practicing quality and safety in medication administration
TRANSCRIPT
fjieowajPracticing Quality and Safety in Medication Administration:
Comparing High-fidelity Simulation to an Escape Room Experience to
Evaluate Student Knowledge, Self- Efficacy, & Critical Thinking
Elise Thompson RN, PhD Colette Waddill DNP, RN, IBCLC, CNE,
CHSE
114th Annual Convention Concord, NC | September 23-24, 2021
®
• No conflicts of interest
• We do not endorse any type of product that may be listed in this presentation
• The pilot study was funded by the UNCW SON Corbett Charitable Trust
Learning Outcomes
1. Describe how to use escape rooms for medication administration.
2. Compare and contrast the use of an escape room versus traditional simulation.
3. Summarize benefits and challenges of using escape rooms in nursing education.
Polling Time!
Table Discussion
1. If you have used escape rooms, how have you used them?
2. If you have not used escape rooms, how do you envision using escape rooms in nursing education?
Discuss for 1-2 minutes. Large Group Discussion
®
• What professions?
• What are some of the benefits of escape rooms?
®
• Student Perceptions – Preparedness for Med Admin – Performance for Med Admin
• Critical Thinking – Mixed Reviews in literature
®
Learning Activity Comparison
High Fidelity Simulation
• Strategy to teach a wide variety of topics and can closely mimic the clinical environment.
• Students implement patient care interventions based on patient presentation.
Escape Room
• Solve puzzles and find clues in order to move to the next task.
®
• What has already been done?
• How do escape rooms work?
• Equipment
®
• Needs Assessment • Measurable Objectives • Simulation Format • Case to Provide Context • Fidelity • Facilitative Approach • Preparation Materials • Pre-brief • De-brief • Evaluation • Pilot Test
®
Scenario • The patient scenario should be based on course content and
objectives of the learning activity. • The scenario is important to provide relevance and realism to
the learning activity. • To care for their patient, they need a backstory and report
about what is going on with the patient now. • They also need to understand the goal of the learning activity
and how they will be able to progress through the scenario. • “There’s a locked box in the room. Your mission is to complete
®
Equipment • iPad • 2 Large Boxes • 2 Small Boxes • 4 Different Locks • Laminator • Velcro • Whiteboard Markers • Manikin: settings, script • Armbands, stethoscope, BP cuff, thermometer,
O2 sat monitor, urine specimen
®
• Openness breeds creativity
®
®
Arts & Crafts
®
• Include scenario
• Pre-work • Pre-brief • Scenario • De-brief
• Be prepared to adapt – COVID restrictions – Time elements
®
Results
Age Mean/ Range 20.29/ 19-22 Gender All Female Culture White: 22; Hispanic: 2
Previous ER Experience 23/24 Previous HFS Experience 21/24 Previous Healthcare Experience
11/24
Results Knowledge ER n=5 Post M=41.2 SD=7.190
> Pre M=36.6 SD=8.849 Knowledge HFS n=8 Post M=34 SD=14.323
< Pre M=37.88 SD=8.999 Self Efficacy ER n=5 Post M=52.8 SD=2.588
> Pre M=49.2 SD=3.421 Self Efficacy HFS n=8 Post M=50.13 SD=6.917
> Pre M=47.5 SD=5.855 Critical Thinking ER n=3 Post M=79 SD=11.79
> Pre M=78 SD=6.245 Critical Thinking HFS n=8 Post M=75.38 SD=8.052
= Pre M=75.38 SD=6.968
Paired t-test Results
*ER: Improvement shown in knowledge, self-efficacy, and critical thinking.
*HFS: Improvement shown in se lf-efficacy, no change in critical thinking, decline in knowledge.
*ER participants had higher scores for all pre - and post- tests except knowledge pre -tests upon comparison of groups.
*not statistically significant due to sample size
®
®
Pilot Study What did we learn? • Students reported enjoying both experiences
• Students reported learning from both experiences
• Initial results suggest ERs may provide equal or
better outcomes than HFS
completion rates
Pilot Study
What do we still want to know? • Is there a difference in ER or HFS experience for
knowledge, self-efficacy, and critical thinking related to safe medication administration?
• Are findings generalizable? – Possible multi-site study (increase diversity) – Include BSN and ADN students
• Are findings statistically significant? – Increase number of completed surveys
®
Benefits of Escape Room Experience • Can be used for a variety of learning needs
• Structured process guides students through recognizing and interpreting patient cues
• Best for novice or new to learning skill/concept
• Combine with simulation or other learning strategies
• Promotes teamwork and collaboration
critical thinking
®
Challenges of Escape Room Experience • Additional time to develop • Requires supplemental equipment
– Set-up and breakdown time – Training students on use – Cost of purchase, maintenance, replacement
®
– Learning skills – Practicing patient care – Reinforcing classroom concepts
• Incorporates visual, verbal, kinesthetic, logical, and social learning styles
®
®
References Adams, V., Burger, S., Crawford, K., & Setter, R. (2018). Can you escape? Creating an escape room to facilitate active
learning.
