Digital Repository Masters Projects Spring 2023 Improving Medication Education for the Float Nurse Victoria Amalaraj Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Amalaraj, V. 2023. Improving medication education for the float nurse. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Improving Medication Education for the Float Nurse Project Title by Victoria Amalaraj Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 2 April 2023 Date Victoria Amalaraj BSN, RN, MSN Student 2 April 2023 Student Name, Credentials Date (electronic signature) April, 4, 2023 MSN Project Faculty (electronic signature) Date 05/24/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Improving Medication Education for the Float Nurse Victoria Amalaraj, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Float nurses are necessary for aiding in staff shortages in the hospital setting. An issue arising from nurses working in varying units is decreased confidence in medication administration. There is a decrease in self-confidence for float nurses because the medications they administer vary in type and class. Time may pass before returning to a unit and administering that floor's commonly used drugs. Nurses struggle with a knowledge gap in the medications they typically administer. This issue causes reduced nurse confidence, increased medication errors, adverse events, and decreased patient trust and outcomes. This project aims to provide float nurses with a quick and easily accessible reference guide. The reference guide will be used before medication administration to increase the nurse's self-confidence. Continuing education and ensuring that float nurses know what resources are available and how to access them is another desired outcome of this project. This project addresses the benefits of a medication reference guide and how medication errors negatively impact nurses and patients. Keywords: float nurses, knowledge gap, self-confidence, trust, medication errors, adverse events, patient outcomes, medication education, common medications. 3 Improving Medication Education for the Float Nurse A float nurse aids with staffing shortages in different units in the hospital setting. Float nurses assist with staffing needs, which can help hospitals lower turnover rates and increase job satisfaction (Straw, 2018). The advantages of having a department of float nurses include meeting staffing needs and demands as well as decreasing the cost associated with incentives and overtime pay (Straw, 2018). Since float nurses consistently work in various units, they are expected to develop a wide range of skill sets (Straw, 2018). Reference tools better equip nurses and bridge the gap between a float pool nurses' knowledge and unit-specific information. Providing nurses with such a resource improves their comfort level and promotes a more positive experience for nurses who do not have a home-based unit (Abdullah-Grayson, 2017). A doctor of nurse practice (DNP) project completed by Abdullah-Grayson (2017) consisted of implementing a reference sheet or pocket guide that included unit-specific information. Abdullah-Grayson conducted a post-survey (N=22), and ninety-two percent of respondents agreed that using a unit-specific reference sheet attributed to a more positive experience while working on varying units (Abdullah-Grayson, 2017). According to the feedback from float nurses, having resources that provided standards of care was an invaluable tool for nurses who float to different departments. Nurses who float are typically provided with unit-specific guidelines. These general guidelines may include when to do postpartum checks on the well-baby floor, how often to take vitals and assess intravenous catheters in the pediatrics unit, or how to fortify milk for neonates in the Neonatal Intensive Care Unit (NICU). Providing float nurses with guidelines they can refer to helps them know what extra requisites must be accomplished in each unit. Supplying this information for the nurse will be helpful since electronic medical record (EMR) systems that 4 nurses use for tasks such as charting typically only lists scheduled medications. A list of drugs in the EMR assists nurses in planning their day but does not include unit-specific guidelines that must be incorporated into the nurses' care. These guidelines are a great resource when nurses may be uncertain about a unit's policies; however, they may lack a reference section for medications. Developing and implementing reference sheets of commonly used medications that are floor-specific may assist float nurses in increasing their knowledge and confidence in medication administration. A multi-method study was conducted in an Intensive Care Unit (ICU) in Spain; the researchers reviewed medical records, interviewed a focus group, and analyzed nurses' responses to a questionnaire. The questionnaire assessed knowledge regarding medications used in the ICU; out of the thirty-eight nurses that took the questionnaire, the high score was sixtynine percent, with an average score of forty-seven percent (Gracia et al., 2019). The researchers concluded that these nurses had insufficient knowledge of the drugs they commonly administered and found a correlation to a more significant number of medication errors committed (Gracia et al., 2019). Therefore, providing float nurses with a reference sheet will reinforce drug knowledge and decrease medication errors. Statement of Problem Float nurses are well-adapted to working on different units, but it is impossible to remember everything that is department specific. Having a resource with unit-specific guidelines helps with the frequent transitions from unit to unit and would benefit float nurses (AbdullahGrayson, 2017). This project aims to improve float nurses' confidence and knowledge when administering medications on different units by providing additional education through a medication reference sheet and training on using medication