A STUDY TO ASSESS THE KNOWLEDGE OF CARDIAC NURSES ABOUT COMMONLY ADMINISTERED DRUGS IN CARDIAC SURGICAL ICU

PROJECT REPORT

Submitted in partial fulfillment of the requirements for the Diploma in Cardiovascular and Thoracic Nursing Submitted by

SUCHITHRA G NAIR

Code No: 6206

SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY, TRIVANDRUM

NOVEMBER 2011

CERTIFICATE FROM SUPERVISORY GUIDE

This is to certify that Miss. Suchithra G Nair has completed the project

work on "A study to assess the knowledge of Cardiac Nurses about

commonly administered drugs in Cardiac Surgical ICU in SCTIMST,

Thiruvananthapuram" under my direct supervision and guidance for the

partial fulfillment of the Diploma in Cardiovascular and Thoracic Nursing

in the University of SCTIMST, Thiruvananthapuram. It is also certified

that no part of the report has been included in any other thesis for

procuring any other degree by the candidate.

Thiruvananthapuram, November 2011.

11

Dr. Saramma P. P.,

Senior Lecturer in Nursing,

SCTIMST,

Thiruvananthapuram.

CERTIFICATE FROM THE CANDIDATE

This is to certify that the project on “A study to assess the knowledge of Cardiac

Nurses about commonly administered drugs in Cardiac Surgical ICU in SCTIMST,

Thiruvananthapuram " is a genuine work done by me, under the guidance of Dr.

Saramma P.P, PhD, Senior Lecturer in Nursing, SCTIMST, Thiruvananthapuram. It is

also certified that this work has not been presented previously to any other University

for award of degree, diploma or other recognition.

Miss. Suchithra G Nair,

Code No: 6206

SCTIMST,

Thiruvananthapuram.

Thiruvananthapuram,

November 2011.

APPROVAL SHEET

This is to certify that Miss. Suchithra G Nair bearing code no: 6206 has been

admitted to the Diploma in Cardiovascular and Thoracic nursing, in January 2011 and

she has undertaken the project entitled, "A study to assess the knowledge of Cardiac

Nurses about commonly administered drugs in Cardiac Surgical ICU” in SCTIMST,

Thiruvananthapuram, which is approved for the Diploma in Cardiovascular and

Thoracic nursing, awarded by the Sree Chitra Tirunal Institute for Medical Sciences

and Technology, Thiruvananthapuram, and is found satisfactory.

EXAMINERS

(1) ………………………

(2) ………………………

GUIDE

(1) ……………………..

(2) …………………….

Thiruvananthapuram,

November 2011.

ACKNOWLEDGEMENT

First of all let me thank God Almighty, who accompanied and directed me to achieve

success throughout this study.

The present study has been completed under the expert guidance of Dr. Saramma. P.P,

Senior Lecturer in nursing, SCTIMST, Thiruvananthapuram. I express my sincere

gratitude to Dr.Saramma P.P, for the valuable guidance, constant support and

encouragement given for the completion of the study.

I express my sincere thanks to Dr.A.V.George, Registrar, SCTIMST,

Thiruvananthapuram, for giving this opportunity for conducting this study.

I greatly value the favour extended by Prof. Jayakumar, Head of the Department of

Cardiac Surgery, SCTIMST, Thiruvananthapuram and Mrs.Aleyamma John, Ward Sister,

CSICU.

I would like to acknowledge the contribution of all the participants who kindly agreed

to take part in the study. They generously gave their time and attention to the research.

This study would have been impossible without their generosity.

Special thanks to computer division and library staff of SCTIMST for granting

permission to utilize computer and library.

Suchithra G Nair.

ABSTRACT

Topic: A study to assess the knowledge of Cardiac Nurses about commonly

administered drugs in Cardiac Surgical ICU.

Nurses are responsible for preparing and administering potent drugs that affects the

patient's cardiovascular functions. Nurses should be competent enough in medicine

administration to prevent medication errors. Each nurse should be aware of indication,

action, contraindications, adverse reactions and interactions of drugs. OBJECTIVES: -1.

To identify knowledge about commonly administered drugs in Cardiac Surgical ICU

among Cardiac Nurses. 2. To identify the relationship between knowledge level about

commonly administered drugs in Cardiac Surgical ICU and selected variables.

METHODS: -Pilot study was done in 5 cardiac speciality nursing students, then 25

cardiac nurses were selected randomly from the CSICU including permanent @

temporary registered nurses for the study; Convenient sampling technique was used for

selecting the sample. Total period of study was from August 2011 to October 2011. A

self-administered questionnaire was used in the form of multiple choices. RESULTS: -

Study shows that 3% of the sample had poor knowledge, 23% had average knowledge,

57% had fair knowledge and 17% had good knowledge about commonly administered

drugs in CSICU. There was no statistically significant difference when comparing the

mean knowledge score with age, professional qualification, year of experience and CPCR

training programme attended. There was statistically significant higher knowledge score

in nurses with increase in ICU experience. CONCLUSION: -Majority of cardiac nurses

have above average knowledge about commonly administered drugs in CSICU.

CONTENTS

CHAPTER NO TITLE PAGE NO

I INTRODUCTION

1-11

1.1 Introduction 1

1.2 Back ground of the study 2-7

1.3 Need and Significance of the study 7-8

1.4 Statement of the problem 9

1.5 Objectives of the study 9

1.6 Operational definitions 9

1.7 Methodology 10

1.8 Delimitations 10

1.9 Organization of the report 11

II REVIEW OF LITERATURE 12-22

2.1 Introduction 12

2.2 Studies related to assessment of nurses

knowledge on medication

12-15

2.3 Studies related to medication errors 15-22

III METHODOLOGY 23-26

3.1 Introduction 23

3.2 Research approach 23

3.3 Setting of the study 24

3.4 Sample and sampling technique 24

3.5 Inclusion criteria 25

3.6 Exclusion criteria 25

3.7 Development of tool 25

3.8 Description of the tool 25-26

3.9 Pilot study 26

3.10 Data collection procedure 26

3.11 Plan of analysis 26

IV ANALYSIS AND INTERPRETATION

OF DATA

27-40

4.1 Introduction 27

4.2 Distribution of sample according to

demographic data

28-33

4.3 Distribution of sample according to

knowledge score.

33-36

4.4

Comparison of mean,SD, and p value of

nurses’ knowledge and selected variables

37-40

4.5 Summary

40

V

Summary, Conclusions, Discussion and

Recommendations

41-44

5.1 Introduction 41

5.2 Summary 41-42

5.3 Limitations 42

5.4 Major findings of the study 42-43

5.5 Recommendations 43

5.6 Discussion 43-44

5.7 Conclusion 44

REFERENCES 45-47

APPENDIX 48-53

LIST OF TABLES

Table Titles Page

No.

