الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Safe medication administration presents difficulties for nurses while providing patient care; medication safety is a major duty that is essential to the long-term viability of healthcare institutions. In order to enhance patient outcomes and nursing care delivery, nurses need possess up-to-date knowledge to carry out their duties more accurately, safely, and with a low mistake rate. Additionally, to increase the nurses’ job satisfaction.
High Alert Medications (HAMs) are medications that have a higher risk of seriously harming patients if they are administered incorrectly or against their intended purpose. While errors involving these medications are more prevalent, the results of such errors are unquestionably more severe for patients. Errors can occur at any stage of the intricate multistep procedure that is medication administration, which includes prescription, transcribing, dispense, providing medications, and monitoring patient reaction.
Therefore, it is critical to give nurses a foundational education and ongoing training to enhance their knowledge of HAMs. Depending on the medications used and the complexity of the patient’s condition, HAMs may differ throughout hospitals, other healthcare settings, and specialist units. While it is crucial to enhance the management of all these kinds of medicationssuch as insulin, anticoagulants, sedatives, and opioidsbecause they are linked to damage and increased risk, they also represent areas where there is the greatest potential for improvement.
Patient injury resulted from deficiencies in nursing HAM’s competencies. To become competent nurses, all healthcare professionals need possess up-to-date information, skills, and unique personal qualities that they can apply to various circumstances. In-service training programs should be used to refresh nurses’ understanding of HAMs. In addition, several kinds of HAMs and their usage are covered in the nursing curriculum.
Aim of the study
The current study aims to:
Evaluate the effect of a training program on nurses’ knowledge and performance in dealing with high alert medications.
Hypotheses of the study:
To fulfill the aim of this study the following hypothesis formulated:
• Nurses going through a training program for dealing with high alert medications, display higher level of knowledge and less medication errors than before attending the program.
Study design:
A quasi experimental research design was utilized to conduct this study (one group pre-test post-test).
Setting:
The study was conducted at Alexandria Main University Hospital including three basic departments selected based on selected types of high alert medications, including (diabetes and metabolism, cardiovascular and oncology department)
Subjects:
• The subject of the study consisted of all the nurses available in the three units as follow (40 nurses) who were given direct care to patients and responsible for administering medications at above mentioned setting and there years of experience not less than three years. They were (one group pre-test post-test).
• The study sample was selected based on Epi info -7 program which was used to estimate the sample size using the following parameters:
• Expected frequency 50%.
• Acceptable error of 5%.
• Confidence level 95%.
• The minimal sample size 40 nurses.
• The final sample size was 40 nurses. 4 nurses from other unit excluded from the original sample as a pilot study.
Tools:
Data of the current study was collected using two tools:
Tool I: Nurses knowledge related to HAMs structured interview schedule. Was developed to determine the knowledge of the nurses related to HAMs.
It was consists of two parts:
• The first part includes nurses’ socio-demographic data
• The second part is nurses’ knowledge related to HAMs structured interview schedule.
• Each correct answer responses were given the score of one and the wrong or I do not know answer will be given the score of zero.
Tool II:(Nurses’ skill competency level in dealing with HAMs observational checklist). Was developed to determine the nurses’ practices related to HAMs at assessment and post program.
The tool was developed by the researcher. It was conducted to assess nurses’ performance related to administration of HAMs.
• The nurse’s general performance when dealing with HAMs.
• Specific performance when dealing with insulin
• Specific performance when dealing with anticoagulants
• Specific performance when dealing with sedatives
• Specific performance when dealing with opioids: it was included
• The item observed done correctly was scored ”1” and the item not done or incorrectly done was scored ”0”
Method
Preparation phase:
1. Approval from the research ethical committee, Faculty of Nursing, Alexandria University was obtained.
2. Permission to carry out the study from the responsible authorities from the Faculty of Nursing, Alexandria University was obtained.
3. An official letter was issued from the Faculty of Nursing, Alexandria University to the director of the hospital and the heads of the departments of the study settings.
4. Tool I and tool II were tested for reliability using Cronbach’s alpha test.
5. Study tools were tested for validity by 5 experts in the field of Medical-Surgical Nursing. Modification was done accordingly.
