Use of local anesthetic drugs in hospital practice.

Kelly, David A.; Henderson, Alex M.

doi:10.1136/bmj.286.6380.1784

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…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: 81%

“…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.…”

supporting

confidence: 73%

“…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: 81%

supporting

confidence: 73%

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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show abstract

“…Overall, our findings are similar to those observed in other smaller cohorts of students [9, 15–17] and also amongst qualified doctors [7, 18, 19, 20]. There are a number of possible reasons for this poor performance.…”

Section: Discussionsupporting

confidence: 90%

eDrugCalc: an online self‐assessment package to enhance medical students' drug dose calculation skills

McQueen¹,

Begg²,

Maxwell

2010

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Dose calculation errors are an important cause of some of the most serious medication incidents in advanced healthcare systems. • A number of small studies have shown that dose calculations are poorly performed by hospital doctors, nurses and medical students. WHAT THIS PAPER ADDS• The performance of dose calculations was highly variable amongst a large cohort of medical students from a leading UK medical school.• Calculations that involved converting concentrations expressed as percentage or calculating infusion rates were identified as major weaknesses.• The availability of an online self-assessment and education package, coupled with encouragement and twice-yearly formative assessment, led to a significant improvement in performance. AIMSDose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students. METHODSWe undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer. RESULTSFinal-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n = 173, P < 0.0001 Wilcoxon matched pairs test] and made a median of three vs. seven errors. Performance was highly variable in all tests with 2.7% of final-year students scoring < 10/20 in test 6. Graduating students in 2009 (30 months' exposure) achieved significantly better scores than those in 2007 (only 6 months): mean 16.5, 95% CI 16.0, 17.0, n = 184 vs. 15.1, 95% CI 14.5, 15.6, n = 187; P < 0.0001, Mann-Whitney test. Calculations based on percentage concentrations and infusion rates were poorly performed. Feedback showed that eDrugCalc increased confidence in calculating doses and was highly rated as a learning tool. CONCLUSIONSMedical student performance of dose calculations improved significantly after repeated exposure to an online formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice.

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“…It seems a compelling argument as it involves little or no cost and should only reduce the likelihood of dosing errors. They pointed out that other researchers had been making similar calls since the early 1980s to no avail [2,3].…”

mentioning

confidence: 97%

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

Wheeler

2004

Eur J Anaesthesiol

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Use of local anesthetic drugs in hospital practice.

Cited by 9 publications

References 3 publications

Retention of drug administration skills after intensive teaching

Retention of drug administration skills after intensive teaching

eDrugCalc: an online self‐assessment package to enhance medical students' drug dose calculation skills

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

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