الفهرس 
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Abstract
SUMMARY
Amedication error is defined as one or more preventable mistakes made during prescription, transcription, dispensing and administration of a medication, potentially leading to inappropriate or, in the worst case, unsafe medication use. Clinical administration of a medication is the final step in the medication process and a fundamental role in nursing practice. Clinical nurses spend as much as 40 percent of their time on the administration of medication. Thus nurses play vital roles in the detection, recording and reporting of medication-related events, discrepancies and errors. The level of medication knowledge and ability to apply this knowledge in monitoring medication usage contribute to a nurse’s ability to discern appropriate and inappropriate prescribing and administration (Heck et al., 2020).
Look-alike sound-alike (LASA) drugs increase the possibility of medication errors. Medical errors due to LASA medication names are responsible for thousands of deaths and millions of dollars in cost every year. Confusing similarities in the brand name and packaging of drugs represent one of the most common reasons for medication errors and are of concern worldwide. Indeed, many medical errors are attributed to similar features of the packages or to ambiguous names of medicines. LASA medication errors occur when a patient receives an incorrect medication because its name is spelled or sounds like another medication (Bryan et al., 2021).
Aim of the study
The current study aimed to evaluate the effect of applying educational program for nursing performance regarding safety infusion of look-alike sound-alike medication through the following:
• Assessing of nurse’s knowledge regarding safety infusion of look-alike sound-alike medication.
• Assessing of nurse’s practices regarding safety infusion of look-alike sound-alike medication.
• Assessing of nurse’s attitude regarding safety infusion of look-alike sound-alike medication.
• Developing and implementing an educational program about safety infusion of look-alike sound-alike medication.
• Assessing the effect of applying educational program on nurses’ performance regarding safety infusion of look-alike sound-alike medication.
Research Hypothesis:
The current study hypothesized that, the educational program has a positive effect on nursing performance regarding safety infusion of look-alike sound-alike medication.
Methodology
Research design:
A quasi experimental research design was followed to achieve the aim of the study.
Subjects & Setting:
Convenience samples of all available nurses (40) were working in intensive care units at Ain Shams University Hospitals (22 nurses at Neurosurgery ICU and 18 nurses at Emergency ICU). The nurses had different qualifications (diploma of nursing, technical institute of nursing, bachelor degree of nursing and master degree of nursing), different job categories, with different age and years of experience.
Tools for data collection:
Three tools for collecting data were used to achieve the purpose of the current study.
1- Medication Safety Assessment Questionnaire: This tool was adapted from NQF, from the Institute for Safe Medication Practices (ISMP, 2004; 2007; 2011), basaed on related literatures (Rash-Foanio, et al., 2017; Di Muzio et al., 2019; Jebaet al., 2020). It was used to assess the nurses’ knowledge regarding intravenous infusion of LASA medications (Appendix I). It included two parts:
Part 1: It was concerned about demographic data and characteristics of the nurses (age, qualification, job categories, nursing experience in intensive care units (years), intensive care training courses and training courses for LASA medications).
Part 2: It was used to assess the nurse’s knowledge regarding intravenous infusion of LASA.
2- Intravenous infusion of LASA medication observational checklist appendix II: This tool was adapted from (Hanarty, 2008), basaed on related literatures (Kane-Gill, et al., 2017; McCoy-Hill 2021). It was used to assess the actual nurses’ practices regarding safety infusion of LASA medication at intensive care units.
3- Nurses attitude regarding LASA safety measures appendix III: It was used to assess the nurse’s attitude regarding medications error reporting made by nurses, it was divided into two sections:
Section A: Nursing Staff Attitude Regarding Error Reporting; this tool was adapted from the Institute for Safe Medication Practices (ISMP, 2002), based on related literature (Santos, 2020). It was used to assess the nurse’s attitude regarding error reporting and safety administration at the intensive care units. This tool divided into two parts:
Part 1: It was used to assess the nurse’s attitude regarding the culture of reporting LASA medications errors made by nurses.
Part 2: It was used to assess the nurse’s attitude regarding intravenous infusion administration of LASA medications error reporting made by nurses which includes two scenarios;
Scenario one about nurse’s attitude toward errors in administration of a look-alike sound alike high alert medication name error made by nurses.
