Effect of Root Cause Analysis on Pre-Licensure, Senior-Level Nursing Students’ Safe Medication Administration Practices

Aim: The aim of this study was to examine if student nurse participation in root cause analysis has the potential to reduce harm to patients from medication errors by increasing student nurse sensitivity to signal and responder bias. Background: Schools of nursing have traditionally relied on strategies that focus on individual characteristics and responsibility to prevent harm to patients. The modern patient safety movement encourages utilization of systems theory strategies like Root Cause Analysis (RCA). The Patient Risk Detection Theory (Despins, Scott-Cawiezell, & Rouder, 2010) supports the use of nurse training to reduce harm to patients. Method. Descriptive and inferential analyses of the demographic and major study variables were conducted. Validity and reliability assessments for the instruments were performed. The Safe Administration of Medications-Revised Scale (Bravo, 2014) was used to measure sensitivity to signal. The Safety Attitudes Questionnaire (SAQ; Sexton et al., 2006) was used to assess responder bias; this was the first use of this instrument with nursing students. Results: The sample consisted of 125 senior-level nursing students from three universities in the southeastern United States. The SAQ was found to be a valid and reliable test of safety attitudes in nursing students. Further support for the validity and reliability of the SAM-R was provided. A significant difference in safety climate between schools was observed. There were no differences detected between the variables. Conclusion: The results of this study provide support for the use of the SAQ and the SAM-R to further test the PRDT, and to explore methods to improve nursing student ability to administer medications safely

Archaeological Investigations at the Christopher Columbus Italian Society Property and Columbus Park: 41BX1968, the Possible First Site of Mission San Antonio de Valero

In May of 2013, the Center for Archaeological Research of The University of Texas at San Antonio was contracted by the San Antonio Conservation Society (SACS) to explore the Spanish Colonial archaeological deposits and a feature that were recently identified in a lot owned by the Christopher Columbus Italian Society and next to the San Francesco di Paola Church in north-central San Antonio, Bexar County, Texas. Based on a number of historical descriptions, the deposits were thought to possibly be associated with the first location of Mission San Antonio de Valero that was established in 1718. Thirty-one shovel tests were excavated in Columbus Park and on property owned by the Christopher Columbus Italian Society near the church. In addition, three test units were excavated at a location downhill from the church on property owned by the Christopher Columbus Italian Society. The archaeological investigations were conducted under Texas Antiquities Permit No. 6534. Steve Tomka served as the Original Principal Investigator, and Kristi Miller Nichols served as Project Archaeologist. The Permit is currently held by Dr. Raymond Mauldin. Surface collection in the open field and in the vicinity of the church produced a small quantity of Spanish Colonial Period material, including wrought iron nails, a majolica ceramic fragment, a trade bead, and melted lead. Shovel tests revealed that the upper 60 cm of soil in the park contains mostly modern and some early twentieth-century materials. Investigations found no evidence of Mission San Antonio de Valero within Columbus Park. Test unit excavations in the Christopher Columbus Italian Society’s property produced fragments of majolica ceramics affiliated with the Spanish Colonial Period and lead-glazed Galera wares of probable Colonial age. While a large proportion of the cultural materials recovered from surface and the shovel tests does consist of nineteenthand twentieth-century materials, the remainder includes a variety of Spanish Colonial artifacts such as tin- and lead-glazed ceramics, bone-tempered sherds, a trade bead, and fragments of wrought iron nails. It is likely that the materials have been re-deposited from the upper portion of the landform where the church and hall had been erected in the late 1920s. In addition, the western portion of the tract had been graded prior to the construction of a paved parking lot, and this further disturbed any buried cultural deposits. The cultural material that is affiliated with the Spanish Colonial Period is overwhelmed by artifacts dated to later periods. This is somewhat expected given the short-lived history of Mission San Antonio de Valero at its first location. Based on archival descriptions, this area matches at least one distance given for the location of the mission in relation to the presidio and villa that are believed to have been located near modern-day San Pedro Park. While it is possible that this location is the first site of Mission San Antonio de Valero, additional archaeological investigations will be required to verify that possibility. It is necessary to obtain larger samples of Colonial materials and architectural evidence that would be consistent with the structures and features likely associated with the site during the first few months of its occupation. Unfortunately, the areas that could hold such artifacts and features are likely to be under the footprint of the church proper and under a nearby asphalted parking lot. It is recommended that if and when the asphalted parking lot is redeveloped and the asphalt removed, archaeological investigations be carried out in the area to determine if any Spanish Colonial Period materials are present. It is the CAR’s understanding that a significant amount of fill was introduced to the area to level it prior to the construction of the parking lot. The fill was borrowed from the grassy field where the testing investigations took place. Furthermore, archaeological investigations are recommended if any future opportunities arise to investigate the crest of the hill, particularly under the footprint of the church and hall