6. A pilot study was conducted on four nurses to testing clarity and visibility for the tools and necessary modifications was done. The subjects of pilot study were from other department (head and neck surgery) and out of the study sample.
To fulfill the study aim, the actual study was carried out in four phases: assessment, planning, implementation and evaluation.
1. Assessment phase:
• Initial assessment of all nurses was carried out, they informed that they were interviewed immediately after the program carry out and after three months for the evaluation of the program effect on their knowledge and their performance.
2. Planning phase:
• The training nursing program was consisted of four sessions over three weeks based on nurses’ educational level and their level of achievement in the program.
• Each training session was covered 45min /day to cover theoretical and practical knowledge.
• An illustrated educational booklet guide\namely “Competency Based Nursing Interventions for HAMs” was developed by the researcher and translated in Arabic language.
Implementation phase:
Each nurse was assessed for knowledge, by using Tool I (nurses’ knowledge related to HAMs structure interview schedule). In additions nurses’ skills was observed using Tool II (Nurses’ Skill competency level in dealing with HAMs by using observational checklist).
The First session:
Started with explain the objective, of the program, introduction of the training program, time schedule, important items, benefits of the program and the first part of theoretical knowledge general information related to HAMs
The second session:
• Reinforcement of knowledge mentioned previously in the first session.
The third session:
• Summarization of the previous session
The fourth session
• Discussed and review knowledge and performance that provided to the nurse previously.
3. Evaluation phase:
• Nurses were evaluated immediately and after three month post the study interventions; it was started on 26 January 2023 and last for two weeks to evaluate the outcome of the program using the same tools that used in assessment phase.
• Data was analyzed using the appropriate statistical analysis.
The following are the main results of the current study:
• In relation tosociodemographic and personal data:Nearly half of nurseswere aged from 40 years to 60 years. The nurses’sample (100.0%) respectively was female nurses. Nearly half of the nurses had technical diploma nursing followed by secondary diploma nursing qualification that was (40.0%). nurses have experience years more than 18 years in the unit it was respectively (55%) followed by nurses whom experience years (from 13 to< 18 years) it was respectively (20.0%).
• In relation to source of general nurses knowledge: nurses allowed to give more than one answer: the study was shown that (100.0%) of them main source of their knowledge was experience and more than half of them were consider the study as second source of knowledge it was equal (72.5%) followed by attending training courses source that equal (62.5%) of them, and only (7.5%) of them chosen internet usage as a source of their knowledge.
• In the relation to assessment of general nurses’ knowledge in dealing with HAMs as general was recorded(FR= 39.298) and (p=<0.001) that meansstatistically significant differences exist across the program’s three phases. Nurses’ knowledge related to insulin treatment: recorded (FR=40.359) and (p=<0.001) that means statistically significant differences exist between the three periods of the program. Nurses’ knowledge in dealing with anticoagulant medications was recorded (FR=61.667) and (p=<0.001) that means between the three program assessment periods, there is a statistically significant change.Nurses’ knowledge in dealing with sedatives recorded (FR= 65.024) also (p=<0.001) that means there is statistically significant between the three periods of the program assessment. Nurses’ knowledge in dealing with opioids drug the method of dispensing and storing recorded (FR=50.816) and (p=<0.001) that meansstatistically significant differences exist across the program’s three phases..Nurses knowledge for safe use of high-alert medications it was recorded (FR=30.769) also (p=<0.001) that means there is statistically significant between the three periods of the program.
• Relationship between three periods of program assessment according to total scores of knowledge: Significant relationship between the three period of the program recorded (p <0.001) in all items of the study. Assessment of general nurses’ knowledge in dealing with HAMs also was recorded (F =33.897), nurses knowledge in dealing with insulin recorded (F= 66.367) treatment, the assessment of nurses’ knowledge in dealing with anticoagulant medications recorded (F=115.575), nurses’ knowledge in dealing with sedatives recorded (F=141.342), nurses’ knowledge in dealing with opioids drug the method of dispensing and storing recorded (F=72.753) and the safe use of HAMs recorded (F=19.182).
