Doctors’ Confusion over Ratios and Percentages in Drug Solutions: The Case for Standard Labelling

Wheeler, Daniel W.; Remoundos, Dionysios-Dennis; Whittlestone, Kim David; Palmer, M.; Wheeler, S. J.; Ringrose, Timothy Richard; Menon, David

doi:10.1177/014107680409700805

Cited by 9 publications

(15 citation statements)

References 8 publications

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“…Students found simulation much more engaging than online teaching. Our research focuses on drug administration skills, originating from our observation that medical students and doctors are confused by expressing the concentration of drug solutions as ratios and percentages rather than mass concentration [1][2][3]. These findings concur with other researchers [4][5][6][7] and, despite calls for ampoule labelling to be standardised [8], drugs are still presented in packaging that is potentially confusing.…”

supporting

confidence: 76%

“…The results would also appear to be clinically significant, in that those students who received the most intensive teaching were more likely to pass the drug administration OSPE station, implying that they had achieved the level of competence expected of a junior doctor. However, a substantial minority did not meet this standard, and neither do many, more senior, doctors [2][3][4][5][6][7]15]. Therefore, better education cannot be the only solution; the problem of labelling drug solutions as ratios and percentages must also be addressed.…”

Section: Discussionmentioning

confidence: 99%

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Retention of drug administration skills after intensive teaching

Wheeler¹,

Degnan

Murray³

et al. 2008

Anaesthesia

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We have identified deficiencies in medical students' drug administration skills, and we attempted to address them with interactive online teaching modules and simulated critical incident scenarios. Short-term improvements have been evident with this intensive effort, but medium-term retention of skills has not been measured. A drug administration lecture, an online module and a simulated emergency scenario were offered to final year clinical students. None of the teaching was compulsory but participation was recorded, along with students' simulator performances and marks in an objective structured practical examination 9 months later. A poor simulator score predicted a poor performance in the later examination. Participation in the simulated scenario only significantly improved examination scores when supplemented by online teaching (p = 0.002). Intensive drug administration teaching using an online module and high fidelity simulation improves drug administration skills in the medium term. Students found simulation much more engaging than online teaching. Our research focuses on drug administration skills, originating from our observation that medical students and doctors are confused by expressing the concentration of drug solutions as ratios and percentages rather than mass concentration [1][2][3]. These findings concur with other researchers [4][5][6][7] and, despite calls for ampoule labelling to be standardised [8], drugs are still presented in packaging that is potentially confusing.Our findings have also suggested that a lack of education about drug administration can lead to drug dosing errors, and served to highlight that drug administration skills in our university were taught on an entirely ad hoc basis [1]. We sought to improve drug administration teaching for our medical students by ensuring that drug dose calculation was included in formal teaching for all students. Traditional teaching was complemented by an interactive online teaching module, which improved students' performances in drug administration questions in end of attachment assessments and final examinations [9]. We went on to examine how better teaching might influence the acquisition of practical skills using students' performance in a simulated critical incident as an outcome measure.We conducted a randomised, controlled trial in a high fidelity patient simulator that showed that additional online teaching also improved medical students' practical skills in a simulated emergency scenario [10]. Students were randomly allocated into two groups: one group was invited to view the additional teaching before their simulated scenario, the other group received the invitation afterwards. Students who had viewed the teaching beforehand were found to have performed significantly

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supporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Retention of drug administration skills after intensive teaching

Wheeler¹,

Degnan

Murray³

et al. 2008

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Use of the simulator allowed us to examine all the steps taken by the medical students in the drug calculations. In contrast, the multiple choice questionnaire format that we used previously [1,4,7] can only establish correct vs incorrect answers, cannot account for those who guess correctly, and gives no information about why a particular answer was given. The simulated critical incident scenarios were ideally suited to answering these questions, and provided valuable insights into the problems and confusion encountered by the students whilst under pressure.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that this may be a global problem for medical students and doctors alike [2][3][4][5], and our past research has led us to recommend that ampoule labels be standardised to mass concentration, and education about drug administration improved [6].…”

mentioning

confidence: 99%

The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario

Degnan¹,

Murray²,

Dunling³

et al. 2006

Anaesthesia

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Medical students have difficulty calculating drug doses correctly, but better teaching improves their performance in written tests. We conducted a blinded, randomised, controlled trial to assess the benefit of online teaching on students' ability to administer drugs in a simulated critical incident scenario, during which they were scored on their ability to administer drugs in solution presented as a ratio (adrenaline) or percentage (lidocaine). Forty-eight final year medical students were invited to participate; 44 (92%) attended but only nine of the 20 students (45%) directed to the extra teaching viewed it. Nevertheless, the teaching module significantly improved the students' ability to calculate the correct volume of lidocaine (p = 0.005) and adrenaline (p = 0.0002), and benefited each student's overall performance (p = 0.0007). Drug administration error is a very major problem and few interventions are known to be effective. We show that focusing on better teaching at medical school may benefit patient safety. Medical students at our university had a poor understanding of different ways of expressing the concentrations of drugs in solution [1]. In a study conducted in 2002, we found that only 62.3% knew that a 1 : 1000 solution of adrenaline (epinephrine) contains 1 mg.ml )1 and only 37.6% knew that 1% lidocaine contains 10 mg.ml . There is evidence that this may be a global problem for medical students and doctors alike [2-5], and our past research has led us to recommend that ampoule labels be standardised to mass concentration, and education about drug administration improved [6].We recently reported the impact of an online teaching module designed to improve our medical students' drug dose calculation and administration skills [7]. The module consisted of interactive tutorials concerning pharmacokinetics, drug interactions and dose calculations, case studies, and the opportunity for self-assessment. The outcome measures were students' performances in regular written and practical assessments throughout their final year of study. The additional teaching improved students' understanding of drug administration, but the effect waned over time.In this study we examined the influence of improved education on the competence and efficiency of medical students to prescribe the correct amount of drugs to patients under more realistic conditions. Medical students in their final year of training were invited to participate in a critical care scenario carried out in a high fidelity patient simulator. The clinical scenario was devised to rely heavily on the use of drugs in solution. Use of the simulator enabled us not only to assess the competence with which the medical students were able to prescribe

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“…Having previously shown that medical students are just as confused by ampoule labels [7], Wheeler and colleagues recently conducted a novel survey of doctors in the UK using the Internet [8]. They posed six multiple-choice questions concerning the mass of drug contained in solutions of epinephrine, lidocaine and atropine.…”

mentioning

confidence: 99%

Dose calculation and medication error – why are we still weakened by strengths?

Wheeler

2004

Eur J Anaesthesiol

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Doctors’ Confusion over Ratios and Percentages in Drug Solutions: The Case for Standard Labelling

Cited by 9 publications

References 8 publications

Retention of drug administration skills after intensive teaching

Retention of drug administration skills after intensive teaching

The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario

Dose calculation and medication error – why are we still weakened by strengths?

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