Archaeological Survey of the West Salado Creek Lift Station Project, San Antonio, Texas

During October of 1999, archaeologists from the Center for Archaeological Research, The University of Texas at San Antonio conducted a pedestrian survey, shovel testing, and backhoe trenching along a portion of Salado Creek in southeastern San Antonio, Texas in order to identify cultural resources that may be impacted by a proposed sewer line. The project encompassed three areas (Phase I, II, and III) where the proposed route of a sewer line was to cross Salado Creek. Phase I and the east side of the Phase II crossing were surveyed. Results from shovel tests and backhoe trenches indicated that the proposed sewer line would not impact cultural resources in Phase I and the eastern portion of Phase II. The survey was not conducted on the west side of Salado Creek in Phase II and all of Phase III due to changes in city planning. This work will need to be completed if, or when, the sewer project is reinstate

Archaeological Investigations in Front of the Spanish Governor’s Palace in Plaza de Armas, San Antonio, Bexar County, Texas

In June of 2015, Raba Kistner Environmental, Inc. (RKEI) was contracted by K. Friese + Associates to perform archaeological investigations related to the replacement of a section of water main located to the east of the Spanish Governor’s Palace and City of San Antonio (COSA) offices within the Vogel Belt Complex. Since the project was sponsored by a political subdivision of the state and impacted land owned by the COSA, it fell under the jurisdiction of the COSA’s Preservation Ordinance (Division 3, Article VI Historic Preservation and Urban Design, Texas Unified Development Code) administered by the Office of Historic Preservation (OHP). Furthermore, the project also falls under the jurisdiction of the Antiquities Code of Texas, as overseen by the Texas Historical Commission. The investigations were conducted under Texas Antiquities Permit No. 7299. Kristi Miller Nichols served as Principal Investigator. The project was divided into two phases. Phase I consisted of exploratory backhoe trenching and the monitoring of water main trenching in front of the Vogel Belt Complex. Phase II consisted of the removal of pavers in front of the Spanish Governor’s Palace and the monitoring of water main trenching and the replacement of the pavers. To accommodate logistical concerns by nearby property owners and to minimize disruptions, the two phases took place nearly a month apart from each other, beginning in June and completed in July. The Phase I trench (9.5 meters; 31.2 feet) was excavated to expose the main from the valve to a bend near Dolorosa Street. No cultural materials were encountered in the exploratory trench, and the SAWS contractor was allowed to continue the remainder of the mechanical trenching while monitored by RKEI archaeologists. Intact cultural deposits were identified near the southern end of the Phase II trench buried at a depth of 80-103 centimeters below surface in an area offset from the original water main installation trench. The intact deposit yielded only Spanish Colonial artifacts, indicating that in situ colonial materials related to the use of the Governor’s Palace and Plaza de Armas are potentially present. Investigations determined that intact cultural deposits dating to the Spanish Colonial Period are found in front of the Spanish Governor’s Palace and may extend across large portions of the Military Plaza. Therefore, as it has been the standard practice to date, archaeological investigations should continue to be carried out prior to future subsurface disturbances planned within Military Plaza

A Cultural Resources Survey Of The Proposed Town Creek/Haeckerville Road Levee Project, Cibolo, Guadalupe County, Texas