• Distribution of the studied nurses according to overall knowledge scoresignificance for the three periods was recorded (FR =70.966) and (F=200.793) moreover the score had given for overall knowledge pre application of the program that was equal= (59.16%) that means fail in nurses over all knowledge for HAMs even that result had improved to equal= (82.44%) that means very good score in knowledge and for post 3 months program that equal = (81.30%).means very good knowledge. In general there was statistically significance between the three period of the program (p=<0.001) for the all items of the study.
• In relation to, assessment of nurses’ performance over all level in dealing with HAMs it was noticed that, nurses performance as general was recorded (FR= 66.606) and (p=<0.001) that means there is statistically significant between the three periods of the program. Moreover, for nurses’ performance in dealing with insulin treatment, the nurses’ performance were noticed that recorded (FR=47.008) and (p=<0.001) that means there is statistically significant between the three periods of the program. Regarding the assessment of nurses’ performance in dealing with anticoagulant medications it was recorded, (FR= 32.521) and also (p=<0.001) that means there is statistically significant through the three periods of the program assessment. Even nurses’ performance in dealing with sedatives it was recorded that, (FR= 7.731) and (p=<0.001) that means there is statistically significant between the three periods of the program. In the relation to nurses’ performance in dealing with opioids drug it was recorded, (FR=10.133) and (p=<0.001) that means there is statistically significant between the three periods of the program assessment.
• Relation between three periods of the program assessment according to overall score of nurses:there was significant relationship between the three period of the program it was recorded, (p <0.001) in all items of the study. Assessment of general nurses’ performance in dealing with HAMs was recorded, (F =200.527) nurses in dealing with insulin was recorded (F=99.324), the assessment of nurses’ performance in dealing with anticoagulant medications was recorded (F=174.935), nurses’ performance in dealing with sedatives was recorded (F=26.586), and nurses’ in performance dealing with opioids drug was recorded (F=27.044).
• In relation to overall of nurses’ performance: test of significance for the three periods of the program assessment recorded (FR = 63.159) and (F=275.686). Moreover, the score had given for overall performance pre application of the program equal= (45.33 %) that means failed in nurses overall performance for HAMs even that result had improved to equal= (64.67 %) that means fair score in performance and for post 3 months program that equal = (64.67%).means fair score in performance In general there was statistically significance between the three period of the program (p=<0.001) for the all items of the study.
• In relation to, overall knowledge and overall performance it was observed that recorded (r=0.162) and (P= 0.317) for preprogram also for immediate recorded (r=0.204) and (P=0.206) even for post program recorded (r=0.192) and (P= 0.235) actually if there is a level of significance correlation between knowledge and performance must be (P=<0.05) but in the result of this study p more than (<0.05) so there was no significance correlation between knowledge and performance.
Conclusion:
The aim of present study was to evaluate the effect of training program on the nurses’ knowledge and performance in dealing with high alert medications. It is possible to draw the following conclusions from the existing research:
• Nurses’ knowledge and performance regarding high alert drugs improved both immediately after the program and three months later compared to preprogram period, indicating the effectiveness of the educational program. They display high level of knowledge and less medication errors than before attending program.
Recommendations:
Following are some recommendations that can be made in light of the current study’s findings:
Recommendation for head nurse:
• Evaluate nursing knowledge and performance on a regular basis to ensure ongoing supervision and direction to minimize mistakes.
• To guarantee efficient management of pharmaceuticals, enhance the efficacy of communication between healthcare providers.
• Ongoing and required in-service training (preparation, storage, transfer, administration) for nurses handling high alert drugs.
• Establishing orientation program for newly graduates’ nurses regarding HAMs.
• To stay up to date with the ever expanding body of information and skills required for providing appropriate nursing care, all nurses should always be encouraged to attend medical lectures or courses.
Recommendation for educational program:
• Each department should have updated handbooks on standard nursing practices and protocols available for HAMs.
• Each department should have basic pictures and posters on HAMs.
• To achieve high standards of performance from nurses, close supervision and on-the-job training are required.
• Provide HAMs orientation program for all newly nurses in the setting.
• Regular courses for nurses on how to deal with high alert medications, the way of handling, separation, dispensing, administration, and the nurses’ action if errors occur.
Recommendation for future study:
• Repeating the study with a bigger sample size from a different geographic location is crucial to help generalize the findings.Studying factors that can cause errors during handling of high alert medications in the clinical setting.