To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified” Clay et al (2017).
RATIONALE: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. While the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students’ formal education may not prepare students adequately for this role.
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OBJECTIVES: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified.
METHODS: Mixed-methods observational study of graduating nursing (n=51) and medical students (n=93) who completed two “Room of Horrors” simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students’ written hazard descriptions. Fisher’s exact test was used to determine differences in frequency of hazards identified between groups.
RESULTS: Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73% vs. 2%, p<0.001), while nursing students noted that there was no order for the restraints (58.5% vs. 0%, p<0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous (10% individuals, p<0.0001). Nevertheless, teams of students missed many ICU-specific hazards: 54% failed to identify the presence of pressure ulcers, 85% did not notice high tidal volumes on the ventilator, and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis.
CONCLUSIONS: Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the ICU. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each other’s roles and responsibilities.
Clay, A.S., Chudgar, S.M., Turner, K.M., Vaughn, J., Knudsen, N.W., Farnan, J.M., Arora, V.M. and Molloy, M.A. (2017) How Well Prepared Are Medical and Nursing Students to Identify Common Hazards in the ICU? Annals of the American Thoracic Society. February 3rd. [Epub ahead of print].
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