reference manuals on EMR systems 5 effectively. The goal of this project will be fulfilled by identifying commonly used floor-specific drugs. Once those medications are identified, they will be narrowed down and formatted into a reference sheet that float nurses can refer to in a quick and easily accessible manner. The reference sheet will include the ten most used unit-specific medications, side effects, and any interactions that require additional medical attention. The intention will be that the float nurse will have a personal copy to refer to, and unit managers will display the sheet in the medication rooms. In research by Hsu et al. (2021), when nurses in the post-anesthesia care unit (PACU) were provided with a reference guide on commonly used unit-based medications, the nurses felt more competent in providing patient care. The nurses were also more willing to cross-train to a different unit with the tool provided, as they believed it offered an extra resource to prevent medication errors (Hsu et al., 2021). As seen in the literature, giving nurses that work in different specialties a similar reference sheet will ease the difficulty of adapting to other units. Providing float nurses with additional resources to prevent medication errors would greatly benefit patient safety. Hanson and Haddad (2022) stated that in a 2018 study, adverse drug events (ADE), meaning medication errors that severely harmed the patient, accounted for more than 770,000 injuries or casualties in United States hospitals. Nurses have a poor understanding of the drugs they frequently administer, which causes significant medication errors (Gracia et al., 2019). Supporting float nurses with additional tools for their practice will benefit their knowledge and confidence and increase patient safety. Ways Project Contributes to Intended Recipients This project can benefit patients as increased medication knowledge reduces medication errors. Patients will feel sure of their nurses' capabilities when they receive proper medication 6 education about what drugs they are taking and if their nurse can answer their inquiries confidently. This resource will be helpful for float nurses and students starting in the field, as pharmacology is overwhelming and challenging to remember. Managers can use this reference sheet to decrease staff dissatisfaction and nurse turnover, as nurses feel more comfortable in their practice with continuing education (Zyoud et al., 2019). This tool will be most beneficial for float nurses as they will refer to the resource to increase their knowledge. The reference sheet can refresh nurses' memory of medications they might not commonly administer. The Rationale for the Importance of the Project When administering medications, it is essential for nurses to know the reasoning behind a medication being dispensed and administered, the typical side effects the patient might experience, drug-to-food interactions, and drug-to-drug interactions. Nurses are not always aware of all the details that should be known and remembered when giving medications, which is risky as it can lead to an ADE (Hanson & Haddad, 2022). A reference that nurses can easily access can fill in the gaps in medication knowledge and make nurses more efficient in the medication administration process (Hsu et al., 2021). After providing nurses with educational tools, a study completed at John Hopkins saw the effects of medication administration practice (Lau et al., 2017). They found that offering education to nurses significantly improved medication administration practice, primarily when it effectively engages the learner (Lau et al., 2017). If nurses who regularly work on the same unit struggle with identifying commonly administered medications, then nurses who do not consistently work on the unit would have a more challenging time identifying and understanding the drugs that are frequently given (Hanson & Haddad, 2022). 7 Various studies have shown that providing nurses with medication education reduces the prevalence of medication errors. A study in Palestine surveyed nurses and found that a lack of knowledge of high-alert medications was the most reported reason for medication errors (Zyoud et al., 2019). Those nurses said they would like additional training to update their pharmacological knowledge. Providing nurses with further medication education is correlated with decreased medication errors and increased patient safety (Høghaug et al., 2021). Literature Review and Framework Inconsistently administering medications leads to decreased confidence in float nurses and risks patient safety. A lack of knowledge of unit procedures and medications was noted in nurses who consistently work in assigned units. Nurses who inconsistently work in units would be more likely to struggle with being up-to-date with this knowledge. Therefore, to counteract the inconsistency in which float nurses administer unit-specific medications, additional resources and education can be provided to increase recognition and knowledge of unit-specific drugs while increasing self-confidence in the float nurse. Framework Applying an evidence-based practice (EBP) framework to clinical practice improves the quality of patient care. Using the Iowa model improves nurses' EBP capacity and potential by ensuring that the way they work in their field is research-based and appropriate for implementation in practice (Iowa Model Collaborative, 2017). Utilizing this model requires encouraging active participation of nurses in the involved unit, having supportive leadership, and integrating the pilot EBP innovation in routine procedures to effectively sustain EBP intervention (Chiwaula et al., 2021). 