Avraham, R., Shor, V., Hurvitz, N., Shvartsur, R., & Kimhi, E. (2018). Transferability of medication administration simulation training to clinical settings. Teaching and Learning in Nursing, 13, 258-262. Doi:10.1016/j.teln.2018.07.004
Backhouse, A. & Malik, M. (2019). Escape into patient safety: bringing human factors to life for medical students. BMJ Open Quality,8, 1-4:e000548. doi:10.1136/bmjoq-2018-000548.
Berthod, F., Bouchoud, L., Grossrieder, F., Falaschi, L., Senhaji, S., & Bonnabry, P. (2019). Learning good manufacturing practices in an escape room: Validation of a new pedagogical tool. J Oncol Pharm Pract, 29:1078155219875504. doi:
10.1177/1078155219875504.
student self-confidence and clinical competence. International Journal of Nursing Education Scholarship, 7(1), 18.
Bourbonnais, F. F. & Caswell, W. (2014). Teaching successful medication administration today: More than just knowing your ‘rights’. Nurse Education in Practice, 14(4), 391-395. doi:10.1016/j.nepr.2014.03.003
Brown, N., Darby, W., & Coronel, H. (2019). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing, (30), 1-6.
Cheragi, M. A., Manocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.
®
References Friedrich, C., Teaford, H., Taubenheim A., Boland P., Sick B. (2019). Escaping the professional silo: an escape room
implemented in an interprofessional education curriculum. J Interprof Care, 33(5), p. 573-575. doi: 10.1080/13561820.2018.1538941. Epub 2018 Oct 26.
French, S. (2015). The unbelievably lucrative business of escape rooms. MarketWatch. Retrieved from https://www.marketwatch.com/story/the-weird-new-world-of-escape-room-businesses-2015-07-20?page=1
Gordon, S.K., Trovinger, S., DeLellis, T. (2019). Escape from the usual: Development and implementation of an 'escape room' activity to assess team dynamics. Curr Pharm Teach Learn. 11(8):818-824. doi: 10.1016/j.cptl.2019.04.013. Epub 2019 Apr 26.
INACSL Standards Committee (2016, December). INACSL standards of best practice: SimulationSM Simulation design. Clinical Simulation in Nursing, 12(S), S5-S12. http://dx.doi.org/10.1016/j.ecns.2016.09.005.
Kan, Y., Chang, C., Kao, C., Chen, C., Wu. C. (2019). Development of a short and universal learning self-efficacy scale for clinical skills. Plos One 14(1), e0209155. doi:10.1371/journal.pone.0209155
Kimhi, E., Reishtein, J. L., Cohen, M., Friger, M., Hurvitz, N., & Avraham, R. (2016). Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students. Nurse Educator, 41(1), E1–E4. doi: 10.1097/NNE.0000000000000194.
Kinio, A.E., Dufresne. L., Brandys, T., Jetty, P. (2019). Break out of the classroom: The use of escape rooms as an alternative teaching strategy in surgical education. Journal of Surgical Education, 76(1). https://doi.org/10.1016/j.jsurg.2018.06.030
Lama, A. V. (2018). Millennial leisure and tourism: The rise of escape rooms. Cuadernos de Turismo, 41, 743-746.
Lee, S. E. & Quinn, B. L. (2019). Incorporating medication administration safety in undergraduate nursing education: A literature review. Nursing Education Today, 72,77-83. doi:10.1016/j.nedt.2018.11.004
®
References Miller, S. (2015). The art of the escape room. Newsweek. Retrieved from http://www.newsweek.com/2015/05/01/art-escape-
room-323150
Mok, H. T., So, C. F., & Chung, J. W. Y. (2016). Effectiveness of high-fidelity patient simulation
in teaching clinical reasoning skills. Clinical Simulation in Nursing, 12(10), 453-467. http://
dx.doi.org/10.1016/j.ecns.2016.06.003.
Tariq, R. A. & Scherbak, Y. (2019). Medication Errors. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519065/
Zhang, X.C., Diemer, G., Lee, H., Jaffe, R., Papanagnou, D. (2019). Finding the ‘QR’ to patient safety: Applying gamification to incorporate patient safety priorities through a simulated ‘Escape Room’ experience. Cureus, 11(2): e4014. DOI 10.7759/cureus.4014.