In December 2014, Vickery and Associates (Client) contracted with Raba Kistner Environmental, Inc. (RKEI) to perform an intensive cultural resources survey of approximately 111-acres for the proposed Town Creek/Haeckerville Road Levee Project in Cibolo, Guadalupe County, Texas. The City of Cibolo is proposing improvements to the floodplain of Town Creek in Guadalupe County, Texas. The project consists of approximately 1.5 miles of drainage improvements, channel modifications, and minor levee or earth embankment construction along Town Creek. The project also will involve the reconstruction of Haeckerville Road and modifications to Schaeffer Road from S. Main to Haeckerville Road. The project easement is owned by a mix of City and private landowners. The archaeological crews investigated all but one private property for which no Right-of-Entry was secured prior to the field work. The purpose of this survey was to determine whether historic or prehistoric cultural resources are located within the Area of Potential Effect (APE), and if so, assess the significance and eligibility for designation as State Antiquities Landmarks (SALs) and for inclusion in the National Register of Historic Places (NRHP). The project was carried out between January 5 and 8, 2015 under Texas Antiquities Permit No. 7123. Dr. Steve A. Tomka served as Principal Investigator. Kristi Miller Nichols served as the Project Archaeologist and Mark Luzmoor, Chris Murray and Cyndi Dickey served as field technicians. A total of 34 shovel tests (STs) and three backhoe trenches were excavated within the APE. Surface visibility was around 90% throughout the APE. No buried or surface-exposed prehistoric materials were encountered during the survey. A historic homestead, 41GU169, was documented near the southern terminus of the project area. Two shovel tests excavated within the boundaries of the site were positive for historic materials. The historic site is a farmstead that likely was constructed circa 1920s. It is recommended that the site is potentially eligible for listing on the NRHP and for formal designation as a State Antiquities Landmark. Proposed project plans call for the acquisition of an access-easement thorough the site. This easement may impact one dilapidated outbuilding found on the site. No other negative impacts are expected. A second historic farmstead may be present on the property that could not be accessed during the survey. No detailed information exists on the condition of this site and therefore its eligibility cannot be assessed. With regards to the remainder of the project area, RKEI recommends that since construction activities will extend to a depth of 20 feet below surface, construction monitoring be carried out to document any cultural materials that may be buried below the reach of the current project activities (i.e. 1.5 meters or 5.5–feet). All project related documents, are permanently housed at the Texas Archeological Research Laboratory. No cultural material was collect over the course of the project

An Intensive Cultural Resources Survey For Goforth Road Between IH-35 And Kyle Parkway, Kyle, Hays County, Texas

In December 2014, Lockwood, Andrews & Newman, Inc. (Client) contracted with Raba Kistner Environmental, Inc. (RKEI) to perform an intensive cultural resources survey along Goforth Road between Interstate Highway (IH)-35 and Kyle Parkway for the expansion of the Right-Of-Way (ROW) and the installation of storm sewer inlets, manholes and one bridge in Kyle, Hays County, Texas. The purpose of this survey was to determine whether cultural resources were located within the Area of Potential Effect (APE), and if feasible, assess their significance and eligibility for designation as State Antiquities Landmarks (SALs) and for listing on the National Register of Historic Places (NRHP). The project was sponsored by the City of Kyle and the owner of the project is the City of Kyle owns the road and its ROW. Since the ROW is owned by a political subdivision of the state, the project falls under the Antiquities Code of Texas as administered by the Texas Historical Commission (THC). The field work was carried out between December 29-30, 2014 under Texas Antiquities Committee Permit No. 7117 issued to Dr. Steve A. Tomka, who served as Principal Investigator. Mark Luzmoor was the Project Archaeologist and Kristi Nichols and Chris Murray assisted during the field work. Background research revealed that no previously recorded archaeological sites are located within the boundary of the APE. However, there are two archaeology sites, seven historical markers and four National Register Properties, within a one mile radius but outside of the APE. A total of 16 shovel tests (STs) were excavated within the APE. Surface visibility was around 10% throughout the APE. Due to extensive disturbances of the banks of Plum Creek, no backhoe trenches were excavated during the project. No artifacts were encountered in any shovel test or on surface during the pedestrian survey. Since no cultural deposits were encountered, RKEI recommends no further archaeological work within the project boundaries. All project related documents are permanently housed at the Texas Archeological Research Laboratory

A Cultural Resources Survey Of The Proposed Water And Sewer Line Project On SH-16 Helotes, Bexar County, Texas

In November 2014, LNV Engineers (CLIENT) contracted with Raba Kistner Environmental, Inc. (RKEI) to perform an intensive cultural resources survey along State Highway (SH) 16 for a proposed water and sewer line project in Helotes, Bexar County, Texas. The project occurred within the existing SH-16 Rightof Way (ROW). The purpose of this survey was to locate surface exposed or buried cultural deposits with the project area. The project is sponsored by the City of Helotes. Therefore, the proposed project falls under the Antiquities Code of Texas as administered by the Texas Historical Commission (THC). The project was carried out between November 24-26, 2014 under Texas Antiquities Committee Permit No. 7087 issued to Dr. Steve A. Tomka, who served as Principal Investigator. Mark Luzmoor served as the Project Archaeologist and Chris Murray served as the field technician. Background research carried out prior to the fieldwork revealed no known archaeological sites within or in the vicinity of the Area of Potential Effect (APE). One historical marker is present within the APE. Although there are no archaeological sites within the boundary of the APE, there are ten sites, three historical markers, and one National Register Property within a one mile radius of the project area. A total of 26 shovel tests (ST) were excavated within the APE. Due to the lack of deep soils within the APE, no backhoe trenches were excavated. No buried artifacts were encountered during shovel testing and none were noted on surface during the pedestrian survey. Since no cultural deposits were encountered, RKEI does not recommend that further archaeological investigations within the project boundaries and the proposed project can proceed as planned. All documents generated during the course of the project are permanently housed at the Texas Archeological Research Laboratory (TARL)