8 As this project aims to improve medication education for float nurses, following the Iowa Model steps to implement this practice and ensure it is practical makes this model beneficial in executing and developing this project. The steps of the Iowa Model include identifying an issue or opportunity for change, stating the purpose, forming a team, assembling evidence, designing the change, integrating the change, and disseminating results (Iowa Model Collaborative, 2017). Following these steps gives clear reasoning for the desired implementation and what needs to occur for the change to transpire. This model was chosen as it clearly states what actions must be followed to implement and integrate the desired change successfully. Evaluating the effectiveness to confirm practicality and make proper adjustments were other elements in selecting this model as a framework. The problem identified in this project is a knowledge deficit amongst nurses on commonly administered medications, which can be more challenging for float nurses who inconsistently use unit-specific medications. The project aims to provide reference sheets to fill the knowledge disparity that float nurses may experience from not routinely administering certain medications. Laminated reference sheets will be provided for the float nurses, a compact version will be given so nurses can have it with them as they go to the different units, and it will also be posted in the medication rooms. Along with the reference tool, an in-service will be conducted on maintaining pharmacology knowledge and efficiently using the other resources provided to nurses. The team will consist of nurse managers, charge nurses, float nurses, and pharmacists, who will be critical in designing, implementing, and using the reference sheet. The Master of Science in Nursing (MSN) student will direct integration, and float nurses will complete implementation. The MSN student will disseminate the reference sheets during the 9 quarterly staff meeting and then measure the effectiveness of implementing the reference sheets in three months on feedback from surveys completed by the nurses who use the reference sheet. Strengths and Limitations A strength of the Iowa Model is the focus on issues that directly affect staff and patients in clinical practice. Duff et al. (2020) found that projects implemented by the suggestion of "frontline staff" were more successful than projects created by upper administration. Bedside staff, including nurses, suggesting and implementing policy changes is more effective as they see firsthand the need for the change and what outcomes it would bring (Duff et al., 2020). The implementation focuses on float nurses and how the change will affect their knowledge of the medication of unit-specific administration practices and confidence. A limitation of using the Iowa model for the application of this project may be the source from which we examine effectiveness (Duff et al., 2020). Other groups of nurses, such as new graduates, and other factors, such as patient experience, may be overseen. Analysis of Literature This literature analysis will contend that providing float nurses with unit-specific education resources will increase knowledge and confidence in medication administration within three months. An exploration of current and peer-reviewed articles will be conducted to identify if there is statistical significance in providing additional pharmacological education and resources to float nurses. Three themes emerged from the reviewed articles. First, there is a knowledge deficit about medications among nurses. Second, float nurses are more likely to be unsure of the unit-specific medication administration since they do not have a home unit. Lastly, providing nurses with additional pharmacology resources increases their knowledge and 10 confidence regarding medication administration. Therefore, implementing a reference sheet for float nurses would offer a tool to improve job performance. Search Strategies The search was conducted using databases such as One Search, Google Scholar, PubMed, and ScienceDirect, to find scholarly and peer-reviewed journal articles published within the past five years. Boolean phrases "medication education for nurses AND knowledge gap and effects of medication administration" was searched. Other keywords searched in the databases included float nurses, preventing medication errors, increasing nurse medication confidence, patient safety, and nurse tools and resources. Nursing Pharmacology A recent study by Goodwin et al. (2019) reported concern among seasoned nurses about the knowledge that nursing students and newly qualified nurses have about medications and their administration. Goodwin et al. (2019) conducted this study in two acute mental health facilities in Ireland; by interviewing nurses. The researchers concluded that student nurses had difficulties interpreting medication charts and could not provide medication-related education; therefore, the participants recommended an enhancement in medication education (Goodwin et al., 2019). The student nurses suggested additional and more practical approaches for their education, including having pharmacists deliver lectures and being taught by nurses who administer medications daily (Goodwin et al., 2019). Adding an emphasis on medications in the continuing education modules will be beneficial for nurses. In this study, the participants thought there was a difficult transition from student to practicing nurse due to a lack of medication understanding (Goodwin et al., 2019). 