Ready for Clinical Practice: Teaching Med Administration to Nursing Students

Hillary Gamblin:

Thank you for joining today’s workshop on techniques for teaching Med Administration. This workshop is brought to you by GoReact. My name is Hilary Gamblin, I’m a GoReact employee. Today we’ll be interviewing Dr. Marsha Cannon.

Hillary Gamblin:

Today’s topic was inspired by an article written a month ago in the Nurse Journal, that identified the five most common mistakes made by new nurses. The number one errors for new nurses was related to medication, and those errors injure 1.5 million Americans each year.

Hillary Gamblin:

To help address this issue, we got together with Dr. Cannon, and today she’s going to share with us how she readies nurse students to administer and communicate effectively about medications. Marsha, do you want to introduce yourself?

Dr. Marsha Cannon:

Good afternoon, everybody. I know, we may be in different areas of the country, but my name is Marsha Cannon. I am actually employed. I’m Associate Professor at the University of West Alabama, in Livingston, Alabama.

Dr. Marsha Cannon:

I have been in nursing education for almost 30 years, and my primary role is with fundamentals. So I do a lot of skills validation, and then I teach pharmacology, as well.

Hillary Gamblin:

Thank you so much for joining us. Now, we have about over 800 people that signed up for this workshop today. I’m sure quite a few of you are new to GoReact’s nursing education Workshops. To help orient you, let me give you a quick outline of how we structure these virtual events.

Hillary Gamblin:

For the first 30 minutes, we’ll discuss with Marsha, her techniques and assignments around medication administration. And then, after interviewing Marsha, we’ll do a live Q&A session for about 15 minutes. If you’d like to submit a Q&A, there’s a tab just below the video feed.

Hillary Gamblin:

If you like a question that someone else asks, there’s actually a really fantastic upvote feature. So make sure to vote for the questions that you like. Don’t forget to use the chat that’s located on the right side of the video feed.

Hillary Gamblin:

This is where attendees share personal information, links, resources, so they can get together and talk after the workshops. So don’t miss out what happens there. And then, right next to Ask A Question is a polling feature.

Hillary Gamblin:

We’d actually like to start off today’s workshop with a quick poll to better understand your specific concerns about medication administration. The polling question is, “In your opinion, which of these medication errors do your students struggle with the most? Dosage abbreviations, giving medications to the wrong patient, the timing of the medication, the preparation of it, or communication about it?”

Hillary Gamblin:

We’ll give you a couple of seconds to answer that. And if you’re curious, there’s actually a link to an article in the chat that breaks down all the studies of how those types of errors is distributed.

Hillary Gamblin:

Okay, it looks like dosage is the highest. Marsha, would you have chosen that, as well?

Dr. Marsha Cannon:

I agree. I do teach dosage calculation, and I think that is something that students struggle with in the skills lab, as well as the clinical setting. I don’t know about other faculty, but we give dosage criticals every semester, and we consistently see that they do struggle with correct dosage calculation, so I do agree with that.

Hillary Gamblin:

Interesting, fantastic. Now, ultimately, the goal of today is to address all of your concerns. Now medication administration is a complex problem, and by no means, can we solve it in a 45 minute webinar. But we’re hoping by the end of this workshop, we’ll provide all of our participants with some ideas of how to better prepare their nursing students for clinical practice, especially when it comes to medication administration.

Hillary Gamblin:

Now we’ve covered all the technical details, learned a bit about your concerns, and outlined our goal, let’s get started. Marsha, I wanted to start off today by having you share one of your unique assignments.

Hillary Gamblin:

As we know, communication for new nurses is another common problem. And you found a really fantastic assignment that pairs these two challenges, communication and medication. Can you tell us about the pharmacology course that you are teaching right now, and the assignment that you’ve given your students?

Dr. Marsha Cannon:

Yes, we teach pharmacology in our fundamentals course. This is the first semester of our [inaudible 00:04:37]. And I have found, through the years, that students have a really struggle with communicating with patients, especially when it is about medication.

Dr. Marsha Cannon:

This year, for the first time, I’m actually having students develop a pharmacologic commercial, and I’ve paired the students up, and assigned them a medication. I’ve given them creative license with this commercial, as long as they include pertinent information, such as side effects of the medication, while the patient’s getting the medication, things to report those kinds of things.