Proposed Salado Creek Trail, Lions Park Lake to SE Military Drive, San Antonio, Bexar County, Texas

In December 2015, Vickrey & Associates, Inc. (Client) contracted with Raba Kistner Environmental, Inc. (RKEI), to perform an intensive pedestrian survey for a proposed 3.2 mile hike and bike trail along Salado Creek near San Antonio, Bexar County, Texas. The proposed trail is an extension of the existing South Salado Creek Greenway Trail which was installed in 2008. The project is owned by the City of San Antonio. Since the project area is currently owned by a political subdivision of the state, the project falls under the Antiquities Code of Texas as administered by the Texas Historical Commission (THC). The purpose of the survey was to determine whether historic or prehistoric cultural resources are located within the Area of Potential Effect (APE), and, if so, assess their significance and eligibility for designation as State Antiquities Landmarks (SALs) and for inclusion on the National Register of Historic Places (NRHP). The project was carried out in early January 2016 under Texas Antiquities Permit No. 7491. Dr. Steve A. Tomka served as Principal Investigator. Kristi Nichols served as the Project Archaeologist, and Mark Luzmoor served as field technician. Several circumstances delayed the completion of the survey. Construction activities for a new apartment complex hindered the survey along the northern portion. During the survey, it was noted that the trail was to be placed on portions of an already laid cart path from the Pecan Valley Golf Club that was in this area from 1963-2012. Furthermore, because the golf course had fill brought in to build up the fairways and greens, no shovel tests or backhoe trenches were placed in these areas. Right-of-Entry issues also delayed progress within the golf course as well. Weather also postponed the survey due to wet and muddy conditions. One backhoe trench (BHT) and 19 shovel tests (STs) were excavated within the APE. Surface visibility was around 90 percent throughout the APE. No buried or surface-exposed historic or prehistoric materials were encountered during the survey. All documents collected during the course of the project were returned to the RKEI Archaeological Laboratory for processing. All project related documents, are permanently housed at the RKEI Laboratory. No cultural material was collected over the course of the project

Proposed Salado Creek Trail, Lions Park Lake to SE Military Drive, San Antonio, Bexar County, Texas

In December 2015, Vickrey & Associates, Inc. (Client) contracted with Raba Kistner Environmental, Inc. (RKEI), to perform an intensive pedestrian survey for a proposed 3.2 mile hike and bike trail along Salado Creek near San Antonio, Bexar County, Texas. The proposed trail is an extension of the existing South Salado Creek Greenway Trail which was installed in 2008. The project is owned by the City of San Antonio. Since the project area is currently owned by a political subdivision of the state, the project falls under the Antiquities Code of Texas as administered by the Texas Historical Commission (THC). The purpose of the survey was to determine whether historic or prehistoric cultural resources are located within the Area of Potential Effect (APE), and, if so, assess their significance and eligibility for designation as State Antiquities Landmarks (SALs) and for inclusion on the National Register of Historic Places (NRHP). The project was carried out in early January 2016 under Texas Antiquities Permit No. 7516. Dr. Steve A. Tomka served as Principal Investigator. Kristi Nichols served as the Project Archaeologist, and Mark Luzmoor served as field technician. Several circumstances delayed the completion of the survey. Construction activities for a new apartment complex hindered the survey along the northern portion. During the survey, it was noted that the trail was to be placed on portions of an already laid cart path from the Pecan Valley Golf Club that was in this area from 1963-2012. Furthermore, because the golf course had fill brought in to build up the fairways and greens, no shovel tests or backhoe trenches were placed in these areas. Right-of-Entry issues also delayed progress within the golf course as well. Weather also postponed the survey due to wet and muddy conditions. One backhoe trench (BHT) and 19 shovel tests (STs) were excavated within the APE. Surface visibility was around 90 percent throughout the APE. No buried or surface-exposed historic or prehistoric materials were encountered during the survey. All documents collected during the course of the project were returned to the RKEI Archaeological Laboratory for processing. All project related documents, are permanently housed at the RKEI Laboratory. No cultural material was collected over the course of the project

Archaeological Investigations and Monitoring of the Installation of a Water Line along Cunningham Avenue Near the Joint Base San Antonio-Fort Sam Houston, San Antonio, Bexar County, Texas