1.1 Common cardiac drugs

3-5

1.2 Steps to improve medication safety 6

4.1 Distribution of sample according to age 28

4.2 Distribution of sample according to sex 29

4.3 Distribution of sample according to professional qualification

30

4.4 Distribution of sample according to experience 31

4.5 Distribution of sample according to ICU experience

32

4.6 Distribution of sample according to CPCR training 33

4.7 Distribution of sample according to knowledge score 34

4.8 Percentage of knowledge in each area of knowledge test

35-36

4.9 Mean, standard deviation and p value of knowledge according to

age group

37

4.10 Mean, standard deviation and p value of knowledge according to

year of experience

38

4.11

Mean, standard deviation and p value of knowledge according to

year of ICU experience

38

4.12 Mean, standard deviation and p value of knowledge according to

professional qualification

39

4.13 Mean, standard deviation and p value of knowledge according to

CPCR training

40

LIST OF FIGURES

Figure Title Page no

4.1 The pie diagram showing distribution of samples

according to age

29

4.2 The pie diagram showing distribution of samples

according to professional qualification

30

4.3 The pie diagram showing distribution of samples

according to ICU experience

32

4.4 The pie diagram showing distribution of samples

according to CPCR training

33

4.5 The bar diagram showing distribution of samples

according to knowledge score

34

ABBREVATIONS

ACE - Angiotensin converting enzyme

CSICU - Cardiac Surgery Intensive Care Unit

CVD - Cardiovascular disease

SCTIMST - Sree Chitra Tirunal Institute For Medical Sciences And Technology

SD - Standard Deviation

WHO - World Health Organization

1

Chapter - 1

INTRODUCTION

1.1 Introduction

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in

many countries worldwide, accounting for 29% of all deaths in 2005 and

mortality from cardiovascular disease is estimated to be 20 million every year by

2015, according to the WHO (Wood, 2003). The risk factors of CVD are on the

rise in the world and` India, already the diabetes capital of the world with 32

million persons with diabetes, is projected to have 69.8 million in 2025, the count

of "hypertensive" individuals is expected to rise from 118 million in 2000 to 214

million in 2025 (Reddy, 2005).

The WHO Programme on CVD is concerned with prevention, management and

monitoring of CVD globally. Major treatment includes administration of drugs

that affect the function of heart and blood vessel (Webster, 2007). Medication

safety is a major concern and global issue related to the quality and safety of

patient care (Sheu, et al 2007). Research findings warn that more than half of

lives threatening errors are related to rapid infusion of high alert medications

(Gladstone, 1995). Many recommended practices have been proposed to

decrease medication errors including avoiding mistakes by storing high alert

medications in specific ways (Cohen, 2007). From an educational point, teaching

and a theory- practical gap lead nurses to make administration errors (Stifter, et

al 1991). The rate of preventable and potential adverse drug events is high in

ICUs compared with non-ICU (Joshua, et al 2009). It is claimed that more than

one million medical mishaps happened each year. Nurses need to have

knowledge and skills necessary to recognize and respond appropriately, when

anaphylaxis occurs. Research has demonstrated that an educational programme

can raise nurses‟ awareness about medication errors and other medication related

safety issues (Altun, et al 2010).

2

1.2 Background

The administration of a medicine is a common but important clinical procedure.

It is the manner in which a medicine is administered that will determine to some

extent whether or not the patient gains any clinical benefit, and whether they

suffer any adverse effect from their medicines.

1.2.1 Cardiovascular drugs

The variety and scope of cardiovascular drugs have increased tremendously in

the past few decades, and new drugs are being approved annually. In the 1950s,

effective oral diuretics became available. These drugs dramatically changed the

treatment of heart failure and hypertension. In the mid-1960s Beta-blockers was

discovered, this led to major changes in physicians‟ ability to treat patients with

hypertension or angina pectoris. Calcium Channel blockers and ACE inhibitors

became widely used in the 1980s and they help to treat patients with

hypertension, heart failure & Coronary artery disease. The development and use

of thrombolytic have revolutionized the treatment of patients having a heart

disease (Karch, 2006).

Types of cardiovascular drugs may be grouped depending upon their action or

what they treat. Treatment categories are more difficult to describe since many of

these medications may treat several symptoms of heart disease and have more

than one use. Categories that might describe drug actions include the following:

statins, diuretics, digitalis, beta blockers, calcium channel blockers,

anticoagulants, anti-platelet, vasodilators, ACE inhibitors, fibrinolytics, anti

arrhythmics, inotropic agents and phosphodiesterase III inhibitors (Webster

2007). Table1.1 shows the common cardiovascular drugs.

3

1.2.2 Nurses responsibilities in administration of highly alert medications

To ensure safe medication administration, the nurse should be aware of what is

ordered, and need to recognize when a prescribed dose of a medication is too

high or low. More education and experience are associated with improved

patients‟ safety. When administering medications, nurses are accountable for

knowing why the medication is being used, what are the possible side effects to

be monitored. Steps to nursing standard called 6 rights of medication

administration that includes right medication, right dose, right client, right route,

right time, and right documentation. Report all medication errors that do and do

not harm patients. Understanding potential errors may provide key information

on how medication errors as a whole can be prevented. Nurses working in an

environment where individuals are punished for making mistakes can result in

omission of error reporting and encourage hiding mistakes, ultimately making it

difficult to identify errors and to prevent them from happening (Fahimi, et al

2008).

Know the medication before administering. Lack of drug knowledge and lack of

important patient information cause medication errors (Cullen et al 1997). Steps

to improve medication safety are given in Table 1.2.

4

Table 1.2 Steps to improve medication safety

Confirm patient information

before administering medications

Double check the patient name, known allergies and

previous medication use.

Double check and collaborate

with clinicians to verify

information

Handwritten orders and verbal orders can lead to

errors and are likely responsible for total overdoses.

If an order is illegible or unclear, the medication

should not be given until after the nurse seeks and

obtain clarification from the prescriber.

Minimize distractions during

medication administration

The inability to concentrate on the medication

administration process and feeling rushed during

medication administration can lead to errors.

Improve communication during

transitioning and handoffs.

Errors can occur due to ineffective handing off a

patient from one caregiver to another. Using written

data and reading back the orders help to improve

medication safety.

1.2.3 Nurses in Sree Chitra Tirunal Institute For Medical Science And

Technology

SCTIMST is a tertiary level referral hospital. Nurses in SCTIMST regularly

engage in activities promoting the health care of patients. Nurses carryout in-

service education programme to improve the professional competency and

knowledge. Nurses carry out health education programme for patients and their

relatives. SCTIMST conduct diploma courses in cardiac and neuro nursing.

Every year 20 new students are getting admitted to the course. Senior nurses are

competent enough to train and supervise the junior nurses and student nurses.

Nurses working in each unit do drug administration.

