الفهرس 
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Abstract
H
igh-alertmedications are defined as medications that are the most likely to cause significant patient harm, even when used correctly. These medications are more likely to be associated with harm due to issues such as narrow therapeutic ranges (increasing the potential for a prescribing error), and also cause more significant harm when an error does occur because of the significant nature of the potential adverse effects such as bleeding or hypoglycemia. Many of these medications are also more likely to be associated with dosing errors, due to issues such as the need to frequently calculated using based on weight. The in statute of safe medication practices identified the number of drug categories and specific medications identified as high alert varies with the agency or organization. All relevant organizations identify four specific high alert drug classes’ anticoagulants, sedatives, insulin, and opioid because they’re frequently linked to potentially harmful out comes (Institute of Safe Practice Medication, 2014)
Cardiac nurses are responsible for preparing and administering potent drugs that affects the patients cardiovascular functions, most of this drug are high alert medications. Each nurse should be aware of indication, action, contraindication, adverse effects and interactions of drug. Errors involving high-alert medications can cause significant patient harm. Exposure to high-alert medications on a daily basis can lead to complacency, and thus effective strategies for safely using high-alert medications are required. A list of high-alert medications is required by The Joint Commission for each in situation along with effective risk-reduction strategies to mitigate possible errors (Nair, 2011).
Aim of the study:
This study aimed to assess nurses’ performance regarding administration of high alert medication in coronary care unit.
Research questions
1- What are nurse’s levels of knowledge regarding administration of high alert medication in CCU?
2- What are nurses’ practices and attitude regarding administration of high alert medication in CCU?
3- What are common errors regarding administration of high alert mediation in CCU?
Research design
A descriptive explanatory design was used to achieve the aim this study.
Setting:
The study was conducted at coronary care unit and post cardiothoracic intensive care unit that are affiliated to Ain Shams University hospital.
Subjects:
As ample of convenience of (32) nurses were working in coronary care unit at Ain Shams University Hospital which include the coronary care unit (17), the post cardiothoracic intensive care unit (15) and the nurses had different qualifications (diploma of nursing, technical institute of nursing, and bachelor degree of nursing, different job categories, with different age group, years of experiences and training courses).
Tools of data collection
Data for this study were collect using the following tools:
1-Nursesself-administered questionnaire:
It was developed by researcher based of the current and related literatures (Nettina, 2014, American Osteopathic Association, 2014, Zhu & Weingart, 2014, Joint Commission International Accreditation, 2015 & Taylor, 2015), it was carried to assess nurses’ knowledge related to high alert medication administration it include the following parts.
Part1: It was concerned with demographic data and characteristic of the nurses under study in addition to previous training courses and availability of manual guide it included (Age, qualifications, and years of experiences, training course about high alert medication, availability of manual guide and high alert medication list).
Part 2: it used to assess nurses’ knowledge about high alert medication admiration regarding general pharmacology, prescription, medication dose calculation, medication administration, documentation, monitoring, storage and patient education.
2-Nurses performance Observational checklists
It was used to assess the nurse’s practices regarding high alert medication administration it was adopted from (Perry & Potter, 2013 and Dewit & O’Neill, 2014), and modified by researcher. The observational checklist consists of (3) main items covering all the procedures which included:
• Nurses practices regarding preparation, administration (during procedure) and (post procedure), of high alert medication administration, in addition to storage observational checklist.
3-Nurses attitude questionnaire sheet toward high alert medication administration
It was developed by their searcher based on current related literatures. It was used to assess nurses’ attitude regarding high alert medication administration it was guided by (Muzio, 2014 & Johnson, 2012). It included (11) structured sentences. Included importance training about usage of high alert medication, presence of policy, patient confidentiality, medication error reporting, patient education, using of informatics technology to reduce medication error, nurse’s responsibility to medication administration. Participants were asked to respond a 5-point Likert scale (agree, strongly agree no opinion, strongly disagree, disagree).
Results
The main result of the study revealed that:
As regards to nurses demographic characteristic; the mean age was 31.57±4.65 years, concerning the academic qualification, it was found that 40.6% of nurses was carrying certificate of diploma nurse. As regards to the mean years of experience among nurses was 6.75±3.41, In relation to attending training courses, 59.4% of them attended high alert medication course. 50% of nurses under study had manual guide and list of high alert medication.
In relation to nurses total nurses knowledge of high alert medication, nurses under the study had unsatisfactory level of knowledge related to high alert medication calculation and measurement, medication preparation and patient education 100.0%, 93.8%, 71.9% respectively. Also, the result showed that 62.5% of nurse under study got total unsatisfactory level regarding high alert medication.
Regarding total nurse’s scores of practice about high alert medication, the result showed that all nurses 100% under study got unsatisfactory scores regarding documentation error of high alert medication and patient education. Meanwhile 78.1% nurses got total unsatisfactory level of practices regarding high alert medication administration.
The result revealed that 53.1% of nurses under study had positive attitude toward administration of high alert medication.
The result of current study reveal that, the percent age of high alert medication errors among the studied nurses (incorrect practice) according to descending order were, wrong rate of infusion, omission dose, wrong time, wrong dose 68.7%, 53.1%, 50%, & 37.5% respectively.
There were statistically significant relationships between total satisfactory score of knowledge & practice among nurses under this study, their age and years of experience. Moreover, there were statistically significant relationship between total satisfactory level of knowledge among nurses and their practice at P<0.001*, .001*<, 0.023*, 0.002* respectively.
Conclusion
Based on finding of the present study, it can be concluded that about two thirds of nurses under study had total unsatisfactory level of knowledge regarding administration of high alert medication (this result answered the first question). While more than two thirds of the nurses under study got total unsatisfactory level of practice, while half of them had positive attitude toward administration of high alert medication (this answered the second question). The most common errors observed among the nurses under study are wrong rate of infusion, omission dose, wrong time and wrong dose. Moreover there are statistically significant relationship between total satisfactory score of knowledge, their practice and attitude.
Recommendation
Based on findings of the present study, the followings are recommended:
1. Offer updated in- service training program for nurses in coronary care unit regarding high alert medication preparation, administration, storage ,calculation and documentation
2. The authorized nurses should developed and utilized medication competency tool for medication administration periodically in order to maintain competency level among nursing staff especially at critical care units.
3. Develop nursing guidelines, policy and unified updated list of high alert medication.
4. Application of Joint commission recommendation and institute of safe medication practices standards as regards to medication safety such as storage ,dispensing and labelling
5. Develop appropriate hospital system for medication error reporting.
6. Utilize information technology for medication administration to reduce medication administration error rate.
7. Reduce work place interruption during high alert medication preparation and administration.
8. Develop patient education material (Brochure & leaflet) regarding high alert medication.
9. Recommended nurse to patient ration not more than one to one in coronary care unit.