Authors (including presenting author) :
Ngan WCA(1), Ho SKS(1), Ho YKE(2), Man YK(2), Chee SMS(2), Tai KYG(2), Lee HY(2), Lam SS(2), Wong THJ(2), Wong CW(1), Woun YSB(1), Tse KYG(2), Pang HSI(2), Leung CP(1)
Affiliation :
(1)Nursing Services Division, Ruttonjee & Tang Shiu Kin Hospitals, (2)Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
Keyword 1: :
Medication Safety
Keyword 2: :
High Alert Medication
Keyword 3: :
Medication Administration
Keyword 4: :
Simulation Training
Keyword 5: :
Collaboration with Clinical Department
Introduction :
Medication incidents occurring quarterly highlight the need for clinical practice improvements, with contributing factors such as limited clinical experience and deviations from standard procedures. Simulation-based training was implemented to enhance safe medication administration skills, particularly for high-alert medications.
Objectives :
To enhance nurses’ ability to prevent, detect, and manage medication administration errors by improving medication knowledge, situational awareness, and error recovery skills through real-life, scenario-based simulation training.
Methodology :
The Nursing Services Division (NSD), following a two-year review of medication incidents, collaborated with the Department of Medicine and Geriatrics (M&G) to design simulation scenarios targeting high-alert medication administration. Nurses with less than five years of clinical experience from M&G wards participated in 90-minute simulation sessions, engaging in role-play, hands-on practice, and discussions. Participants practiced collecting clinical information, preparing medications, and administering treatment to a high-fidelity manikin. Trained assessors provided feedback, guiding participants to identify errors, reflect on contributing factors, and develop strategies to prevent future errors in clinical practice.
Result & Outcome :
A total of 84 nurses from 15 inpatient wards participated in the program, with post-training assessments showing notable improvements in medication-related knowledge. These improvements ranged from 10% to 48%, with the most significant gains in narcotics patch administration (48%), independent double-checking (39%), and stat medication handling (25%). Mean pre-test scores increased from 6.99 (SD = 1.17) to 9.08 (SD = 0.76) post-test. Years of post-registration experience showed a weak positive correlation with medication knowledge (Pearson’s r = 0.29). Performance errors predominantly occurred during independent double-checking (32%), followed by allergy checking, infusion pump use, incorrect timing, medication preparation, and patient identification. Guided debriefing facilitated error identification and the development of corrective strategies through self-reflection and peer discussion. At the hospital level, medication incidents decreased from 23 in 2024 to 18 in 2025, representing a 21.7% reduction. Nursing Quality Indicator (NQI) for Medication Administration Incident shows 70% reduction from 2024 (N=10) to 2025 (N=3). Conclusion: Simulation-based training in a controlled environment allows nurses to safely identify and practice strategies to prevent medication errors, and serves as a valuable Continuous Quality Improvement (CQI) intervention, promoting sustainable patient safety improvements.
