Evidence-based instruction strategies to improve Drug Calculation Skills

Abstract

Introduction: Medication errors and insecure practices harm healthcare systems worldwide. Each year, around 7,000 to 9,000 people in the United States die due to medication errors. (Tariq et al., 2023). There is no standardized method of educating healthcare providers on medication calculations.

Objectives: Identify evidence-based instruction strategies for drug calculation skills development and describe the strategies based on the research-based principles for smart teaching.

Methods: Through an evidence-based systematic review, we followed Whittemore and Knalf (2005) steps to assess the level and quality of evidence. The research process involved five steps: (1) defining the research question, (2) conducting a literature review, (3) gathering data from primary sources, (4) analyzing data, and (5) presenting findings. An electronic search of CINAHL, PubMed, and PsycINFO was conducted using the search terms “students,” “nursing,” “education,” “drug dosage calculations,” and “mathematics.” To qualify for inclusion in the review, the studies had to include nursing students or nurses, be written in English, and not restricted in regards of the country. Articles were not restricted to any one country because medication calculation errors related to patient safety remain a significant global issue. From 2014 to 2020, a total of 1793 articles were retrieved.

Results: For this review, we found 51 studies that met the eligibility criteria. Most of these studies reported results based on evidence levels III (23.5%) and V (41.2%). The majority of the information quality was from Level B (82.4%). Table 1 summarizes the level of evidence, quality of evidence, role of evidence in learning and teaching, and the research-based principles addressed in the studies reviewed. The major teaching strategies were early diagnostic assessments of students' knowledge, anxiety, and self-confidence; stimulate self-directed learning, and working on knowledge organization by scaffolding complex tasks, and being explicit about objectives and expectations. The use of e-learning has become increasingly popular since 2018.

Discussion: Utilizing technology can greatly benefit education by complementing in-class practice and providing students with opportunities for creative, autonomous, collaborative, and interactive learning. In recent years, there has been an increase in publications utilizing e-learning, smartphone apps, and web pages to improve drug calculation skills (for example: https://www.safemedicate.net/ and https://testandcalc.com/index.html). However, due to the low levels and quality of evidence, we recommend that future studies use research designs that produce higher levels of evidence. For instance, randomizing teaching methods per semester allows for a standardized approach to data gathering in nursing programs, which enhances consistency in monitoring student progress and evaluating teaching effectiveness. Implementing web-based software can also support effective research-based approaches. We recommend that teaching approaches address cognitive, motivational, and developmental goals to ensure student success. Future trends are adaptive web-based technology aiming at improving the learning of medication calculation skills (Ravik & Andresen, 2023).