Dr. Marsha Cannon:

They can do a PowerPoint, a skit, it doesn’t matter, but they actually are going to develop and create, and record and play, or whatever, but they’re going to record this commercial through GoReact. Then they’re going to submit it, and I will grade it.

Dr. Marsha Cannon:

I am going to allow other students, because one good thing about GoReact is, I can allow other students to view their commercials, without seeing my comments. So I’m going to go in and make comments on the students’ commercials, but then I’m actually going to allow other students to review all the commercials.

Dr. Marsha Cannon:

We’ll see how it goes. It’s a little different, but I just want them to be able to learn to talk about medications, and kind of figure out what’s important to tell the patient.

Hillary Gamblin:

I love the idea. I think it’s fantastic. Before you do the final checkoff for med administration, are there any other assignments or techniques or resources you use to help your students be better prepared?

Dr. Marsha Cannon:

Well, one thing in the fundamentals course in pharmacology, we want the students to understand how important medication administration is. It’s not just giving a pill. There’s a lot that goes into medication administration and medication safety.

Dr. Marsha Cannon:

So I actually had the students watch a YouTube about a nurse at Vanderbilt who went around those medication administration rights, and administered the wrong medication to a patient, and the patient subsequently died. And she is actually being charged with reckless homicide.

Dr. Marsha Cannon:

So I want that to really hit home with them how important medication administration is. We talk about their feelings about that, and the importance.

Dr. Marsha Cannon:

We also want to make sure that the students practice, so we have them practice before the medication administration setup times. We go in, of course, and help them if they have any questions.

Dr. Marsha Cannon:

I also have them research case studies about medication errors. We talk about that, and identify how the medication error could have been prevented, as far as the responsibilities of the nurse, what the nurse could have done to actually have prevented that medication error. So it makes them look at the importance of medication, and medication rights, and how important those rights are, and how they have to do those every time they give a medication

Hillary Gamblin:

A sobering way of starting, I like that. It really hits home. Now I know that the people that are participating in this webinar also have their own brilliant ideas, techniques, assignments, resources, when it comes to medication administration.

Hillary Gamblin:

We’re actually going to pause for a minute, so our participants can share their own ideas in the chat. So whether it’s a link, a few words, a few sentences, just take the next minute to submit a comment that shares what you do to help better prepare your students for medication administration.

Hillary Gamblin:

We’re actually going to come back and review a couple towards the end, but we’re going to collect everything that has been said in the chat, and we’re going to put it into a document that we’re going to send with you in the after e-mail, so you have everybody’s ideas there as a resource. So please share your brilliant ideas, so everybody else can learn and use them as well.

Hillary Gamblin:

Now, Marcia, you mentioned how your students shared their video, the pharmacology assignment, using GoReact. GoReact is a video-based assignment and assessment software, and it’s actually the key to another strategy for conducting and preparing your students. How does your program use video for medication administration checkoffs?

Dr. Marsha Cannon:

Okay, and I’ll be honest. We have, we use GoReact now for all of our skills validation, except for vital signs. And we actually started this. This is our third year of using GoReact.

Dr. Marsha Cannon:

We kind of tweak it a little bit as far as, every year, we find things we want to change a little bit. But as far as medication menstruation, the students select a partner, because you have to have someone video you as your performance skill.

Dr. Marsha Cannon:

So the student selects a partner, and that partner will video. I want to show you a video in just a moment, of one of our former students, who actually did a medication checkoff.

Dr. Marsha Cannon:

But we encourage the students to practice videoing this step, because there are certain things we require. We require them to pan around the room before the video actually starts, so that we can make sure there are no aids, or anything like that, they don’t have anything posted on the walls.

Dr. Marsha Cannon:

We have them get a close shot, like they’re drawing up a medication, a board medication. They have to get up close, so that we can make sure that they have an accurate dosage.

Dr. Marsha Cannon:

After they video the [inaudible 00:10:04], then they will upload it to GoReact. Then we’re actually were able to go in there and grade the skill, based on our rubric.

