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Opportunities for performance improvement in relation to medication administration during pediatric stabilization
  1. N Morgan1,
  2. X Luo2,
  3. C Fortner3,
  4. K Frush2,3
  1. 1School of Nursing, Duke University, Durham, NC, USA
  2. 2Center for Patient Safety and Clinical Quality, Duke University Health System, Durham, NC, USA
  3. 3Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
  1. Correspondence to:
 Dr K Frush
 Duke University Medical Center, Box 3055, Durham, NC 27710, USA; frush002{at}


Objectives: To identify and characterize areas for improvement in the clinical performance of nurses in relation to medication administration.

Method: Nurses participated in a simulated pediatric stabilization event which was videotaped. Their clinical performance was evaluated at each of the following steps: (1) communicating and confirming the dose of medication; (2) converting the dose; (3) selecting the correct medications; (4) properly preparing the medication formulation; and (5) measuring medication doses. The time required to convert and draw up the medications was also evaluated.

Results: A total of 150 medication orders for five medications were given by the physician. Only 55% of the orders were verbally repeated back by the nurses. Of the 120 orders in which the doses were converted from milligrams to milliliters by nurses, 17 (14.2%) were converted incorrectly and the maximum dose deviation reached 400%. Selection of the wrong medication occurred in 11 of the 150 orders. Dextrose (which requires dilution before being administered to children) was not diluted in 17% of the medication orders and in 12% it was diluted improperly. About 40% of the orders for ceftriaxone (which requires reconstitution) were not properly reconstituted. In 49 (32.7%) of the 150 medication orders that were drawn up in a syringe, the amount measured was not consistent with the stated dose. For some medications, a prolonged time was required by nurses to convert the doses and draw up the medications.

Conclusions: By observing the clinical performance of nurses in a simulated videotaped pediatric stabilization event, we have identified some important areas in need of improvement in each step of the medication administration process. These findings indicate a need for improved education, training, and use of clinical aids or adjuncts for pediatric emergency nurses.

  • nursing
  • clinical performance
  • medication administration
  • children
  • medication error
  • patient safety

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  • Funding: none.

  • Competing interests: none declared.