5

Table 1.1 Common Cardiac Drugs

Drugs Main effects Mechanism Sites of action

abciximab anticoagulant stops

platelet activation

monoclonal antibody

to fibrinogen receptors

platelets

amiodarone class III anti-

arrhythmic

prolongs action

potential duration

myocardium

aspirin anticoagulant stops

platelet activation

blocks TXA2

synthesis

platelets

atropine parasympatholytic,

increases heart rate

blocks muscarinic

AcCh receptors

pacemaker cells

(sino-atrial node)

captopril reduces arterial

blood pressure

ACE inhibitor relaxes vascular

smooth muscle

clopidogrel anticoagulant stops

platelet activation

blocks ADP receptor platelets

digitalis and

ouabain

increase cardiac

contractility, delay

AV node triggering

block Na / K ATPase

raising intracellular

sodium, then calcium

Na/Ca exchanger is

mainly in heart

furosemide diuretic Na & chloride

channels

Kidney

6

Table 1.1 Common Cardiac Drugs

Drugs Main effects Mechanism Sites of action

isoprenaline increase cardiac

contractility

beta agonist raises

cyclic AMP

many tissues

losartan reduces arterial

blood pressure

angiotensin AT1

receptor blockade

vascular smooth

muscle

lovastatin reduces blood

cholesterol levels

HMG-CoA reductase

inhibitor

liver

morphine pain relief opiate receptors brain

nitroglycerine reduce cardiac

work load

metabolised to NO vascular smooth

muscle

propranolol reduces cardiac

contractility

beta blocker lowers

cyclic AMP

many tissues

quinidine, class I anti-

arrhythmics

delay recovery of

sarcolemma sodium

channels after AP

myocardium

spironolactone reduces diuretic

potassium losses

aldosterone antagonist kidney (distal

tubules)

7

Table 1.1 Common Cardiac Drugs

Drugs Main effects Mechanism Sites of action

streptokinase dissolves blood

clots (fibrinolytic

activates plasminogen

to plasmin (protease)

blood clots

verapamil,

nifedipine and

other

class IV anti-

arrhythmic

block sarcolemma

calcium channels

Myocardium,

vascular smooth

muscle

warfarin anticoagulant, vit.

K antagonist

blocks carboxy

glutamate synthesis

liver

1.3 Need and significance of the study

Patients’ safety is increasingly recognized as essential in the practice of

intensive care medicine. Patients in intensive care unit require high intensity

care and may be at high risk for iatrogenic injury. Individuals have right to safe

and effective quality health care (Metnitz, et al 2009).

Cardiac nursing is a specialty that deals with various conditions of

cardiovascular system such as unstable angina, cardiomyopathy, Coronary

artery disease, and congestive heart diseases. Cardiac nurses must assess and

care for patients with heart problems that range in severity from arrhythmias to

heart transplants (Pettinger, et al 2003).

Nurses must be able to assist the Physician in diagnosing & treating a sudden

life-threatening emergency. Cardiac nurses monitor patients, administer

8

medication, help with basic personal care needs and work with the doctor to

develop a plan of action for patient care(Sheu, et al 2007).

Patients in ICU are prescribed twice as many medications as non- ICU patients.

The critical care safety demonstrated that 78% of serious errors in ICU patients

are attributable to medication. Nearly two third of medication in ICU are given

by IV route, leading to a greater risk of errors due to miscalculation of doses

and improper medication administration. Cardiac nurses are responsible for

preparing and administering potent drugs that affects the patients cardiovascular

functions. Each nurse should be aware of indication, action, contraindication,

adverse effects and interactions of drug(Kopp,et al 2006).

The investigator’s experience in cardiac surgical intensive care units in Sree

Chitra Tirunal Institute for Medical Sciences and Technology, shown that the

nurses need to have much knowledge about the highly potent drugs in the unit.

Postoperative care of the cardiac surgery patient is challenging in that changes

can occur rapidly. A compassionate, knowledgeable, and skilled nurse caring

for the patient after open-heart surgery is an asset in the achievement of positive

outcomes for the patient. Hence the investigator planned to conduct a study to

assess the knowledge of staff nurses in cardiac surgical ICU on commonly

administered drugs.

1.4 Statement of the problem

“A study to assess the knowledge of Cardiac Nurses about commonly

administered drugs in Cardiac Surgical ICU in SCTIMST.”

9

1.5 Objectives

The objectives of this study are: -

1. To identify the knowledge about commonly administered drugs used in

Cardiac Surgical ICU among Cardiac Nurses.

2. To identify the relationship between knowledge level of Cardiac nurses

about commonly administered drugs in Cardiac Surgical ICU and selected

variables.

1.6 Operational definitions: -

Knowledge: - a state of awareness or understanding with conscious mind. In

this study the investigator assesses the knowledge on selected Cardiovascular

drugs among Cardiac Nurses using a self-administered validated questionnaire.

Cardiac Surgical Nurses: - It means registered staff nurses working in Cardiac

Surgical Intensive Care Unit.

Cardiovascular drugs:- agents that affects rate or strength of cardiac

contraction, blood vessel diameter or blood volume. Investigator is conducting a

study to identify the knowledge of cardiac nurses on selected cardiovascular

drugs like statins, diuretics, digitalis, beta blockers, calcium channel blockers,

anticoagulants, anti-platelet, vasodilators, ACE inhibitors, fibrinolytics, anti

arrhythmics, inotropic agents and phosphodiesterase III inhibitors.

1.7 Methodology: -

This is a descriptive survey of nursing staff. The investigator assesses the

knowledge about commonly administered Cardiovascular drugs among Cardiac

nurses with a self-administered questionnaire. Registered staff nurses working

in Cardiac Surgical Intensive Care Unit will be selected for the study.

10

1.8 Delimitation: -

The study is delimited to Cardiac nurses working in Cardiac Surgical ICU in

Sree Chitra Tirunal Institute for Medical Sciences and Technology,

Trivandrum.

1.9 Organization of the report

The report is divided in to five chapters. The first chapter is introduction. In this

chapter the background of the study is outlined, the subject –assessing nurses‟

knowledge about medication therapy, the need and significance of the research

problem is stressed, and the problem and objectives are stated. The operational

definitions, methodology, and delimitations are specified. A summary of related

studies pertaining to relevant areas of the present study is reviewed in chapter II,

chapter III deals with the materials and methods of the study and chapter IV

analyses and interprets the findings, chapter V presents the summary of the study

including major findings, conclusions, implications, limitations of the present

study together with certain recommendations for further research. The report also

includes selected references and appendices.

11

Chapter - 2

REVIEW OF LITERATURE

2.1 Introduction

Review of literature is an important aspect of any research project

from, beginning to end. It refers to a broad, comprehensive in depth, systematic

and critical review of scholarly publications, print materials and audiovisual

materials.

It gives character insight into the problem and helps in selecting methodology,

developing tool and also analyzing data. With these in view a review of

literature has been done.

The review of literature relevant to this study is presented in the

following sections.

2.2 Studies related to assessment of Nurses' knowledge on medicine

administration.