Hillary Gamblin:

I like how you’re mentioning that these students need to maybe practice to, when to zoom in, to show the dosage, and another thing that we, actually, I was thinking about when you were talking about that is, a video software that allows for multiple cameras to record simultaneously, like GoReact, it can record nursing students, entering medical information for a patient during a med administration checkoff.

Hillary Gamblin:

Or you can even simply create a video assignment. The student can record themselves practicing a task in an EHR system, explain what they’re doing as they do it, and then later, the instructor can provide feedback. As a lot of mistakes with med administration happen in an EHR system, a video assignment like that could really help address that issue.

Hillary Gamblin:

Oh, so thank you for sharing, that’s how you use it. What have been the benefits of using a video software to record med administration checkoffs?

Dr. Marsha Cannon:

Well, I think it’s beneficial to the faculty and students as well. I would say, as far as faculty, it helps with time management, or just flexibility. Because traditionally, we would go to the skills lab for hours at a time, and watch students over and over and over, as they would come to the skills lab.

Dr. Marsha Cannon:

Well, now I can actually sit at my computer, between class or at lunch, or even at home, if I want to, and I can grade the video. So I think it helps with time management, with just flexibility, and just being more efficient.

Dr. Marsha Cannon:

I think one of my colleagues actually wanted to study for her dissertation. She found out that it really did help with time management, that we found that there was a significant decrease in time.

Dr. Marsha Cannon:

Because the good thing about GoReact, the videos is, I can speed them up if I want to, or if I need to slow them down. So there’s a lot of things I can do, to help with my time management. But I would say flexibility and time management is real, and just the convenience of being able to just sit down.

Dr. Marsha Cannon:

And I’ll be honest, it was hard for me. I had a buy-in. It was very difficult for me, because I’m used to being in the lab. For someone who’s been in education for almost 30 years, it was a hard change for me, but I’ll be honest. I would not want to go back to a traditional skills validation. I love GoReact.

Dr. Marsha Cannon:

I was just talking to Alexa, it was hard for me, but I really do like it. Now as far as the students, how are things beneficial? I think there’s probably a little bit less stress when you have a fellow classmate or a peer video you, instead of a intimidating instructor standing over you.

Dr. Marsha Cannon:

Also, what I like about GoReact, as well, is that the students can go back and do the video after I’ve [inaudible 00:13:12], and gone through the rubric, and grading, and I then can make a comment on the video. I can stop it, and I can comment if a student is doing something incorrectly. I can actually make a comment, and it will mark it on the video, at that point.

Dr. Marsha Cannon:

Or if I wanted to make it on something positive, I do positive, as well, and it will mark it on that video. So they could come back and watch the video, and see that maybe they didn’t mark the top of the vine, or the angle of the syringe wasn’t correct. So I think that constructive feedback is really important for them to understand, what they did correct, and what they did incorrectly.

Hillary Gamblin:

Yeah. Seeing yourself on video perform a skill really helps with reflection.

Dr. Marsha Cannon:

Yeah, it does.

Hillary Gamblin:

It does.

Dr. Marsha Cannon:

Especially if you have someone is not successful, and they have to come back. I really think it’s good that it’s objective.

Dr. Marsha Cannon:

I had a student almost 20 years ago, who, still today, tells me that … I mean, I failed him on a scale. He still tells me today that he did not break stability, but he did.

Dr. Marsha Cannon:

Now if we’d had that video, then I could say, “Okay, look right here. You broke stability.”

Dr. Marsha Cannon:

I just think it’s really good to have that objective method of evaluation, especially if you’re going to have someone who’s not going to be successful in the course, or whatever. I just think the objectivity is really great, as well.

Hillary Gamblin:

True. And to what you were speaking about earlier, again and again, when I chat with nursing programs that are using GoReact, they always mentioned how much time they’re saving for skills checkoff.

Hillary Gamblin:

On average, I’d say they tell me it’s a third of the time or half of the time that normally took them beforehand. But speed itself isn’t a virtue. So even though GoReact speeds up the process of skill checkoffs, what about the quality of those assessments?

Dr. Marsha Cannon:

Well, I do think that using the video, and I was going to show you the video just in just a moment, but it allows me to really thoroughly review the video. As I said, you can slow it down. I can pause it if I need to.