Scenario two about nurse’s attitude toward errors’ infusion rate and administration of wrong high alert medication dose).
Section B: - Nursing Staff Attitude Regarding Safety Measures Questionnaire: This tool was adapted from The University of Texas at Austin (2003 & 2006); it was used to assess the nurse’s attitude regarding working in a team work and safety climate at the intensive care units.
Results
The main result of the study revealed that:
• About 62.5%of the study subject was aged from 25 to < 30 years and the mean age was 26.37 ± 0.576. Female represented a higher percentage 62.5% of the studied subject. Concerning the educational level 35% of them were having Institute of nursing degree. Regarding positions 55% of them were charge nurses. Concerning the years of experience 40% of the study subjects were between 3 to 5 years. In relation to intensive care units training courses 55% of the study subjects were having courses.
• The percentage of study subjects with satisfactory level of total knowledge was 27.5% pre educational program increased to 65% post educational program. And the unsatisfactory level decreased from 72.5% pre educational program to 35% post educational program.
• The satisfactory level of total error reporting toward the infusion of LASA medications was increased from 25% of study subjects’ pre educational program to 55% post educational program. While, the unsatisfactory level of total error reporting toward the infusion of LASA medications was decreased from 75% of study subjects’ pre educational program to 45% post educational program.
• The satisfactory level of total safety strategies toward the infusion of LASA medications was increased from 52.5% of study subjects’ pre educational program to 63% post educational program. While, the unsatisfactory level of total error reporting toward the infusion of LASA medications was decreased from 47.5% of study subjects’ pre educational program to 37% post educational program.
• In relation to the percentage of satisfactory level of practices regarding total practices Intravenous infusion of LASA medications observational checklist, the satisfactory level was increased from 42.5% pre educational program to 73% post educational program. While, the unsatisfactory level pre educational program was decreased from 57.5% to 27% post educational program
• There was highly statistically significance relation pretest between total practices and total knowledge and culture surveys about error reporting. While, there was statistically significance relation pre educational program between total skill practices and total error reporting.
• There was highly statistically significance relation post educational program between total skill practices and total knowledge.
• There was highly statistically significance relation pre educational program between total practice and total knowledge and culture surveys about error reporting. While, there was highly statistically significance relation post educational program between total practice and total knowledge only.
• There was highly statistically significance relation pretest between total knowledge and intensive care units training courses. While, there was statistically significance relation pretest between total knowledge and level of education, position and training courses for infusion of look-alike sound-alike medications.
• There wasn’t any statistically relation between demographic data and total LASA Medications practice (pretest). while, there was a statistically relation posttest between total LASA Medications practice and training courses for infusion of look-alike sound-alike medications.
• There was highly statistically significance relation pretest and posttest between total and total knowledge.
Conclusion
The present study concluded that:
The study subjects had performance deficit regarding safety infusion of look- alike sound- alike medications, which were affected by the following; the total nurses’ knowledge regarding administration of LASA medications was unsatisfactory and the majority of the study subjects’ attitude regarding the culture of error reporting and safety strategies related to look- alike sound- alike medications was also unsatisfactory. This can be explained by the highly statistically significance relation pre educational program between total practice and total knowledge and culture surveys about error reporting. In addition to there was highly statistically significance relation post educational program between total practice and total knowledge.
Recommendations
Based on the previous results, the following recommendations are suggested:
1. Offer continuous intravenous infusion of high alert medication educational programs until nurses reach the point of competency in responding to a serious high alert medication error.
2. Nurses should receive ongoing information about high alert medication errors occurring within the hospital, error prone situations, and strategies to prevent such errors.
3. Create safe havens for error reporting. Encourage and reward error reporting so that changes can be made to correct the underlying causes.
4. The high alert medication order should be written clearly and complete containing patient name, medication name, metric doses or household measurement, for solution per ml, route, infusion rate, date of orders, and signatures.
5. Nurses should highlight critical mark sign on medication by standardized methods for labeling, packaging, and storing of high alert medications, separate storage of different strengths, and use of warning labels on different strengths of the same high alert medications to alert users to the potential for mix-ups
6. Write hospital protocols/guidelines, dosing scales, and/or checklists for high alert medications in Arabic and English procedure book to be readily accessible for physicians, pharmacists, and nurses, which are used when high alert medications are prescribed, dispensed, and administered.