test. The results were further analysed and compared to ascertain the types and numbers of errors made in each of the sample groups. The results showed that there is a highly significant difference between the two samples using a two-tailed test (U=39.5, p<0.001). The strategies implemented therefore did make a difference to the retention of drug calculation skills in the students in the intervention group. Further research is required into the retention of drug calculation skills by students and nurses, but there does appears to be evidence to suggest that sound teaching and learning strategies do result in better retention of drug calculation skills.

Social policy for nurses and the helping professions

The book examines the relationship between welfare and health and includes discussion of key policy issues such as; changes in health care delivery, regulation of professionals, privatisation, welfare pluralism and the tackling of health and social inequalities. The significance of social policy in preventing ill health and disability, as well as supporting the sick and disabled people, is emphasised throughout the book.

Characteristics of people who assault nurses in clinical practice

This article discusses certain variables relating to the characteristics of people who assault nurses, including patients, relatives and friends. The author suggests that the nature of nurses' occupational roles and responsibilities puts them at risk in their work but that individual or organisational strategies can be developed to minimise this risk.

The exposure to verbal abuse of student nurses gaining placement experience

Clinical placement experience has a key role to play in the socialisation and preparation of future members of the nursing profession. Aggression experienced by healthcare workers is currently receiving considerable attention and student nurses have been identified as a group vulnerable to experiencing workplace abuse (Little 1999). The primary aim of the study is to gain a greater understanding of the nature, severity, frequency and sources of verbal abuse experienced by student nurses in health care settings in the south east of England, using as a definition, “the use of inappropriate words… causing distress” (Department of Health 2003). A convenience sample of 156 third year student nurses of all four branches of one preregistration nursing programme in the south east of England was studied with questionnaires distributed retrospectively; 11 4 student nurses returned the questionnaires equating to a response rate of 73%. Results 46% of respondents reported experiencing verbal abuse, 39% had witnessed other students experiencing verbal abuse and 61% reported that they were aware of other students experiencing verbal abuse. Students reported experiencing threats to kill, racial abuse, sexually orientated verbal abuse and bullying while gaining placement experience. Student nurses are a high risk group for experiencing verbal abuse whilst gaining placement experience.In the literature, mental health and learningdisability settings are viewed as high risk areasfor experiencing aggression (Beech and Leather 2003); this study suggests that student nurses experience verbal abuse in a variety of settings and verbal abuse may be more prevalent on general medical and surgical wards than previously expected.

Student nurses need more than maths to improve their drug calculating skills

Nurses need to be able to calculate accurate drug calculations in order to safely administer drugs to their patients (NMC, 2002). Studies have shown however that nurses do not always have the necessary skills to calculate accurate drug dosages and are potentially administering incorrect dosages of drugs to their patients (Hutton, M. 1998. Nursing Mathematics: the importance of application. Nursing Standard 13(11), 35–38; Kapborg, I. 1994. Calculation and administration of drug dosage by Swedish nurses, Student Nurses and Physicians. International Journal for Quality in Health Care 6(4), 389–395; O’Shea, E. 1999. Factors contributing to medication errors: a literature review. Journal of Advanced Nursing 8, 496–504; Wilson, A. 2003. Nurses maths: researching a practical approach. Nursing Standard 17(47), 33–36). The literature indicates that in order to improve drug calculations strategies need to focus on both the mathematical skills and conceptual skills of student nurses so they can interpret clinical data into drug calculations to be solved. A study was undertaken to investigate the effectiveness of implementing several strategies which focussed on developing the mathematical and conceptual skills of student nurses to improve their drug calculation skills. The study found that implementing a range of strategies which addressed these two developmental areas significantly improved the drug calculation skills of nurses. The study also indicates that a range of strategies has the potential ensuring that the skills taught are retained by the student nurses. Although the strategies significantly improved the drug calculation skills of student nurses, the fact that only 2 students were able to achieve 100% in their drug calculation test indicates a need for further research into this area.

Fast and frugal models of clinical judgement in novice and expert physicians

Our objective was to study whether “compensatory” models provide better descriptions of clinical judgment than fast and frugal models, according to expertise and experience. Fifty practitioners appraised 60 vignettes describing a child with an exacerbation of asthma and rated their propensities to admit the child. Linear logistic (LL) models of their judgments were compared with a matching heuristic (MH) model that searched available cues in order of importance for a critical value indicating an admission decision. There was a small difference between the 2 models in the proportion of patients allocated correctly (admit or not-admit decisions), 91.2% and 87.8%, respectively. The proportion allocated correctly by the LL model was lower for consultants than juniors, whereas the MH model performed equally well for both. In this vignette study, neither model provided any better description of judgments made by consultants or by pediatricians compared to other grades and specialties.

Can diagnostic triage by general practitioners or rheumatology nurses improve the positive predictive value of referrals to early arthritis clinics?

Objectives: To determine whether diagnostic triage by general practitioners (GPs) or rheumatology nurses (RNs) can improve the positive predictive value of referrals to early arthritis clinics (EACs).

Methods: Four GPs and two RNs were trained in the assessment of early in?ammatory arthritis (IA) by four visits to an EAC supervised by hospital rheumatologists. Patients referred to one of three EACs were recruited for study and assessed independently by a GP, an RN and one of six rheumatologists. Each assessor was asked to record their clinical ?ndings and whether they considered the patient to have IA. Each was then asked to judge the appropriateness of the referral according to predetermined guidelines. The rheumatologists had been shown previously to have a satisfactory level of agreement in the assessment of IA.

Results: Ninety-six patients were approached and all consented to take part in the study. In 49 cases (51%), the rheumatologist judged that the patient had IA and that the referral was appropriate. The assessments of GPs and RNs were compared with those of the rheumatologists. Levels of agreement were measured using the kappa value, where 1.0 represents total unanimity. The kappa value was
0.77 for the GPs when compared with the rheumatologists and 0.79 for the RNs. Signi?cant stiffness in the morning or after rest and objective joint swelling were the most important clinical features enabling the GPs and RNs to discriminate between IA and non-IA conditions.

Conclusion: Diagnostic triage by GPs or RNs improved the positive predictive value of referrals to an EAC with a degree of accuracy approaching that of a group of experienced rheumatologists.