Dr. Marsha Cannon:

If I’m unsure about something, I can even rewind it and look at something again, if I’m sure if a student did something correctly or not. So I think it makes it more consistent.

Dr. Marsha Cannon:

I don’t miss things, like maybe I would have, in just a face to face traditional skills validation. I can actually really look at things really closely. Sometimes, it’s to the student’s benefit. I mean, I thought they did something incorrectly, and they didn’t.

Dr. Marsha Cannon:

I just think that it allows me to be more consistent. It allows me to really look at their video, and determine if they are, were successful or not.

Dr. Marsha Cannon:

I think right now I actually want to show the video, and I have a student that, as I said, she’s actually one of our second level students right now. But she gave me permission to show her video.

Dr. Marsha Cannon:

So we’re going to try to show her … Well, just a moment. If you will hold on just a second, guys.

Dr. Marsha Cannon:

(silence)

Hillary Gamblin:

While Marcia is finding that out, something that we were brainstorming for this, that I really love this point, that it can help, a video can help better identify errors in checkoffs.

Hillary Gamblin:

It reminded me of a conversation I actually had with two of her colleagues over a year ago. I wrote a case study for UWA’s nursing program. And the professor told me this amazing statistic, I’ll tell you after, but …

Dr. Marsha Cannon:

Okay. Let’s see if we can see this [inaudible 00:17:15] As I said, we had them pan around.

Video:

[inaudible 00:17:21].

Dr. Marsha Cannon:

You see, I can move it forward.

Video:

[inaudible 00:17:39].

Dr. Marsha Cannon:

You can pause it. If I were wanting to look at something, I could pause it. I can slow it down. So I think it’s just really good. As I said, we can really watch as they go through.

Dr. Marsha Cannon:

There are areas where you can speed it up, you can slow it down. Also, what you do as they go through this, we just go down the rubric. It’s really convenient, because you go down as they’re doing something, and you either mark Satisfactory or Unsatisfactory.

Dr. Marsha Cannon:

If I make a comment, then the student can read the comment. Like I said, it just really allows me, in real time, to look at something. It allows me to really focus on things to review, to rewind. As I said, the student can go in afterwards, and just read the comments.

Hillary Gamblin:

Thank you for sharing that. I love those videos.

Dr. Marsha Cannon:

Well, I think a really important thing for the student is, that’s just it. It makes you do a really good job. I have students that struggle, so I think, going through and really looking at their comments, and being able to view the video, really helps them.

Hillary Gamblin:

Perfect. Thank you. As I was saying, while you were looking for that video, I interviewed some of your colleagues at UWA, and Dara Murray told me this really striking observation, about how video helps you really notice all the errors.

Hillary Gamblin:

She was saying that before using GoReact, UWA’s first time pass rate for IV insertion checkoffs was 89%. And then, the first semester using GoReact, the pass rate went down to 51. Why?

Hillary Gamblin:

Because GoReact allowed UWA’s faculty to rewind and pause, slow down during the skill checkoffs. They were catching all the errors that they were missing before in a traditional live skill checkoff.

Hillary Gamblin:

According to Professor Murray, GoReact gave them a more accurate representation of what their students can do. As we’re discussing how to better prepare nursing students for clinical practice, the benefit of using video, whether it’s GoReact or some other software, seems like a great place to start to make sure you’re catching all those errors. And you’re really seeing what your students can do.

Dr. Marsha Cannon:

I agree. And I think it’s really important that they see. It’s important that we see. Because, as I say, sometimes, when they are in the skills checkoff, they don’t realize they didn’t wipe off the top.

Dr. Marsha Cannon:

Or they didn’t realize things it’s really important, I think, for them to realize. So yes, we catch a lot of errors. And the students will see those errors, as well.

Hillary Gamblin:

Yes, that’s very true. Now, besides using video for skill checkoffs, I know there are lots of wonderful to help better prepare nursing students for medication administration.

Hillary Gamblin:

So we’ve actually pulled a few of your ideas that you submitted in the chat. One is have students make a pamphlet to be used for teaching the client?

Dr. Marsha Cannon:

Yeah, I think I’m going to do that next year, I kind of saw that. I liked the video, and I think I like the pamphlet too. I love that.

Hillary Gamblin:

Another one is a [inaudible 00:21:10] and flash card, mix and match, generic and trade names. Oh, all those names sounds so similar. That would be a hard game.

Hillary Gamblin:

Another person said, “We have medication workshops that students participate in, going through all the steps of the med administration. It sounds like you do something similar with your students.” And then, there’s a separate math course to teach dosage calculations.

Dr. Marsha Cannon:

I do.

Hillary Gamblin:

I was actually reading some scholarly articles, and they were suggesting that, maybe a math course, so that actually makes a lot of sense. I think that is just one of the four, but I know that there are a ton more. So thank you for submitting the ideas.

Hillary Gamblin:

Like I mentioned, we’re going to collect all of these ideas and resources, and put them in a document, and send it to you in the follow-up email, so you guys can peruse and find fantastic new approaches to teaching your students.

Hillary Gamblin:

Now, I’m sure the last 20-25 minutes has sparked some ideas and questions for those participating today. So we’re actually going to take the next 10 to 15 minutes to do a live Q&A.

Hillary Gamblin:

Again, it’s not too late. You can submit a question for the Q&A, to the tab just below the video feed. My colleagues have been monitoring your questions, and selected a few that we can ask.

Hillary Gamblin:

Question number one is, “I always insist the students tell me about the patient, and tell me why the patient is on the medication, and its side effects. Is there a shorter way to get that information, and know the student is prepared without taking so long?”

Dr. Marsha Cannon:

I don’t think so, but I think that’s one of the most important things, and I said, that’s where we have found that students are struggling with. Part of it, I think, is just the communication part, but I don’t think there is a shorter way.

Dr. Marsha Cannon:

I think they have to understand what’s going on with the patient, and the major side effects and everything. So I don’t think there really is that I can think of a shorter way of doing that. Maybe someone else in the chat might have a good idea.

Hillary Gamblin:

Okay. Yes. Maybe there is a one in the chat. We’ll actually go on to the next question.

Hillary Gamblin:

It says, “Students seem to miss the nursing implications when looking at the med, I talk about it, provide illustrations and activities we do, and they still seem to not get the level of importance. Any ideas to help with this?”

Dr. Marsha Cannon:

No. Again, and then, maybe, it’s sometimes the costs are so many nursing implications, that I think it’s difficult sometimes for the students to pick out the most important things. When you have 20 different things listed, I think sometimes it’s hard for the student to pick out maybe the top four or five.

Dr. Marsha Cannon:

But I do think that they have to understand that safety is a really big thing. So I would say anything has to do with safety, such as checking, of course, a blood pressure before giving antihypertensive, or checking lab work. I think that’s one of the big things, is just focusing on safety.

Hillary Gamblin:

Perfect. The third question, “Do you use the textbook or simulation when you teach dosage calculation? Which is more effective, in your opinion?”

Dr. Marsha Cannon:

I do a combination. We do have the textbook and they do have chapters in the textbook, but then we do a simulation. We do dosage problems in class. I have videos, actually, that I have on Blackboard, our learning management system for them, as I go through dosage calculation.

Dr. Marsha Cannon:

A lot of times, I will actually break them up into groups. Now, we can’t do it this year, and we’re trying to minimize contact. A lot of times, we’ll actually break them up into groups and give them patient’s areas, and have them where they have to calculate a dosage, and then look at lab work and see, again, if they can give, administer that medication. So it’s actually a combination of the two.

Dr. Marsha Cannon:

We also, honestly, on every, about all of our module exams, we put dosage calculation questions. So they start, even in our fundamentals or adult channels, they’re going to get dosage on every test.

Hillary Gamblin:

Start early.

Dr. Marsha Cannon:

Yeah.

Hillary Gamblin:

“Any ideas on how to simulate looking through a patient’s chart to look up pertinent lab values and vital signs? I find students struggle to understand the right assessment part.”

Dr. Marsha Cannon:

We do. We are trying to incorporate more things like unfolding case studies. We’re moving away from just lecture. We’ve moved away from that, but we’re more or less developing our content based on unfolding case studies.

Dr. Marsha Cannon:

We also use EHR in our simulation labs, so we do require the students to look through the charts, through that, as well. But a lot of it’s through things we give them in the class

Hillary Gamblin:

That’s so important, that you have them actually work in an EHR.

Dr. Marsha Cannon:

Right.

Hillary Gamblin:

Yeah, fantastic. Well, those are just some of the questions right now. I think we’ve answered everything, yes.

Hillary Gamblin:

Now, thank you to everybody that submitted questions. Your questions for these workshops are invaluable resources, and they make this whole process more collaborative. So we appreciate you doing that.

Hillary Gamblin:

Now, before we end, I always like to have our presenters give us three takeaways from the workshop. Is there something that they could tattoo into the brains of those that are participating as takeaways? What would they be? Marsha, what are your takeaways

Dr. Marsha Cannon:

Takeaways? Number one, and I think there’s a PowerPoint. Okay, takeaway number one is that, and I hate say it’s convenient for faculty, but it is convenient for faculty. I think the takeaway is, that it is great for time management, it is great for efficient time use.

Dr. Marsha Cannon:

Like I said, I was a hard sale on it, because I like that hands-on. But I think it’s just really, one of the main things that we have learned through this, is that as nursing faculty, we know we have so much today.

Dr. Marsha Cannon:

Instead of going up and spending hours and hours and the skills lab, I have found that it’s just as good just to view the videos, and actually I think it’s better, but time management’s a really big thing for faculty. Again, I think it’s wonderful for the students to be able to see those comments, and that constructive feedback.

Dr. Marsha Cannon:

But that’s amazing, to just effect, one, the medication administration feel. It may actually affect identifying the patient’s [inaudible 00:28:32], no matter what skill they do. So I just think, going back and seeing that constructive feedback, and like I said, criticism, at that point in time on the video, is really important for them to understand, again, what they may have done incorrectly, and so that they can correct it moving forward.

Dr. Marsha Cannon:

I just think that, as I said, I would not go back. I think the biggest takeaway, or one of the biggest takeaways, is that it’s objective. Again, when you get, if you’re doing a face to face feel about skills validation, sometimes that can be almost subjective.

Dr. Marsha Cannon:

This is very objective. It doesn’t matter. I mean, it’s there on tape, so they cannot agree with you, but it’s on tape. The student can’t say they did something if it’s right in front of them. I just think the fact that it’s very objective, especially when it’s high stakes, and you’re talking about not passing someone at a course, or maybe dismissing someone from your program, if they can’t do a skill, I think that the objective ability to do that is really wonderful.

Hillary Gamblin:

Thank you for those three takeaways. We’ve actually got another question that I missed, so sorry.

Hillary Gamblin:

I wanted to ask you before, so we can get everybody’s questions answered. It said, “Do you have any new recent ideas for teaching the weight-based dosage calculations for pediatrics?”

Dr. Marsha Cannon:

No, we are still doing kilograms. I think it’s been some controversy about whether to even teach BSA. We still teach BSA. I know that we’re moving away from that, but we still teach, I still teach BSA. I still teach milligrams per kilogram, even though they may not use it at, there’s always that chance that I may have to use that.

Dr. Marsha Cannon:

Yeah, we just do simulation. We did questions and questions and questions. We put in clinical scenarios. Again, we put in some apartment building case days, where things change, with a pediatric patient, but yes, I still teach milligrams, kilograms. I still teach BSA.

Hillary Gamblin:

Okay. Maybe there’s another, another answer that someone put in the chat, so make sure. I’m excited to see what everybody put in there.

Hillary Gamblin:

Marsha, thank you so much for your sharing your techniques and your experiences with us today. You did this voluntarily. So we thank you just taking your personal time to share this with your fellow nursing educators.

Hillary Gamblin:

We know this workshop will be particularly valuable for everybody, so we’re going to make a recording of this available as soon as possible. We’re going to send an e-mail with a link to the recording, a captioned version, and this resource that you have helped us create, by putting your suggestions and ideas in the chat. So watch for that in your inbox.

Hillary Gamblin:

That’s it for today. Thank you to our participants. Thank you to those working behind the scenes. Thank you to our guests, Dr. Marsha Cannon, and we will see you next time.