11 A survey done by Zyoud et al. (2019) consisted of administering a four-part survey to the emergency room (ER), intensive care unit (ICU), pediatric, or medical ward nurses in Palestine. Two hundred eighty nurses participated, answering questions about demographic characteristics, drug administration knowledge, understanding of drug regulation, and self-evaluation (Zyoud et al., 2019). Of the participants, it was discovered that ninety-three percent had insufficient knowledge about high-alert medications (HAMs), common in these units and that eighty-two percent of correspondents hoped to receive supplementary training (Zyoud et al., 2019). The questionnaire results show that a knowledge deficit was an obstacle nurses faced during the administration of HAMs, which increased the risk of medication error (Zyoud et al., 2019). The nurses questioned expressed a desire for further training to revise medications and stay informed about their pharmacological education (Zyoud et al., 2019). Continuing education focusing on pharmacology is desired by nurses and would be advantageous as there is an apparent and significant misunderstanding of applicable drugs. Researchers conducting a multi-method study in an ICU in Spain reviewed medical records, conducted interviews with nurses, and collected responses to a questionnaire completed by nurses (Gracia et al., 2019). The researchers determined that the ICU nurses had insufficient knowledge of the drugs they used most frequently, which caused more significant medication errors (Gracia et al., 2019). The literature review revealed a deficiency in medication literacy among nurses, which supports the need for supplemental resources. Unit-Specific Medication Administration Assimilating to a different unit is challenging with the unfamiliarity of working in varying departments. Nurses who lack unit-specific medication familiarity may be unable to answer patient inquiries or adequately address concerns; these factors can compromise nurse 12 credibility and poorly reflect on the facility (O'Connor & Dugan, 2017). Lack of competency or experience from nurses does not contribute to the previously mentioned concerns of medication expertise or ability to answer inquiries. However, if patients notice the nurse's struggle to adjust to an unaccustomed situation, they may feel insecure, destabilizing the nurse-patient relationship (O'Connor & Dugan, 2017). Medication administration is a laborious part of each shift, especially when the medications to be administered vary in commonality. Statistics gathered by Dirik et al. (2019) observed that nurses have more than fifty medication orders in each shift, and distributing these medications takes forty percent of their working time. Providing float nurses with a reference sheet during their duty period will save time, decrease frustration, and increase patient safety. Godshall and Riehl (2018) identified that 1% to 2% of hospitalized patients are affected by medication errors, while adverse drug events harm nearly 5%. Further educating float nurses can decrease these occurrences. In research by Marufu et al. (2022), they stated that there is not one solution to reducing medication administration errors, but administering medicines to children via any route can be complex, demanding special awareness and multifaceted interventions to avoid potential mistakes. Marufu et al. (2020) findings were determined by examining current intervention tactics to reduce medication administration errors in pediatric and neonatal populations. The meta-analysis did not focus on float nurses as a variable but concluded that constant assessment of interventions is vital for measuring efficiency and ensuring patient safety. Nurses who consistently work with these populations struggle to ensure proper administration. Float nurses are more susceptible to this issue and should have additional resources to safeguard their patients. 13 Pharmacology Resources Venous thromboembolism prevention includes pharmacologic agents that prevent blood clots. In Lau et al. (2017), a study was completed at John Hopkins by randomly selecting nine hundred and thirty-three medical/surgical nurses to give education tools about medication administration practice, highlighting venous thromboembolism prevention. They found a significantly improved medication administration practice among nurses with supplementary education (Lau et al., 2017). The supplemental education proposed for this project will be the reference sheet and in-service. A research article explained the effects of a medication management program in a Norway hospital, and the effects were still present after three months (Høghaug et al., 2021). Newly employed nurses working on medical or surgical units at a university hospital were selected to complete voluntary additional education about medications (Høghaug et al., 2021). As well as pre and post-exams to test their knowledge of pharmacology, medication administration, generic medication replacements, and medication calculations (Høghaug et al., 2021). Høghaug et al. (2021) concluded that completing a medication management program after formal education and continuously providing medication management education can assist nurses in recalling and applying learned medication principles. These effects are present three months after the initial training; however, continuous education is essential to reinforce nursing knowledge (Høghaug et al., 2021). Reducing total errors in medication administration in medical units correlates with improving nursing performance by providing blending learning courses to clinical nurses (Farzi et al., 2020). In an Iranian hospital, nurses from the medical wards were randomly selected to participate in a blended learning course; the researchers observed that medication errors 14 decreased by eleven percent after the learning intervention was implemented (Farzi et al., 2020). These findings demonstrate why continuous supplemental education for nurses is beneficial to reduce medication errors, increase confidence among nurses, and increase patient satisfaction. A Doctor of Nursing Practice project completed by Abdullah-Grayson (2017) observed that implementing a reference sheet with unit-specific information positively impacted the comfort level, experience, and role satisfaction of float pool registered nurses. In a research study by Hsu et al. (2021), nurses in the post-anesthesia care unit (PACU) were provided with a reference guide on commonly used unit-based medications. The reference guide was an effective resource tool to help promote medication safety, increase