In the fall of 2016, Raba Kistner Environmental Inc. (RKEI) contracted with K Friese & Associates (CLIENT) to monitor the installation of a San Antonio Water System (SAWS) waterline along Cunningham Avenue (Ave.), between Broadway Street (St.) and N. Pine St., along the northern fence line of Joint Base San Antonio-Fort Sam Houston (JBSA-FSH) and the old Playland Park property. SAWS plans to install waterlines along four distinct locations surrounding JBSA-FSH. Of the four proposed waterlines, only one waterline has the potential of impacting a recorded archaeological site. The proposed waterline warranting archaeological investigation is located along Cunningham Ave. and is projected to intersect the known route of the Acequia de Valero (Acequia de Valero) also known as archaeological site 41BX8. As the utility installation is located on land owned by the City of San Antonio, a political subdivision of the State, and funding will be partially derived from public sources; the project is subject to review under the Antiquities Code of Texas (Texas Natural Resource Code, Title 9, Chapter 191) which protects historic resources found on state lands or lands owned by a political subdivision of the state. Additionally, the project is subjected to review by the City of San Antonio under the City of San Antonio’s Preservation Ordinance (Article VI, Historic Preservation and Urban Design, City of San Antonio, Unified Development Code). All work was performed in accordance with the Council of Texas Archeologists (CTA) and Texas Historical Commission (THC) Survey Standards, under Texas Antiquities Committee Permit No. 7833. Kristi Miller Nichols served as Principal Investigator and Mark Luzmoor served as Project Archaeologist. Assistant City Archaeologist, Matt Elverson was present during the exposure and documentation of the acequia. The Acequia de Valero was the first irrigation canal excavated by the Spanish colonists in the upper San Antonio River drainage. The construction of the canal began in January of 1719 for the purpose of transporting water to the agricultural fields of Mission San Antonio de Valero. Previous research conducted by RKEI within the former Playland Park property, south of the current project area, revealed a portion of the Acequia de Valero. Due to the potential of the acequia extending into the project area, the City of San Antonio’s Office of Historic Preservation (COSA-OHP) requested that RKEI monitored the mechanical excavation of a 1,000-foot portion of the waterline along Cunningham Ave., specifically focusing on an approximately 66-feet (20 meter [m]) area where the project route of the Acequia de Valero intersects Cunningham Ave. Prior to the installation of the SAWS waterline, the COSA-OHP requested that a Ground Penetrating Radar (GPR) survey be conducted to determine if the acequia alignment is still present within the project area. Additionally, the COSA-OHP requested that an exploratory trench be excavated in the area where the acequia crosses the APE, in an attempt to identify and document the acequia. On November 28, 2016, Kristi Miller Nichols and Cynthia Dickey conducted the GPR survey; however, no distinguishable anomalies were detected within in the GPR data. Therefore, on March 7, 2017, monitoring of the exploratory trenching began of an approximately 20 m long trench. The purpose of excavation of the trench was to determine if remnants of the acequia existed within the project area, prior to installation of the waterline. Due to the many layers of fill within the acequia at this location, it was difficult to identify the channel during excavation of the trench. After sections of the trench were excavated, an archaeologist entered the trench and cleared the trench walls to carefully inspect each profile for any signs of the acequia. Approximately 140 m to the east of the intersection of Broadway/Cunningham Ave., there appeared to be an outline of a ditch. Based on the location of the alignment of the acequia on historic maps and further investigations of the profiles, it was determined to be the Acequia de Valero. The north wall profile of the trench revealed the acequia to be approximately 4.15 m wide at the top of the channel and 70 centimeters (cm) wide at its base. The base of the acequia was 1.24 m below the top of the asphalt and neither the base nor its walls were lined. The south wall profile of the trench revealed that the acequia had been partially impacted on this southern edge as it was only 2.9 m wide. The southern wall profile revealed that the eastern end of the acequia was offset from the northern wall, approximately 60 cm to the east, indicating that the trench crosscut the acequia at an angle. Some similarities were noticed between this portion of the acequia and that uncovered within Playland Park, although, the Playland Park portion appears to have been truncated. Similarities between the two sections included the soil types encountered (i.e. the dark soil with cultural material). Once the documentation of the trench walls was complete the trench was filled in. After consultation with the THC and COSA-OHP, SAWS was permitted to install the waterline in the already excavated trench. No further investigations are recommended for this project as long as excavations did not further impact the acequia. All field records and photographs produced during investigations were curated at the Center for Archaeological Research at the University of Texas at San Antonio