2.3 Studies related to medication errors

2.2 Studies related to assessment of Nurses' knowledge on medication

administration

Flynn et al (1996), conducted a study to compare the effects of three teaching

methods on registered nurses' and licensed practical nurses' knowledge of

medication error risk reduction strategies, and (2) to compare registered nurses'

and licensed practical nurses' knowledge of medication error risk reduction

strategies using a pretest/posttest design. Registered nurses (n = 129) and

licensed practical nurses (n = 21) employed by two hospitals constituted the

study sample. Subjects were assigned alternately to three intervention groups:

videotape (n = 50); instructional booklet (n = 50); and lecture (n = 50). A 38-item

12

test, including true-false, multiple choice, matching items and dosage calculation

problems, was administered to subjects in each group before and after the

teaching intervention. On the basis of the results, there was no statistically

significant difference in total knowledge scores for the three intervention groups

(F=2.07, P=0.130). Study concluded that instructors should consider the

advantages of a videotape and instructional booklet over the time-intensive

lecture strategy.

Schreiber et al (2007) , conducted an evidence based practice project to decrease

adverse patient events related to the use of cardiac medications on a post

operative orthopedic unit and also to determine and implement the best nursing

practices for safe cardiac medication administration to these patients. An

education programme was developed based on best practices of safe

administration of cardio vascular drugs and nurses‟ knowledge were measured

using a pre and post-test assessment. Pre-test survey of drug administration

practices showed wide inconsistency in practice. Post-test scores for 23 RN

averaged 92%. The study concluded that nurses require continuous education to

prevent adverse drug events.

Ndosi and Newell (2009), conducted a study to determine whether nurses had

adequate knowledge of the drugs they commonly administer. The researchers

used a non-experimental causal comparative and co relational design. Recruited a

convenience sample of 42 nurses working in surgical wards of a foundation

hospital in the North of England. Data were collected by structured interview and

questionnaire methods. Answers were given a score out of 10 (100%) to

determine their actual pharmacology knowledge. The sample comprised of 18

(42.9%) junior nurses and 24 (57.1%) senior nurses. They had a median

experience of 10.87 years post registration. Their mean knowledge score was six

ranging between two and nine (SD 1.9). Only 11 (26.1%) nurses scored eight or

above and the majority 24 (57.2%) scored below seven, indicating inadequate

knowledge. Knowledge of the mechanism of action and drug interactions was

13

poor. The results of this study suggested that nurses have inadequate knowledge

of pharmacology. This study supported the need for supplementary

pharmacology education for nurses in clinical settings, focusing on common

drugs they administer in order to increase nurses' knowledge and confidence in

drug administration and safer medicines management.

Elganzouri et.al (2009), conducted a study to develop and test a

method for assessing nursing effort and workflow in the medication

administration process. A descriptive observation study of 151 nurses during 980

unique medication observations in medical-surgical units at a rural hospital, an

urban community hospital, and an academic medical center was conducted.

Nurses averaged more than 15 minutes on each medication pass and were at risk

of an interruption or distraction with every medication pass. Study concluded that

system challenges faced by nurses during the medication administration process

lead to threats to patient safety, work-arounds, workflow inefficiencies, and

distractions during a time when focus is most needed to prevent error.

Altun et. al (2010), conducted a study to determine the role of structured

workshop on best practice technique for the administration of

injection for the nurses. Nurses attended an interactive lecture based workshop

on best practice technique for the administration of injections. The participants

completed a multiple choice question test derived from topics covered in this

presentation prior to the lecture. The multiple choice question was repeated after

the lecture to assess retention and application of knowledge 38

nurses participated in the workshop. There was a significant improvement in the

mean score after the lecture when compared with the pre-lecture scores

(mean=16.5,SD=3.7 Vs mean=7.8,SD=1.9,P<0.001). The study concluded that

lecture based practice technique of administration of injections helped to improve

nurses knowledge and helped to overcome deficiencies in nurses training.

14

2.3 Studies related to medication errors

Cullen et al (1997), conducted a study to compare the frequency and

preventability of adverse drug events and potential adverse drug events in

intensive care units (ICUs) and non-ICUs. Prospective cohort study was used.

Participants included all 4,031 adult admissions to a stratified, random sample of

11 medical and surgical units in two tertiary care hospitals over a 6-month

period. Units included two medical and three surgical ICUs and four medical and

two surgical general care unit No interventions were done. Incidents were

detected by stimulated self-report by nurses and pharmacists and by daily review

of all charts by nurse investigators. Two independent reviewers as to whether

they represented adverse drug events or potential adverse drug events and as to

severity and preventability subsequently classified incidents. Those individuals

involved in the preventable adverse drug event and potential adverse drug event

underwent detailed interviews by peer case-investigators. The rate of preventable

adverse drug events and potential adverse drug events in ICUs was 19 events per

1000 patient days, nearly twice that rate of non-ICUs (p < .01). The medical ICU

rate (25 events per 1000 patient days) was significantly (P < .05) higher than the

surgical ICU rate (14 events per 1000 patient days). When adjusted for the

number of drugs used in the previous 24 hrs or ordered since admission, there

were no differences in rates between ICUs and non-ICUs. ICU acuity, length of

stay, and severity of the adverse drug event were greater in ICUs than non-ICUs,

but there were no differences between medical ICU and surgical ICU patients.

Study concluded that the rate of preventable and potential adverse drug events

was twice as high in ICUs compared with non-ICUs.

Calabrese et al (2001), conducted a study to quantify the incidence and specify

the types of medicines from a list of error-prone medications and to determine

these errors. An observational evaluation is conducted in five intensive care units

in USA. Study conducted in 851 patients admitted in surgical, medical or mixed

15

ICUs in3 month period. A list of error prone medications was adapted from the

literature and evaluated for medication errors. Of 5,744 observations in 851

patients, 187(3.3%) medication errors were detected. Errors were associated with

vasoactive drugs 61(32.6%) and sedatives/analgesics 48(25.7%). The most

common type of error was wrong infusion rate with 71(40.1%) errors. Study

evaluation found fewer medication errors than the published literature.

Lorazepam and wrong infusion rates are associated with errors that occurred

frequently, resulted in the greatest potential for harm. Study concluded that the

errors should be considered potential ares for betterment in the medication use to

improve patient safety.

Whitman, et al (2002), conducted a study to determine the relationships between

nursing staffing and specific nurse-sensitive outcomes (central line blood-

associated infection, pressure ulcer, fall, medication error, and restraint

application duration rates) across specialty units (cardiac and noncardiac

intensive care, cardiac and noncardiac intermediate care, and medical-surgical).

Secondary analysis of prospective, observational data from 95 patient care units

(cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac

intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical-

surgical, n = 43) across 10 acute hospitals taken. No statistically significant

relationships were found between central line infection and pressure ulcer rates

and staffing across specialty units. Significant inverse relationships were present

between staffing and falls in cardiac intensive care, medication errors in both

cardiac and noncardiac intensive care units, and restraint rates in the medical-

surgical units. Results from this study suggested that the impact of staffing on

outcomes is highly variable across specialty units.

