Nurses' perceptions of the impact of work systems and technology on patient safety during the medication administration process

This dissertation examines nurses' perceptions of the impacts of systems and technology utilized during the medication administration process on patient safety and the culture of medication error reporting. This exploratory research study was grounded in a model of patient safety based on Patricia Benner's Novice to Expert Skill Acquisition model, James Reason’s Error Theory and the Toyota Production Systems quality management approach. Data were collected from professional nurses in the mid-Atlantic United States, through exploratory interviews, an online survey and post-survey follow-up interviews.The findings indicate that advances in the medication administration process and the use of technology have provided the potential to improve the quality of patient care while reducing errors associated with the medication administration process. Several process and work environment issues remain however. These include frequent distractions and interruptions during the process; the inability to take breaks during work-shifts, and the potentially negative impact of technology systems on the duration and flow of work. In addition, the findings indicate that nurses may still not be reporting medication errors.The main contributions of this study are to highlight the mechanisms that lead to medication errors and to demonstrate the key rationale for integrating standardized procedures with effective support for nurses at the point of care. This study provides an important point of reference, indicating how medication administration has changed since the findings of earlier studies. Changes to management policy in the area of medication administration are indicated, to make the process safer and more reliable.Ph.D., Information Studies -- Drexel University, 201

Evaluating the impact of the human simulation standardized patient experience on the undergraduate nursing student

Competency in the clinical setting involves the assimilation of theory and the development of skills. The integration of a human simulation standardized patient experience is one method to enable students to demonstrate competency of complex skills in a controlled or testing environment. The human simulation standardized patient experience is part of a new generation of ‘authentic assessment exercises’ that challenge students with realistic simulations of clinical experiences likely encountered in practice. Standardized patients can be utilized throughout an undergraduate nursing program to provide realistic, structured learning opportunities in a safe and supported environment while also providing opportunities for review and self-critique. Examples include: 1) therapeutic communication experience; 2) dealing with a difficult, anxious or agitated patient experience; 3) complex patient teaching experience; 4) summative evaluation of a patient encounter including history taking, focused physical exam and patient teaching. This college of nursing utilizes a human simulation standardized patient experience as part of the summative evaluation of the undergraduate nursing program. The students are presently given the opportunity to have the experience twice during their senior year. In their first experience, the nursing students have two fifteen minute experiences. The second standardized patient experience incorporates one forty minute comprehensive session. The purpose of this study was to examine the impact of the human simulation standardized patient experience on the student outcomes of confidence, nursing activity, and self esteem

National Library of Medicine and the Marine Biological Laboratory Biomedical Informatics Fellowship – one team’s experience

Poster presented at the International Medical Informatics Association’s 9th International Congress on Informatics, June 2006, Seoul, Korea

The effect of human simulation on student outcomes

Poster presented at the American Nursing Informatics Association and Capital Area Roundtable on Informatics in Nursing Collaborative Conference

Preparing for disaster response: A collaborative partnership

Oral presentation given at the International Council of Nurses International Conference, May 2007, Yokohama, Japan

Simulation case development and training

Poster presented at the American Association of Colleges of Nursing 2007 Hot Issues Conference, April 2007, Denver, Colorado

Bringing Brotherly Love to Interprofessional Education - Creating a Curriculum of Simulation with Multidisciplinary Objectives

Objectives: Learners attending this presentation/workshop will: Discuss the current trends in an interprofessional education curriculum Explore the possible pinnacles and pitfalls in developing an IPE educational curriculum, including institutional support for IPE programs Acquire the skills to develop simulation cases that foster interprofessional objectives Interprofessional collaboration and teamwork among health care professionals is essential to provide safe, high quality patient care. Unfortunately, dismantling of the existing educational silos between disciplines is fraught with challenges. Success requires multidisciplinary commitment and leadership, and must occur early in each student’s educational training. Although gaining popularity, interprofessional education (IPE) and communication is not commonly a focus in all health care disciplines. Drexel University ‘s College of Medicine and College of Nursing and Health Professions have developed a successful IPE curriculum in Women’s Health, built on a foundation of simulation and communication. Occurring three days per academic year over the last five years, the curriculum engages OB/GYN and anesthesia residents, undergraduate nursing, nurse practitioner, nurse anesthesia, physician assistant and midwifery students in outpatient and inpatient scenarios with active participant communication activities that crescendo through the year. Expert faculty with enhanced credentials in multi-fidelity simulation, Debriefing with Good JudgmentTM, and TeamSTEPPSTM participate in faculty development and interactive curriculum review to provide learners with rigorous, life-like experiences while learning to appropriately give bad news, handle stressful situations, and discuss important health related issues in a collaborative environment. The Drexel University Partnership for Interprofessional Education (DU-PIE) has presented workshops and live demonstrations nationally to teach faculty and staff how to devise an interprofessional curriculum for their institutions. Pinnacles and pitfalls encountered during the development and roll out of the Drexel model can assist programs to sustain and further enrich IPE programs. This interactive workshop will consist of a brief presentation, a small group activity to assist faculty and professional staff in creating the building blocks of an IPE simulation program including identifying stakeholders, lobbying for administrative support, and developing simulation cases that incorporate multidisciplinary IPE objectives, and group debriefing to share gained insights

Lipid remodelling and an altered membrane proteome may drive the effects of EPA and DHA treatment on skeletal muscle glucose uptake and protein accretion

In striated muscle, EPA and DHA have differential effects on the metabolism of glucose and differential effects on the metabolism of protein. We have shown that, despite similar incorporation, treatment of C2C12 myotubes (CM) with EPA but not DHA improves glucose uptake and protein accretion. We hypothesized that these differential effects of EPA and DHA may be due to divergent shifts in lipidomic profiles leading to altered proteomic profiles. We therefore carried out an assessment on the impact of treating CM with EPA and DHA on lipidomic and proteomic profiles. FAME analysis revealed that both EPA and DHA led to similar but substantial changes in fatty acid profiles. Global lipidomic analysis showed that EPA and DHA induced large alterations in the cellular lipid profiles and in particular, the phospholipid classes. Subsequent targeted analysis confirmed that the most differentially regulated species were phosphatidylcholines and phosphatidylethanolamines containing long chain fatty acids with 5 (EPA treatment) or 6 (DHA treatment) double bonds. As these are typically membrane associated lipid species we hypothesized that these treatments differentially altered the membrane-associated proteome. SILAC based proteomics of the membrane fraction revealed significant divergence in the effects of EPA and DHA on the membrane associated proteome. We conclude that the EPA specific increase in polyunsaturated long chain fatty acids in the phospholipid fraction is associated with an altered membrane associated proteome and these may be critical events in the metabolic remodelling induced by EPA treatment

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy