Nurses' individual accountability was insufficient to generate accountability behaviours. They tended to weigh up the unit's accountability level in gauging risks and benefits before acting accountably. Risks of accountability behaviour included isolation, resistance and bullying, while benefits included professionalism, empowerment and pride.
The questionnaire portrays accountability in nursing, by capturing nurses' subjective perceptions of accountability dimensions (responsibility, transparency, answerability), as demonstrated by personal and organizational values.
Background
‘Pharmaceutical calculation’ is the mathematical process required for the accurate determination of dose, units, solution concentration and rate according the medical needs of the patient. The literature shows that errors in drug calculations contribute significantly to the number of errors in medical treatment (e.g., Wheeler, Wheeler, & Ringrose, 2007). Calculation errors occur both while entering prescriptions and dispensing the medicines. Probably, part of these mistakes is caused by lack of education and training of the staff (e.g., Wheeler, Remoundos, Whittlestone, House, & Menon, 2004). In Israel, the knowledge and training levels of nurses is examined before their enter hospital work. However, the process of accepting medical residents and physicians to hospitals does not include such testing. The impression is that residents and physicians need more training in performing calculations required for medical treatment. Against this background, we developed a unique project aiming to raise the knowledge of pharmaceutical calculation of medical residents working in the hospital.
Purpose
To improve the quality and safety of medical treatment in the hospital by raising the awareness and knowledge of pharmaceutical calculations by medical staff. The aims were to check opinions, knowledge level and self-confidence of medical residents performing pharmaceutical calculations in order to improve their skills in this topic.
Materials and methods
We defined a course format and ways of teaching.
We developed questionnaires to examine knowledge and opinions.
We taught a course.
We summarised data from the questionnaires, concluding and giving recommendations for the future.
Results
Overall questionnaires: 42 (22 pre-test and 20 post-test). All residents who had had previous training (half of the pre-test group) stated it wasn’t enough. Overall opinion was that pharmaceutical calculations are important for daily professional functioning (x = 4.6, on a scale of 1 to 6, std = 1.4). Examination of the difference in knowledge of residents between pre- and the post- test showed that in the post-tests, residents were better at answering objective question (sig. = 0.06). Wrong answers were both over-dose and under-dose. There was a significant statistical difference in difficulty level while answering objective knowledge questions between pre- and the post-test (average of 8.9 and 4.8 respectively, sig <0.001). We found no references comparing pre- and post- results.
Conclusions
Raising the awareness, knowledge and skills of the medical staff can contribute to minimising errors in medicinal treatment. We strongly recommend giving essential education in pharmaceutical calculation to all medical staff. Leading and teaching the subject by hospital pharmacists will significantly empower the pharmacist in his role and his contribution to safe medical treatment.
No conflict of interest.
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