Rothschild et al (2005), conducted a study to identify the incidence and nature of

adverse events and serious errors in the critical care setting. They conducted a

prospective 1-year observational study. Incidents were collected with use of a

multifaceted approach including direct continuous observation. Two physicians

16

independently assessed incident type, severity, and preventability as well as

systems-related and individual performance failures. Medical intensive care unit

and coronary care unit patients in a tertiary-care urban hospital were selected.

The primary outcomes of interest were the incidence and rates of adverse events

and serious errors per 1000 patient-days. A total of 391 patients with 420 unit

admissions were studied during 1490 patient-days. We found 120 adverse events

in 79 patients (20.2%), including 66 (55%) nonpreventable and 54 (45%)

preventable adverse events as well as 223 serious errors. The rates per 1000

patient-days for all adverse events, preventable adverse events, and serious errors

were 80.5, 36.2, and 149.7, respectively. Among adverse events, 13% (16/120)

were life threatening or fatal; and among serious errors, 11% (24/223) were

potentially life threatening. Most serious medical errors occurred during the

ordering or execution of treatments, especially medications (61%; 170/277).

Adverse events and serious errors involving critically ill patients were common

and often potentially life threatening. Study concluded that although many types

of errors were identified, failure to carry out intended treatment correctly was the

leading category.

Kopp et al (2006), conducted a study to determine the incidence and

preventability of medication errors and potential/actual adverse drug events in a

medical/surgical intensive care unit & to evaluate system failures leading to error

occurrence. It was a prospective, direct observation study. Conducted in a

Tertiary care academic medical center. Observers would intervene only in the

event that the medication error would cause substantial patient harm or

discomfort. The observers identified 185 incidents during a pilot period and four

phases totaling 16.5 days (33 12-hr shifts). Two independent evaluators

concluded that 13 of 35 (37%) actual adverse drug events were nonpreventable

(i.e., not medication errors). An additional 40 of the remaining 172 medication

errors were judged not to be clinically important. Of the 132 medication errors

classified as clinically important, 110 (83%) led to potential adverse drug events

and 22 (17%) led to actual, preventable adverse drug events. There was one error

17

(i.e., resulting in a potential or actual, preventable adverse drug event) for every

five doses of medication administered. The potential adverse drug events mostly

occurred in the administration and dispensing stages of the medication use

process (34% in each); all of the actual, preventable adverse drug events

occurred in the prescribing (77%) and administration (23%) stages. Errors of

omission accounted for the majority of potential and actual, preventable adverse

drug events (23%), followed by errors due to wrong dose (20%), wrong drug

(16%), wrong administration technique (15%), and drug-drug interaction (10%).

All of the potential adverse drug events and approximately two thirds of the

actual adverse drug events were judged to be preventable. The study found that

most of the errors were due to dose omission, wrong dose, wrong drug, and

wrong interaction.

Bennet et al (2006), conducted a study to compare the effectiveness of an

existing unit dose system using a medication cart to a new system where

medications are decentralized to a locked cupboard at the patient's bedside in

enhancing medication safety. Quantitative and qualitative approaches were used

to determine the effectiveness and efficiency of the medication administration

systems. Data was collected using time studies to evaluate the efficiency of the

two systems. This data included medication errors, missing doses and

interruptions occurring during the medication preparation and administration

process. Study results demonstrated benefits associated with decentralizing the

medication distribution to the bedside, including nurses spending more time with

patients, nurses investing less time preparing and distributing medication and

fewer interruptions for nurses as they prepared and distributed medication.

Fahini et al (2008), conducted a study to determine the frequency

of medication errors that occurred during the preparation and administration of

IV drugs in an intensive care unit. The study was conducted in a 12-bed intensive

care unit of one of the largest teaching hospitals in Tehran. Data were collected

over 16 randomly selected days at different medication round times, between

18

July and September 2006. A trained observer accompanied nurses during

intravenous (IV) drug rounds. Medication errors were recorded during the

observation times of IV drug administration and preparation. Drugs with the

highest rate of use in the intensive care unit (ICU) were selected. Details of the

process of preparation and administration of the selected drugs were compared to

an informed checklist, which was prepared using reference books and

manufacturers' instructions. They observed a total of 524 preparations and

administrations. The calculated number of opportunities for error was 4040. The

numbers of errors identified were 380/4040 (9.4%). Of those, 33.6% were related

to the preparation process and 66.4% to the administration process. The most

common type of error (43.4%) was the injection of bolus doses faster than the

recommended rate. Amikacin was involved in the highest rate of error (11%)

among all the selected medications. It was found that the IV rounds conducted at

9:a.m. had the highest rate of error (19.8%). No significant correlation was found

between the rate of error and the nurses' age, sex, qualification, work experience,

marital status, and type of working contract (permanent or temporary).Since the

system is devoid of a well-organized reporting system, errors are not detected

and consequently not prevented. The study suggested the need to take the

initiative of developing systems that guarantee safe medication administration.

Hsaio et al (2010), conducted a study to measure nurses' knowledge of high-alert

medications and to analyze known administration errors. A cross-sectional study

was conducted in 2006 in Taiwan using a questionnaire developed from literature

review and expert input, and validated by subject experts and two pilot studies.

Section 1 of the questionnaire (20 true-false questions) evaluated nurses'

knowledge of high-alert medications and section 2 was designed to analyze

known administration errors. Snowball sampling and descriptive statistics were

used. A total of 305 nurses participated, giving a 79.2% response rate (305/385).

The correct answer rate for section 1 was 56.5%, and nurses' working experience

contributed to scores. Only 3.6% of nurses considered themselves to have

sufficient knowledge about high-alert medications, 84.6% hoped to gain more

19

training, and the leading obstacle reported was insufficient knowledge (75.4%).

A total of 184 known administration errors were identified, including wrong drug

(33.7%) and wrong dose (32.6%); 4.9% (nine cases; 9/184) resulted in serious

consequences. The questionnaire was valid and reliable. These evidence-based

results strongly suggested that nurses have insufficient knowledge about high-

alert medications and could benefit from additional education, particularly

associated with intravenous bolus administration of high-alert medications.

Summary:-

Review of literature enabled the investigator to have a deep knowledge and

insight in to the problem. This chapter-covered introduction, review of literature

related to assessment of nurses' knowledge on medicine administration and

medication errors. Most of the studies concluded that nurses have insufficient

knowledge about high-alert medications. Studies recommended the importance

of educational programme in improving the knowledge.

20

Chapter - 3

METHODOLOGY

3.1 Introduction

Research methodology is the systematic way to solve the research problem. It

studies the steps that researcher adopts to study his problem with the logic

behind.

This chapter deals with the research approach, setting, the sample and sampling

technique, development of tool, description of tool, pilot study, data collection

procedure and plan for analysis.

3.2 Research Approach

Descriptive study approach is used.

The objective of the study is: -

[a] To identify knowledge about commonly administered drugs in Cardiac

Surgical ICU among Cardiac Nurses.

[b] To identify the relationship between knowledge level about commonly

administered drugs in Cardiac Surgical ICU and selected variables.