nurse satisfaction, minimize drug errors, and improve patient care. (Hsu et al., 2021). A post-implementation survey was obtained with feedback from forty-one nurses' on the reference guide's effectiveness; the results showed that ninety-three percent found the tool valuable to their patient care (Hsu et al., 2021). Ninetyfive percent also agreed that having such a tool would promote medication safety when crosstraining in a different specialty area (Hsu et al., 2021). Summary of Literature Review Findings and Application to the Project A review of current literature related to float nurses' administration of unit-specific medications illuminated a knowledge deficit among nurses. Float nurses may be at higher risk of being unfamiliar with unit-specific medications as they may not administer them routinely. Providing float nurses with a resource to bridge that gap will increase their knowledge and confidence in medication administration and decrease medication errors. 15 Project Methodology The goal of this Master's in Nursing project is to reinforce float pool nurses' education on medications they do not consistently administer. Nurses who work in the same unit have insufficient knowledge of the drugs they commonly administer (Gracia et al., 2019). This knowledge gap correlates with a significant number of medication errors (Gracia et al., 2019). Prevention of medication administration errors is critical to ensure the safety of patients; although a complex and multifaceted issue, it is critical to make medication administration guidelines available for nurses (Wondmieneh et al., 2020). Description and Development of Project Deliverables For this project, the evidence-based research on the benefits of having medication reference guides will be presented at an in-service with a brochure (see Appendix A). The brochure will have statistics and information on the importance of continuing education, especially for float nurses dealing with various drugs on the different units. After the introduction of the project, the quick reference guides (see Appendix B) will be presented. The reference guide will include the most commonly used floor-specific medications and side effects to be aware of when given. These guides will be available in each medication room, and pocket guides will be provided for float nurses. A pre-survey (see Appendix C) and post-survey (see Appendix D) will then be supplied so the float nurses can evaluate the efficacy of the quick reference guides. Plan and Implementation Process This MSN project aims to bridge the knowledge deficit amongst nurses on commonly administered medications, which can be even more challenging for float nurses who sporadically use unit-specific drugs. After consulting with the float pool manager and approval is obtained, an 16 in-service will be announced with the implementation objective. Firstly, the pre-survey questionnaire will be distributed to the float pool nurses. Upon completion of the pre-survey, the brochure will be presented explaining the importance of continuing medication education. A compact laminated reference sheet will then be provided for the float nurses to have it with them as they go to the different units. The reference guide will also be posted in the medication rooms. After three months, a post-survey will be distributed via email to float pool nurses inquiring about feedback on the helpfulness of the reference sheet and any suggestions for improvement. Interdisciplinary Teamwork The interdisciplinary team will be critical in designing, implementing, and using the reference sheet. The healthcare professionals required to carry out this implementation will consist of nurse managers, charge nurses, float nurses, and pharmacists. The nurse manager will allot time during an in-service and aid in the approval of implementing the reference guides. The charge nurses will help by posting the lamented reference guide in the units' medications rooms and break rooms. The pharmacists will contribute to this project by verifying the accuracy of the information provided in the medication reference guides and making any suggestions for commonly used floor-specific medications. The Master of Science in Nursing (MSN) student will direct integration and dissemination, while the float nurses will complete implementation. This team will impact patient care and outcomes by increasing nurses' confidence during medication administration and strengthening patient trust in their nurses' competence and ability. Timeline Before implementing this MSN project, authorization to hold an in-service and to complete the project plan will be requested from management. The in-service will provide information on enhancing medication education for float pool nurses and disperse reference 17 guides. Once the administration has granted permission, a date and time will be selected a month later for the in-service, allotting sufficient time for the nurses to plan on attending. The in-service will be held in person and be available via video conference and recording, to have the information available to the vast majority of stakeholders. Directly after the recording will be emailed to float pool personnel and charge nurses with the attached brochure, pre-survey, and reference guide. After three months, the post-survey will be emailed to the participants. Depending on the feedback received, changes may be made to the reference guide or accessibility (see Appendix E). Plan for Evaluation of Project The effectiveness of this project will be evaluated by comparison of the feedback of the pre and post-surveys. Before presenting the brochure, the pre-survey will be given and contain a section on self-reflection about medication administration and confidence. After three months of implementation, the post-survey will be distributed. The post-survey will include another selfreflection section, consisting of an inquiry into usage. If staff states that they are not using