Successful and accessible: developing an e-learning resource for safer medicine administration

Medicines, mistakes, and knowledge

During 2003 senior staff at Chesterfield Royal Hospital NHS Foundation Trust became aware of a rise in the number of significant clinical incidents associated with administration of medicines.

In early 2004 the pharmacy department undertook a baseline survey of 100 randomly selected nurses to gauge levels of medicines-related knowledge. This survey confirmed significant shortcomings in the level of knowledge and awareness of nursing staff with regard to safe medication practice. From these findings the Trust realised that there was a need to establish a formal medicines administration education and competency assessment process for all its nurses.

Where to begin?

From previous experience we knew that we would have difficulty releasing staff from clinical duties to attend formal teaching sessions, so developing of an e-learning solution was proposed. We carried out a literature search and used DATIX E-Forum to determine if other organisations had developed similar systems. We discovered that some NHS trusts had developed written or oral assessments of competency to administer medicines. But the electronic systems reported in the literature were generally limited to drug calculation skills (1). We required a more comprehensive package and realised that, as there was no suitable package commercially available, we would have to develop our own. As part of our investigation we contacted NHS University (NHSU), which put us in contact with programmers at the University of Derby Centre for Interactive Assessment Development (CIAD). CIAD has extensive experience of using online assessment throughout its undergraduate courses and agreed to help us produce a package.

Development of the package

The pharmacy department worked with nurse colleagues involved in education and practice development to develop the content and design of the package over a six month period. We decided the package should have the following characteristics:

easily distributed and accessible via the internet so that it may be used by staff in community hospitals
password protected
able to provide feedback to both user and mentor/line managers
adaptable for future changes
undertaken within defined time periods
able to suspend an assessment and return it at a later time
able to provide and print additional supporting information
able to randomise questions of a similar type, in particular questions regarding calculations, so that if a nurse revisited the site their understanding of underlying principles would be tested, rather than their memory of a particular answer
inclusion of an element of negative/weighted scoring for each question to discourage guessing.

Using scenarios as a powerful learning tool

It was agreed that the clinical content of the package should be based on realistic scenarios extracted from clinical practice to reflect the practical problems that nurses are confronted with every day. Also, the tool should also raise awareness of the Trust's medicines management policies and how these should be implemented in practice.

The package was split into a 'core' element and a series of 'specialist' sections as follows:

Core section to include medicines management policies and procedures, drug calculations, medication allergy, and common adverse reactions.
Specialist sections dedicated to medicine, surgery, critical care, emergency care, paediatrics, maternity, and community.

Once the clinical content for the package had been created we worked closely with the programmers to refine technical aspects of the product. At all stages in its development, the product was shared widely among the Trust's senior nursing and pharmacy staff to ensure they were fully supportive of its content and development. In addition, the package was piloted among junior nurses to ensure they were able to undertake the necessary assessments.

Some screen shots from the online tool are shown in Figure 1. Figure 1: Screen shots from the e-learning tool for safer medicines practice.

Progress so far

The 'core' package was incorporated into the preceptorship training programme in 2005. Feedback from the first batch of nurses was very encouraging (Figures 2 and 3) and individual comments about the style of the package were fed back to the programmers to help improve the system further.

Figure 2: Ease of using the e-learning system.

Figure 3: Acceptability of the e-learning system.

Specialist packages are now being rolled out ward by ward (throughout 2006) and the feedback so far has been very positive from staff of all grades.

We have also shared our innovation widely in our local health community and with acute and primary care trusts in our region, where it has been greeted with widespread interest. As a result we are actively exploring means of sharing our work with other organisations. We are also undertaking the development of a prescribing education tool for junior doctors, based on the same principles.

A tool for learning or assessment?

Our package has been well accepted as an educational resource, but there's less certainty with regard to its use as a competency assessment tool:

Should it be used as a determinant of nurses' clinical practice dependent upon their relative success in completing the course?
What would be an acceptable pass mark? What should we do when individuals fail to reach this mark?
Should those nurses no longer administer medicines?

At present we have not resolved these issues and anticipate that this debate will extend as the system enters wider use.

References

1. Gray J, Jackson C. The development of an online quiz for drug calculations. Nurs Times 2004;100:40-1. [PubMed]

Author

Caroline Hare, Senior Pharmacist, Pharmacy Department, Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire. E-mail - caroline.hare@chesterfieldroyal.nhs.uk

Organisation

Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK

Team

Caroline Hare, BPharm, Senior Pharmacist, Medicines Management, Education and Training Martin Shepherd, MSc, BPharm, Head of Therapy and Medicines Management Clare Davies, RGN, Clinical Education Advisor, Surgical Directorate