3.3 Setting

The study is conducted in Sree Chitra Tirunal Institute for Medical Sciences and

Technology, Thiruvananthapuram; an institute of national importance established

by an Act of the Indian Parliament. The rationale for selecting this institute was

that the investigator was doing Diploma in cardiovascular @ thoracic nursing

course in this institution. There is a separate department for cardiac surgery,

21

which includes cardiac operation theatre, cardiac surgery ICU @ cardiac surgery

ward. The investigator is conducting the study in cardiac surgical ICU .

3.4 Sample and Sampling technique

The sample was selected from the registered staff nurses in cardiac surgery ICU ,

in Sree Chitra Tirunal Institute for Medical Sciences and Technology,

Thiruvananthapuram. The size of the sample was thirty. The convenient

sampling technique was used to collect the samples. At first the prepared tool

was given to experts to check content validity. The pilot study was conducted in

five cardiac speciality nursing students @ the findings revealed that the tool was

feasible and practicable. The remaining 25 sample was selected from the staff

nurses working in CSICU. The duration of the study period was from August

2011 to October 2011.

3.5 Inclusion Criteria

Staff nurses working in Cardiac Surgical Intensive Care Unit in Sree Chitra

Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram,

who were willing to participate in the study. Both temporary @ permanent staff

nurses, irrespective of their experience were included in the study

3.6 Exclusion Criteria

Staff nurses working in departments other than CSICU.

3.7 Development of tool

An extensive study and review of literature helped in preparation of the tool. A

self prepared validated questionnaire is used as the tool for this study.

22

3.8 Description of the tool

The structured questionnaire consists of two parts.

Part i: - This part contains items such as demographic data that includes age,

sex, professional qualification, total years of experience, ICU experience,

whether undergone CPCR training programme.

Part ii: - Questionnaire to assess the knowledge of cardiac nurses about the

commonly administered drugs in cardiac surgical intensive care unit. It consists

of a total 15 questions regarding the management of administration of high alert

medication. The total score is 15 marks and each correct answer carries „1‟ mark

and each wrong answer carries „0‟ mark. Total knowledge is calculated with

percentage of marks scored by the sample.

* <40% - poor

* 41-60%-average

* 61-80%-fair

* >80%-good

3.9 Pilot study

Pilot study was done on September 2011. Five DCN students were taken for the

pilot study. The pilot study was conducted to find out the feasibility of the study.

The questionnaire was used for this study. After pilot study modification of the

tool was done.

3.10 Data collection

The data was collected from staff nurses working in Cardiac surgical ICU of Sree

Chitra Tirunal Institute for Medical Sciences and Technology. The period of data

collection was from August 2011 to October 2011. The assessment of staff

nurses was done while they were in CSICU.

23

3.11 Plan for analysis

After data collection, The investigator decided to organize, tabulate ,summarize

and analyze the data. The data were coded, entered in excel sheet and analyzed

by descriptive statistics like frequency, mean and inferencial statistics using Epi

info Version.

24

Chapter - 4

ANALYSIS AND INTERPRETATION OF DATA

4.1 Introduction

This chapter presents the analysis and interpretation of data collected from thirty

cardiac nursing staff working in CSICU at SCTIMST. Trivandrum. Nurses were

assessed on knowledge of commonly administered drugs in CSICU. Analysis is a

process of organizing and synthesizing data in such away that research questions

can be answered. The over all objective of the analysis is to organize, structure

and elicit answers from the assessment.

Interpretation is the process of making sense of the result and examining the

implication of finding with in the broader content.

The finding of the study were analyzed and arranged under the following

sections.

4.2 Distribution of sample according to demographic data.

4.3 Distribution of sample according to knowledge score.

4.4 Comparison of mean, standard deviation and p value of nurses‟ knowledge

about selected cardiovascular drugs and selected variables.

4.2 Distribution of sample according to demographic data.

Distribution of sample according to age: -

The age of sample ranged from 24 years to 51years with a mean age of 31.63,

standard deviation of 7.61, and median age of 29 and mode of 26.

25

Table 4.1. Distribution of sample according to age category

AGE CATEGORY FREQUENCY PERCENTAGE

24 – 33 22 73. 34 %

34 – 43 4 13.33 %

44 – 53 4 13.33 %

TOTAL 30 100 %

Age categories were made based on the age distribution of sample so as to have

a minimum number under each class. The data given in table 4.1 shows that

majority of samples belonged to the younger age category (24 - 34).

Fig 4.1 The pie diagram showing the distribution of

samples according to age category.

Distribution of sample according to sex:-

Table 4.2 shows the distribution of sample according to sex. There were 27(90%)

females in the sample.

24-33 74%

34-43 13%

44-53 13%

Distribution of sample according to age

24-33

34-43

44-53

26

Table 4.2. Distribution of sample according to sex: -

SEX FREQUENCY PERCENTAGE

FEMALE 27 90%

MALE 3 10%

TOTAL 30 100%

Distribution of sample according to professional qualification.

Data given in table 4.3 shows that 50% of them were GNM and 50% of them are

BSc (N).

Table 4.3 Distribution of sample according to professional qualification

QUALIFICATION FREQUENCY PERCENTAGE

GNM 15 50%

BSc (N) 15 50%

TOTAL 30 100%

Fig 4.2 The pie diagram showing the distribution of sample

according to professional qualifications.

50% 50%

Distribution of sample according to professional qualification

GNM

BSc(N)

27

Distribution of sample according to years of professional experience

Data collected from cardiac nurses in CSICU shows that the year experience

ranged from 1-29 years.

Table 4.4 Distribution of sample according to professional experience

EXPERIENCE FREQUENCY PERCENTAGE

1-10 YEARS 22 73.33%

11-20 YEARS 6 20.00%

21-30 YEARS 2 6.67%

TOTAL 30 100%

Data given in table 4.4 shows that 73.33% have 1-10years of experience, 20%

have 11-20 years of experience and 6.67% have 21-30 years experience.

Distribution sample according to years of Cardiac ICU experience

Data collected from cardiac nurses in CSICU shows that the years of ICU

experience ranged from 0-20 years. Table 4.5 shows that 26 of them have -10

years of experience and 4 of them have 11-20 years of experience in ICU.

28

Table 4.5 Distribution of sample according to ICU experience

ICU EXPERIENCE FREQUENCY PERCENTAGE

0-10 YEARS 26 86.7%

11-20YEARS 4 13.3%

TOTAL 30 100%

Fig 4.3 The pie diagram showing the distribution of sample

according to years of ICU experience

87%

13%

Distribution of sample according to ICU experience

0-10years

29

Distribution of sample according to CPCR training

Data shows that 10 of them have attended CPCR training program and 20 of

them have not attended the CPCR training program.

Table 4.6 Distribution of sample according to CPCR training.

CPCR TRAINING

PROGRAMME

FREQUENCY PERCENTAGE

ATTENDED 10 33.3%

NOT ATTENDED 20 66.7%

TOTAL 30 100%

Fig 4.4 The pie diagram showing distribution of sample

according to the CPCR training.