the reference guide, they will be asked why and what changes should be made for it to be worthwhile via the post-survey questionnaire. After receiving the feedback, suggested changes will be considered to enhance the reference sheet's usage. Ethical Considerations Anonymity and confidentiality will be upheld when gathering information in this MSN project to protect the privacy of those that voluntarily agree to participate—protecting privacy aids in building trust and rapport with the participants and is essential to preserve integrity in the research process (Abadie et al., 2021). The surveys will be submitted anonymously to get open and sincere feedback. Results will be gathered with consent to participation and shared with the 18 participant's permission. Float nurses were made aware that answers would be confidential, personal information would not be asked, and no repercussions would occur if they did not wish to participate. If nurses decide not to participate in the survey or do not use the reference guide, they will just be asked for reasoning to improve the project; however, confidentiality will be maintained. Privacy will be upheld by utilizing paper submissions of the survey to avoid linking a person to the study by the email from which it is being received. Discussion This project aims to provide float nurses with knowledge of available resources and additional education to decrease the risk and occurrence of adverse events. The research examined for this MSN project reinforces the need for float nurses to have extra resources to increase their confidence level and better care for their patients. This portion of the paper focuses on the desired change's possible effects, recommendations, merits, and demerits. Evidence-based Solutions for Dissemination A poster will be created to disseminate the significant project findings. This poster will be presented to peers, faculty, and float nurses at McKay Dee Hospital. Other dissemination ideas include publishing the poster on Folio or presenting the evidence from the literature during meetings or in other classes. Significance to Advance Nursing Practice The revised literature indicates a knowledge gap among nurses with the medications they frequently administer to patients. Nurses cannot remember every detail of every drug they may administer, so the learning they have received in their schooling must be reinforced and continuously reviewed. It is especially essential among float nurses who constantly administer various classes of medications. Unfamiliarity with pharmacology causes a decrease in confidence 19 among nurses. Being unable to answer patient questions concerning the drugs they are receiving makes the nurse feels inadequate and causes uneasiness for the patient. Professional confidence affects all members of the receiving and providing side of healthcare and influences the patient's quality of care (Makarem et al., 2019). Patients will feel more at ease knowing they receive care from a well-informed nurse. Providers will feel assured of their patient's safety when they are under the care and supervision of a knowledgeable nurse. A nurse with self-confidence will have a less stressful experience knowing they have the required skill set for their practice and adequate education to perform in their workplace (Makarem et al., 2019). Research by Sanjeevi and Cocoman (2020) explored nurses' self-confidence, knowledge, and skills when administering medications. Their findings suggested that there needs to be more education on pharmacology for nurses working in clinical settings to assist patients efficiently in managing their medication regimens (Sanjeevi & Cocoman, 2020). Implications This project will support nursing knowledge by reinforcing pharmacological understanding, providing quickly accessible medication information, and ensuring awareness of resources. The project will help the nursing profession by aiding nurses to feel more confident in their skills and abilities. Another positive outcome would be decreased medication errors (Gracia et al., 2019). When nurses have additional resources to assist them in their practice, adverse events can be reduced, improving patient outcomes. Although this project would be immensely beneficial, there are limitations to acknowledge. Firstly, the project is focused on float pool nurses. However, the resource could be dispersed among all floor nurses and tweaked to fit each unit's needs. Secondly, the resource is 20 limited to several commonly administered medications. This limitation will be addressed by providing easy and quick access to online medication information. Recommendations Once the effectiveness of the medication reference guides is evaluated on the critical care floors, the next step would be creating and disseminating reference guides for the other specialty floors. Further research on the effects of the medication education gap and the more efficient ways to bridge the gap would be beneficial. Surveys on nurses' experience with floating to different units, particularly on administering medications sporadically, would also be helpful. It would also be valuable to determine what barriers or obstacles are present in making online information quicker and easier to access. Conclusions Evidence-based literature indicates that medication errors occur even among commonly administered medications. This project will provide float nurses with the necessary tools and training to efficiently and effectively administer medications to varying patient populations. With continuing education, additional resources, and more accessible information, nurses will feel more confident administering medications. Reinforcing and providing tools to increase nurse confidence supports staff, decreases adverse events, and improves patient outcomes. 21 References Abadie, R., Fisher, C., & Dombrowski, K. (2021). 