Disclosures
High Fidelity Simulation
Learning Activity Comparison
Escape Room Design: Best Practices
Scenario
Equipment
Brainstorming
Collaboration
Implications for Nursing Education
114th Annual Convention Concord, NC | September 23-24, 2021
®
• No conflicts of interest
• We do not endorse any type of product that may be listed in this presentation
• The pilot study was funded by the UNCW SON Corbett Charitable Trust
Learning Outcomes
1. Describe how to use escape rooms for medication administration.
2. Compare and contrast the use of an escape room versus traditional simulation.
3. Summarize benefits and challenges of using escape rooms in nursing education.
Polling Time!
Table Discussion
1. If you have used escape rooms, how have you used them?
2. If you have not used escape rooms, how do you envision using escape rooms in nursing education?
Discuss for 1-2 minutes. Large Group Discussion
®
• What professions?
• What are some of the benefits of escape rooms?
®
• Student Perceptions – Preparedness for Med Admin – Performance for Med Admin
• Critical Thinking – Mixed Reviews in literature
®
Learning Activity Comparison
High Fidelity Simulation
• Strategy to teach a wide variety of topics and can closely mimic the clinical environment.
• Students implement patient care interventions based on patient presentation.
Escape Room
• Solve puzzles and find clues in order to move to the next task.
®
• What has already been done?
• How do escape rooms work?
• Equipment
®
• Needs Assessment • Measurable Objectives • Simulation Format • Case to Provide Context • Fidelity • Facilitative Approach • Preparation Materials • Pre-brief • De-brief • Evaluation • Pilot Test
®
Scenario • The patient scenario should be based on course content and
objectives of the learning activity. • The scenario is important to provide relevance and realism to
the learning activity. • To care for their patient, they need a backstory and report
about what is going on with the patient now. • They also need to understand the goal of the learning activity
and how they will be able to progress through the scenario. • “There’s a locked box in the room. Your mission is to complete
®
Equipment • iPad • 2 Large Boxes • 2 Small Boxes • 4 Different Locks • Laminator • Velcro • Whiteboard Markers • Manikin: settings, script • Armbands, stethoscope, BP cuff, thermometer,
O2 sat monitor, urine specimen
®
• Openness breeds creativity
®
®
Arts & Crafts
®
• Include scenario
• Pre-work • Pre-brief • Scenario • De-brief
• Be prepared to adapt – COVID restrictions – Time elements
®
Results
Age Mean/ Range 20.29/ 19-22 Gender All Female Culture White: 22; Hispanic: 2
Previous ER Experience 23/24 Previous HFS Experience 21/24 Previous Healthcare Experience
11/24
Results Knowledge ER n=5 Post M=41.2 SD=7.190
> Pre M=36.6 SD=8.849 Knowledge HFS n=8 Post M=34 SD=14.323
< Pre M=37.88 SD=8.999 Self Efficacy ER n=5 Post M=52.8 SD=2.588
> Pre M=49.2 SD=3.421 Self Efficacy HFS n=8 Post M=50.13 SD=6.917
> Pre M=47.5 SD=5.855 Critical Thinking ER n=3 Post M=79 SD=11.79
> Pre M=78 SD=6.245 Critical Thinking HFS n=8 Post M=75.38 SD=8.052
= Pre M=75.38 SD=6.968
Paired t-test Results
*ER: Improvement shown in knowledge, self-efficacy, and critical thinking.
*HFS: Improvement shown in se lf-efficacy, no change in critical thinking, decline in knowledge.
*ER participants had higher scores for all pre - and post- tests except knowledge pre -tests upon comparison of groups.
*not statistically significant due to sample size
®
®
Pilot Study What did we learn? • Students reported enjoying both experiences
• Students reported learning from both experiences
• Initial results suggest ERs may provide equal or
better outcomes than HFS
completion rates
Pilot Study
What do we still want to know? • Is there a difference in ER or HFS experience for
knowledge, self-efficacy, and critical thinking related to safe medication administration?
• Are findings generalizable? – Possible multi-site study (increase diversity) – Include BSN and ADN students
• Are findings statistically significant? – Increase number of completed surveys
®
Benefits of Escape Room Experience • Can be used for a variety of learning needs
• Structured process guides students through recognizing and interpreting patient cues
• Best for novice or new to learning skill/concept
• Combine with simulation or other learning strategies
• Promotes teamwork and collaboration
critical thinking
®
Challenges of Escape Room Experience • Additional time to develop • Requires supplemental equipment
– Set-up and breakdown time – Training students on use – Cost of purchase, maintenance, replacement
®
– Learning skills – Practicing patient care – Reinforcing classroom concepts
• Incorporates visual, verbal, kinesthetic, logical, and social learning styles
®
®
References Adams, V., Burger, S., Crawford, K., & Setter, R. (2018). Can you escape? Creating an escape room to facilitate active
learning.