33%

67%

Distribution of sample according to the CPCR training

Attended

Not attended

30

4.3 Distribution of sample according to percentage of knowledge score about

commonly administered drugs in CSICU among cardiac nurses

There were 15 questions in the knowledge test related to cardiovascular drugs

with the maximum score of fifteen. Total knowledge score obtained ranged from

6-14 with a mean of 10.47, standard deviation of 1.89, median of 10 and mode of

10.

Table4.7 Distribution of sample according to knowledge score

Knowledge in percentage Frequency Percentage of sample

≤ 40% 1 3

41- 60% 7 23

61- 80% 17 57

>80% 5 17

Table 4.7 shows that 3% of the sample had poor knowledge, 23% had average

knowledge, 57% had fair knowledge and 17% had good knowledge about

commonly administered drugs in CSICU.

Fig4.5 The bar diagram showing distribution of sample

according to knowledge score

0%

10%

20%

30%

40%

50%

60%

<40% 41-60%

61-80%

>80%

3%

23%

57%

17%

% of sample

percentage of marks

Distribution of sample according to knowledge score

sample%

31

Percentage of score in the area of knowledge about commonly administered

cardiovascular drugs in CSICU.

The data given in table 4.8 shows the percentage of knowledge score in each

area of knowledge test on cardiovascular drugs. Result of questions given in

appendix shows that the area of lesser knowledge (50%) are the adverse effect of

aspirin ( 30%), time taken for the onset of action of Lasix after oral

administration (30%), adverse effect of amiodarone(43.33%) and treatment

option of hyperkalemia(46.66%).The area of higher knowledge are(≥85%)

contraindication of atorvastatin(93.33%) ,calculation of heparin infusion

rate(96.66%) and drug used in bradycardia (100%).

Table4.8 Percentage of knowledge about commonly administered drugs in

CSICU in each area of knowledge test among cardiac nurses.

N=30

AREA OF KNOWLEDGE FREQUENCY PERCENTAGE

Blood test for calculating daily

dosage of warfarin

25 83.33%

Drug used in bradycardia 30 100%

Treatment option of hyperkalemia 14 46.66%

Drug contraindicated in bronchial

asthma

24 80%

Normal digoxin level 21 70%

Side effect of Verapamil 23 76.66%

Contraindication of atorvastatin 28 93.33%

Effect of low dosage of dopamine 20 66.66%

32

AREA OF KNOWLEDGE FREQUENCY PERCENTAGE

Side effect of amiodarone 13 43.33%

Adverse effect of ACE inhibitors 22 73.33%

Adverse effect of aspirin 9 30%

Time taken for the onset of action of

Tab.lasix

9

30%

Pharmacology of inotropes 24 80%

Calculation of Inj. Adrenaline

infusion rate

23 76.66%

Calculation of heparin infusion rate 29 96.66%

4.4 Comparison of mean, standard deviation and p value of knowledge score

by age group.

Table 4.9 Mean, standard deviation and p- value of

knowledge score by age group.

AGE IN YEARS MEAN STANDARD DEVIATION P VALUE

Young age

≤ 29 years

10 1.93

0.15 Older age

>29

11 1.75

The median was used to divide the group in to two- young age (≤29 years) and

older age (> 29 years).

33

The knowledge score of younger age group ranged from 6 to 14 with a mean of

10 ± 1.93 and that of older age group ranged from 7-13 with a mean of 11 ± 1.75.

Even though the older age group have higher knowledge score, an unpaired „t‟

test showed that the result is not significant.

According to year of experience: -

Table 4.10 Mean knowledge score by year of experience

Year of experience Mean Standard Deviation P Value

Lesser experience <7 years 10.28 1.63 0.63

More experience (≥7 yrs) 10.63 2.13

The knowledge score of less experience group ranged from 8- 13 with mean of

10.28 ± 1.63 and that of high experience group ranged from 6-14 with a mean of

10.63 ± 2.13. An unpaired „t‟ test showed that the high experience group had

insignificantly higher mean knowledge.

According to year of ICU experience:-

Table 4.11 Mean knowledge score by year of ICU experience

Year of experience Mean Standard Deviation P Value

Lesser experience ≤ 2.5 years 9.73 1.49 0.03

More experience (>10 yrs) 11.2 2.01

The knowledge score of less ICU experienced group ranged from 7- 13 with

mean of 9.73 ± 1.49 and that of high ICU experienced group ranged from 6-14

with a mean of 11.2 ± 2.01. An unpaired „t‟ test showed that the high ICU

experienced group had significantly higher mean knowledge.

34

According to gender difference: -

There were 3 male staff and their knowledge score ranged from 9-13. There

were 27 female staff and their score ranged from 6-14. Numbers of male staff

were less. So comparison is insignificant.

According to professional qualification: -

Table 4.12 Mean knowledge score by professional qualification

Professional Qualification Mean Standard Deviation P Value

GNM 10.2 1.74 0.45

BSc (N) 10.73 2.05

The knowledge score of GNM group ranged from 7- 13 with mean of 10.2± 1.74

and that of BSc(N) group ranged from 6-14 with a mean of 10.73 ± 2.05. An

unpaired „t‟ test showed that the BSc(N) group had insignificant higher mean

knowledge.

According to CPCR training programme:-

Table 4.13 Mean knowledge score by CPCR training programme

CPCR Training Programme Mean Standard Deviation P Value

ATTENDED 11.2 1.31 0.14

NOT ATTENDED 10.1 2.05

The knowledge score of nurses who have attended the CPCR training

programme ranged from 9 - 13 with mean of 11.2± 1.31 and those who have not

attended the CPCR programme ranged from 6-14 with a mean of 10.1 ± 2.05. An

35

unpaired „t‟ test showed that there is statistically insignificant higher mean

knowledge score in nurses who have attended the CPCR training programme.

4.5 Summary

This chapter contains distribution of samples according to selected demographic

variables and the association between mean knowledge score and selected

variables.

36

Chapter - 5

SUMMARY, CONCLUSION, LIMITATION,

DISCUSSION AND RECOMMENDATION

5.1 Introduction

This chapter gives a brief account of the present study including conclusion

drawn from the findings and possible application of the results.

Recommendations for further research and suggestion for improving the present

study are also presented.

5.2 Summary

This study was undertaken to assess the knowledge of cardiac nurses about

commonly administered drugs in CSICU, SCTIMST, Trivandrum.

The specific objectives of this study:-

a. To identify the knowledge about commonly administered drugs in

Cardiac Surgical ICU among Cardiac Nurses.

b. To identify the relationship between knowledge levels about commonly

administered drugs in Cardiac Surgical ICU and selected variables.

Need for the study was that many studies done so far revealed that knowledge

of critical nurses on high alert medications is not satisfactory.

Cardiac nurse are responsible for preparing and administering potent drugs that

affects the patients cardiovascular functions. Each nurse should be aware of

indication, action, contraindication, adverse effects and interactions of drug.