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Https://doi.org/10.1186/s12912-019-0336-0 25 Appendix A Staff Development Brochure 26 Appendix B Sample Medication Reference Guides Intensive Care Unit Drug Amiodarone Uses Intended for use only in patients with indicated lifethreatening arrhythmias because its use is accompanied by substantial toxicity Dexmedetomidine Sedation Agitation Side effects • Constipation. • Upset stomach or vomiting. • Feeling tired or weak. • Decreased appetite. • Stomach pain. • Headache. • Trouble sleeping. • Flushing. • Change in taste. • Change in sense of smell. • More saliva. • • • • • • • Diltiazem Oral: Hypertension, chronic stable angina, vasospastic angina Injection: Atrial fibrillation or atrial flutter for acute ventricular rate control, conversion of supraventricular tachycardia • • Feeling sleepy. Upset stomach. Numbness or tingling in the mouth. Dizziness. Dry mouth. Upset stomach. Constipation. Headache. Feeling dizzy, tired, or weak. Comments • May cause severe and sometimes deadly side effects such as lung, thyroid, or liver problems. • Can also cause abnormal heartbeats to get worse. • Blood work, tests, and other exams will need to be done to check for side effects. • Avoid grapefruit and grapefruit juice. • Some patients who received this drug for up to seven days had withdrawal signs when this drug was stopped. This includes tachycardia or signs of high blood pressure, such as severe headache. 27 Dobutamine Acute decompensated heart failure: Shortterm management of patients with cardiac decompensation. • • • • • • Dopamine Ephedrine Bradycardia Atrioventricular block Symptomatic (unresponsive to atropine) • Treatment of anesthesia-induced hypotension • • • • • • • • • • Esmolol Intraoperative and postoperative tachycardia and/or hypertension • Allergic reactions. Severe headache or dizziness, syncope Change in eyesight. Tachycardia. A new or worsening arrhythmia. Fever. Upset stomach or vomiting. Headache. Anxiety. Goosebumps. • This drug may cause tissue damage if the drug leaks from the vein. Look for any redness, burning, pain, swelling, blisters, skin sores, or leaking of fluid at the insertion site. Dizziness or headache. Feeling nervous and excitable. Trouble sleeping. Upset stomach or Vomiting. Decreased appetite. Restlessness. Excessive sweating. Upset stomach. • It may increase blood pressure or pulse. Avoid the use of caffeine. • • • Sinus tachycardia It may increase blood glucose. Do not stop taking this drug suddenly, may increase risk of heart attack. Supraventricular tachycardia and atrial fibrillation/flutter Fentanyl Pain management • Feeling dizzy, sleepy, tired, or weak. • Monitor for respiratory depression. 28 • • • • • • • Ketamine Anesthesia • • • Feeling sleepy. Decreased appetite. Upset stomach or Vomiting. Irritation where this drug is given. • • • • Allergic reaction acidosis Methemoglobinemia Severe headache. Severe dizziness or syncope. Ringing in ears. Small pupils. • Nitroprusside Acute decompensated heart failure Hypertensive emergency Dry mouth. Constipation, diarrhea, stomach pain, upset stomach, Vomiting, or decreased appetite. Headache. Feeling cold. Trouble sleeping. Sweating a lot. Irritation where this drug was used. • • • • • • Norepinephrine Hypotension Shock • Headache • Propofol Anesthesia Sedation • • Severe headache. Severe dizziness or syncope. Ringing in ears. Small pupils. • • • • Monitor blood pressure, heart rate, and oxygen levels closely. Some mood and behavior changes can happen when the effects of Ketamine wear off. Monitor blood pressure. Should not be given to patients with low blood volume or blood clots. Increased triglyceride levels may occur. No eating or drinking anything until the effects of this drug wear off. May require a swallow study if 29 mechanically ventilated. Cardio Vascular Thoracic Unit Drug Amlodipine (Norvasc) Classification Angina Hypertension Apixaban (Eliquis) Deep vein thrombosis Nonvalvular atrial fibrillation Postoperative venous thromboprophylaxis Pulmonary embolism Side effects • Feeling dizzy, sleepy, tired, or weak. • Flushing. • Upset stomach. • Stomach pain. • • • • • • Dizziness or syncope. Feeling tired or weak. Feeling confused. Headache. Joint pain or swelling. Chest pain or pressure. Comments • It is rare, but chest pain that is new or worsening can happen after this drug is first started or after the dose is raised. Heart attack can also happen. The risk may be greater in people with severe heart blood vessel disease. • Do not stop taking this drug without talking to the doctor who ordered it for you. Stopping this drug when you are not supposed to may raise the chance of blood clots. This includes stroke in certain people. • People who have any type of spinal or epidural procedure are more likely to have bleeding problems around 30 • Atorvastatin (Lipitor) Hypercholesterolemi a Prevent atherosclerotic cardiovascular disease • • • • • • Carvedilol (Coreg) Heart failure with a reduced ejection fraction Hypertension • • • • • Clopidogrel (Plavix) Acute coronary syndrome • Diarrhea. Joint pain. Pain in arms or legs. Upset stomach. Nose or throat irritation. Trouble sleeping • Feeling dizzy, tired, or weak. Headache. Diarrhea, upset stomach, or Vomiting. Weight gain. Joint pain. • Signs of an allergic reaction • • the spine when already on this drug. This bleeding rarely happens, but can lead to paralysis. You may bleed more easily. Be careful and avoid injury. Use a soft toothbrush and an electric razor. Avoid or limit drinking alcohol to 2 drinks a day. If you drink grapefruit juice or eat grapefruit often, talk with your doctor If you are taking this drug and have high blood pressure, talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen or naproxen, and some natural products or aids. Do not stop taking this drug 31 Myocardial infarction Ischemic stroke/ transient ischemic attack Peripheral atherosclerotic disease • • • Signs of bleeding Signs of low blood sugar Thrombotic thrombocytopen ic purpura • • • Digoxin (Lanoxin) Atrial fibrillation Atrial flutter Heart failure with reduced ejection fraction • • Dizziness or headache. Stomach pain. • without talking with your doctor. You may have a greater risk of heart attack or stroke. If you fall or hurt yourself or hit your head, call your doctor immediately. Talk with your doctor even if you feel fine. You may bleed more easily. Be careful and avoid injury. Use a soft toothbrush and an electric razor. Rarely, some bleeding problems have been deadly. Talk with your doctor before using products that have aspirin, blood thinners, garlic, ginseng, ginkgo, ibuprofen or like products, pain drugs, or vitamin E. Have your blood work (digoxin levels) checked. Have blood drawn before the daily dose (take digoxin after blood drawn) 32 Heparin Anticoagulation • • • • • • • • • • • Hydralazine Hypertension • • • Feeling confused. Severe headache. Severe dizziness or syncope. Swelling, warmth, numbness, change of color, or pain in a leg or arm. Chest pain or pressure. Shortness of breath. Back pain. Groin or pelvic pain or swelling. Change in skin color where the shot was given. Skin breakdown where this drug is used. Fever or chills. Headache. Diarrhea, upset stomach, or Vomiting. Decreased appetite. • • • You may bleed more easily. Be careful and avoid injury. Use a soft toothbrush and an electric razor. Severe and sometimes deadly bleeding problems have happened with this drug. This drug has caused a problem called heparin-induced thrombocytopen ia (HIT). HIT that leads to blood clots is called heparininduced thrombocytopen ia and thrombosis (HITTS). HIT and HITTS can be deadly or cause other problems. They can happen up to several weeks after stopping this drug. 33 Lisinopril (Prinivil, Zestril) Heart failure with a reduced ejection fraction Hypertension Myocardial infraction • • Dizziness or headache. Cough • • • • Losartan (Cozaar) Hypertension Proteinuric chronic kidney disease • • • • • Signs of a common cold. Feeling dizzy, tired, or weak. Diarrhea. Back pain. Stuffy nose. • • Fetal toxicity Tell your doctor if you have too much sweat, fluid loss, Vomiting, or loose stools. This may lead to low blood pressure. This drug may not work as well to lower blood pressure in Black patients. Sometimes another drug may need to be given with this drug. A severe and sometimes deadly reaction called angioedema has happened. The chance of angioedema may be higher in Black patients. Fetal toxicity If you are taking this drug and have high blood pressure, talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, nonsteroidal antiinflammatory 34 Metoprolol (Lopressor, Toprol XL) Propranolol (Inderal) Angina Heart failure with reduced ejection fraction Hypertension Myocardial infarction • Sacubitril/valsarta n (Entresto) Heart failure • • • • Feeling dizzy, tired, or weak. Diarrhea, upset stomach, or Vomiting. • Cough Feeling very tired or weak Dizziness or syncope • • *Comment section will be omitted from pocket guide version drugs (NSAIDs) like ibuprofen or naproxen, and some natural products or aids. Do not stop taking this drug all of a sudden. If you do, chest pain that is worse and in some cases heart attack may occur. The risk may be greater if you have certain types of heart disease. To avoid side effects, you will want to stop this drug as ordered by your doctor slowly Fetal toxicity A severe and sometimes deadly reaction called angioedema has happened. The chance of angioedema may be higher in Black patients. 35 Appendix C Pre-Survey Pre-Survey 1) On a scale of 1-10, how confident do you feel administering unit-specific medications (1 being diffident and 10 being confident)? 1 2 3 4 5 6 7 8 9 10 2) Can you answer the patient's questions about the medications you are giving? Yes or No 3) Do you tell your patients: a) What medication they are receiving? Yes or No b) Its purpose? Yes or No c) Possible side effects? Yes or No 4) Are you aware of the resources available to find out information on medications? Yes or No 5) How often do you look up a medication before administering it? a) Always b) Often a) Sometimes b) Rarely c) Never 6) On a scale of 1-10, do you feel confident performing discharge teaching on floor-specific medications (1 being diffident and 10 being confident)? 1 2 3 4 5 6 7 8 9 10 36 7) My concerns about infrequently administering unit-specific medications are: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 8) Any comments, questions, or concerns can be noted below: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Thank you for taking the time to complete this survey. Your responses will remain anonymous. 37 Appendix D Post-Survey Post-Survey 1) On a scale of 1-10, how confident do you feel administering unit-specific medications using the reference guide (1 being diffident and 10 being confident)? 1 2 3 4 5 6 7 8 9 10 2) Could you answer the patient's questions about the medications you were giving? Yes or No 3) Did you tell your patients: a) What medication they were receiving? Yes or No b) Its purpose? Yes or No c) Possible side effects? Yes or No 4) Did you use the available resources to find out medication information? Yes or No 5) Did you use the reference guide? a) Always b) Often c) Sometimes d) Rarely e) Never 6) Why or why not? 38 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 7) How often do you look up a medication before administering it? a) Always b) Often c) Sometimes d) Rarely e) Never 8) On a scale of 1-10, do you feel confident performing discharge teaching on floor-specific medications (1 being diffident and 10 being confident)? 1 2 3 4 5 6 7 8 9 10 9) My concerns about infrequently administering unit-specific medications are: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 10) Any comments, questions, suggestions, or concerns can be noted below: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Thank you for taking the time to complete this survey. Your responses will remain anonymous. 39 Appendix E Timeline