Avraham, R., Shor, V., Hurvitz, N., Shvartsur, R., & Kimhi, E. (2018). Transferability of medication administration simulation training to clinical settings. Teaching and Learning in Nursing, 13, 258-262. Doi:10.1016/j.teln.2018.07.004
Backhouse, A. & Malik, M. (2019). Escape into patient safety: bringing human factors to life for medical students. BMJ Open Quality,8, 1-4:e000548. doi:10.1136/bmjoq-2018-000548.
Berthod, F., Bouchoud, L., Grossrieder, F., Falaschi, L., Senhaji, S., & Bonnabry, P. (2019). Learning good manufacturing practices in an escape room: Validation of a new pedagogical tool. J Oncol Pharm Pract, 29:1078155219875504. doi:
10.1177/1078155219875504.
student self-confidence and clinical competence. International Journal of Nursing Education Scholarship, 7(1), 18.
Bourbonnais, F. F. & Caswell, W. (2014). Teaching successful medication administration today: More than just knowing your ‘rights’. Nurse Education in Practice, 14(4), 391-395. doi:10.1016/j.nepr.2014.03.003
Brown, N., Darby, W., & Coronel, H. (2019). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing, (30), 1-6.
Cheragi, M. A., Manocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.
®
References Friedrich, C., Teaford, H., Taubenheim A., Boland P., Sick B. (2019). Escaping the professional silo: an escape room
implemented in an interprofessional education curriculum. J Interprof Care, 33(5), p. 573-575. doi: 10.1080/13561820.2018.1538941. Epub 2018 Oct 26.
French, S. (2015). The unbelievably lucrative business of escape rooms. MarketWatch. Retrieved from https://www.marketwatch.com/story/the-weird-new-world-of-escape-room-businesses-2015-07-20?page=1
Gordon, S.K., Trovinger, S., DeLellis, T. (2019). Escape from the usual: Development and implementation of an 'escape room' activity to assess team dynamics. Curr Pharm Teach Learn. 11(8):818-824. doi: 10.1016/j.cptl.2019.04.013. Epub 2019 Apr 26.
INACSL Standards Committee (2016, December). INACSL standards of best practice: SimulationSM Simulation design. Clinical Simulation in Nursing, 12(S), S5-S12. http://dx.doi.org/10.1016/j.ecns.2016.09.005.
Kan, Y., Chang, C., Kao, C., Chen, C., Wu. C. (2019). Development of a short and universal learning self-efficacy scale for clinical skills. Plos One 14(1), e0209155. doi:10.1371/journal.pone.0209155
Kimhi, E., Reishtein, J. L., Cohen, M., Friger, M., Hurvitz, N., & Avraham, R. (2016). Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students. Nurse Educator, 41(1), E1–E4. doi: 10.1097/NNE.0000000000000194.
Kinio, A.E., Dufresne. L., Brandys, T., Jetty, P. (2019). Break out of the classroom: The use of escape rooms as an alternative teaching strategy in surgical education. Journal of Surgical Education, 76(1). https://doi.org/10.1016/j.jsurg.2018.06.030
Lama, A. V. (2018). Millennial leisure and tourism: The rise of escape rooms. Cuadernos de Turismo, 41, 743-746.
Lee, S. E. & Quinn, B. L. (2019). Incorporating medication administration safety in undergraduate nursing education: A literature review. Nursing Education Today, 72,77-83. doi:10.1016/j.nedt.2018.11.004
®
References Miller, S. (2015). The art of the escape room. Newsweek. Retrieved from http://www.newsweek.com/2015/05/01/art-escape-
room-323150
Mok, H. T., So, C. F., & Chung, J. W. Y. (2016). Effectiveness of high-fidelity patient simulation
in teaching clinical reasoning skills. Clinical Simulation in Nursing, 12(10), 453-467. http://
dx.doi.org/10.1016/j.ecns.2016.06.003.
Tariq, R. A. & Scherbak, Y. (2019). Medication Errors. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519065/
Zhang, X.C., Diemer, G., Lee, H., Jaffe, R., Papanagnou, D. (2019). Finding the ‘QR’ to patient safety: Applying gamification to incorporate patient safety priorities through a simulated ‘Escape Room’ experience. Cureus, 11(2): e4014. DOI 10.7759/cureus.4014.
Disclosures
High Fidelity Simulation
Learning Activity Comparison
Escape Room Design: Best Practices
Scenario
Equipment
Brainstorming
Collaboration
Implications for Nursing Education