37

The investigator‟s experience in cardiac surgical intensive care units in Sree

Chitra Tirunal Institute for Medical Sciences and Technology, shown that the

nurses need to have much knowledge about the highly potent drugs in the unit.

So this study was done to understand nurses knowledge . A self-administered

questionnaire was used for collecting data from 30 samples. Questionnaire had

two parts, first part consists of socio demographic data and second part consists

of 15 questions on cardiovascular drugs. Data collection done from the month of

August 2011 to October 2011, analyzed and interpreted using descriptive and

inferential statistics.

5.3 Limitations

The study was limited to cardiac specialty nursing students and cardiac nurses

working in CSICU in SCTIMST, Trivandrum. The sample size is limited to 30.

5.4 Major findings of the study

This study showed that there was statistically insignificant higher knowledge

score with increase in age, qualification,CPCR training and experience .There

was significant higher knowledge score of staff with increase in ICU experience.

Numbers of male staff were less, so comparison of knowledge by gender was

insignificant.

5.5 Recommendations

Keeping in mind the findings and limitations of the study, the following

recommendations were made for future research.

1. Similar study can be conducted in other intensive care units and wards of

this institute.

2. Similar study can be conducted by increasing the size of the sample.

38

5.6 Discussion

The findings of the study were discussed with reference to the objectives and

with the findings from other studies. The objective of the study were to identify

knowledge about commonly administered drugs in Cardiac Surgical ICU

among Cardiac Nurses and to identify the relationship between knowledge level

about commonly administered drugs in Cardiac Surgical ICU and selected

variables.

In this study 15 items survey includes specific questions regarding

cardiovascular drugs. A total of 30 cardiac nursing staff responded to the

survey. The data given table 4.7 shows that 3% of the sample had poor

knowledge, 23% had average knowledge, 57% had fair knowledge and 17%

had good knowledge about commonly administered drugs in CSICU. Schreiber,

et al (2007), conducted an evidence based practice project to decrease adverse

patient events related to the use of cardiac medications on a post operative

orthopedic unit and also to determine and implement the best nursing practices

for safe cardiac medication administration to these patients. The study

concluded that nurses require continuous education to prevent adverse drug

events. Ndosi and Newell (2009), conducted a study to determine whether

nurses had adequate knowledge on drugs they commonly administer. The study

supported the need for supplementary pharmacology education for nurses in

clinical settings; focusing on common drugs they administer in order to increase

nurses' knowledge and confidence in drug administration and safer medicines

management. Most of the studies concluded that nurses have insufficient

knowledge on high-alert medicines ,also recommended the importance of

educational programme in improving the knowledge. But, results in the present

study shows that majority of nurses (57%) have fair knowledge on cardiac

drugs.

39

5.7 Conclusion

A descriptive study was undertaken to assess the knowledge about commonly

administered drugs in Cardiac Surgical ICU among Cardiac Nurses in

SCTIMST, Trivandrum. The study was conducted in a relatively small sample

of 30 nurses. This study clearly portrays that the majority of nurses had average

or above average knowledge score on commonly administered drugs in CSICU.

However, poor knowledge was seen in 3% of the sample. It is also observed

that higher ICU experience significantly influence knowledge score.

40

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44

APPENDIX

INFORMED CONSENT

I hereby agree to participate in the research study “ A study to assess the

knowledge of cardiac nurses about the commonly administered drugs in cardiac

surgical intensive care unit” conducted by Suchithra.G.Nair, first year Diploma

in Cardiovascular and Thoracic Nursing student of SCTIMST, Trivandrum. I

understand that the data given by me will be kept confidential and be used only

for research purpose.

Place Signature of staff

Date

45

KNOWLEDGE TEST ON COMMONLY ADMINISTERED DRUGS FOR

CARDIAC NURSES IN CARDIAC SURGICAL ICU

SOCIO DEMOGRAPHIC DATA

Note : fill up or tick mark (√) appropriately

1. Age : ― years

2. Sex : Male/ Female

3. Qualification : GNM BSc (N) MSc (N) DCN/PBCN

4. Total years of professional experience: ― years

5. Total years of CCU/CSICU experience : ― years ― months

6. CPCR training programme : Attended / Not attended

Note: encircle (O) the most appropriate answer. Total 15 questions, each

question carries one mark.

1) The nurse is caring for a client receiving Warfarin sodium (Coumadin).

Which test is presently used for calculating the daily dosage of this

anticoagulant?

a) International Normalized Ratio

b) Activated partial thromboplastin time

c) Bleeding time

d) Fibrinogen level

46

2) While cardioversion is being given, the client‟s heart rate drops to

36b/minute. What medication does the nurse expect the physician to order?

a) Digoxin

b) Atropine sulphate

c) Lidocaine

d) Procainamide

3) Which of the following can be the treatment option for hyperkalemia?

a) Glucose plus insulin

b) Furosemide

c) Nebulization with albuterol

d) All the above

4) Which drug is contraindicated in patients with bronchial asthma?

a) Propranolol

b) Clonidine

c) Enalapril

d) Nifedipine

5) The nurse is preparing to administer digoxin to a client. The most recent

serum digoxin level is 2.5ng/ml. Which nursing action is most appropriate?

a) Administer the drug

b) Check the pulse. If it is 60beats/ minute, administer the drug

c) Withhold the drug and administer the regular dose the next day.

d) Withhold the drug and notify the physician.

47

6) A nurse is caring for the client with atrial fibrillation who has received Inj.

Verapamil for rate control. What side effect should the nurse check for?

a) Hypertension

b) Wheezing

c) Hypotension

d) Dysphagia

7) Atorvastatin has been prescribed for a client with an elevated cholesterol level.

The nurse collects the health history from the client, knowing that the medication

is contra indicated in which one of the following conditions?

a) Cirrhosis

b) Hypertension

c) Hypothyroidism

d) Diabetes mellitus

8) A 25-year-old man is noted to be in septic shock. A low-dose dopamine

infusion is administered, and will likely result in which of the following?

a) Decreases cardiac output

b) Decreases systemic blood pressure

c) Increases renal blood flow

d) Produces significant peripheral vasoconstriction

9) When assessing a patient who has been taking amiodarone for 6 months,

which adverse reaction might the nurse identify?

a) Glycosuria

b) Tinnitus

c) Corneal micro deposits

d) Peripheral edema

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10) When a client is being taught about the potential adverse effects of an ACE

inhibitor, which of the following should be mentioned as possibly occurring

when this drug is taken to treat hypertension?

a) Hypokalemia

b) Nausea

c) Dry cough

d) Sedation

11) Which one of the following drugs can result in Tinnitus?

a) Atenolol

b) Aspirin

c) Labetalol

d) Digoxin

12) Which one of the following is a false statement?

a) The maximum dose of dobutamine infusion is 5 mcg/kg/min

b) Isoproterenol has a chronotropic effect

c) Dopamine must be given into a central vein/ large peripheral vein

d) Inj. Adrenaline causes marked bronchial dilatation

13) A client is receiving Tab.Lasix (20mg) twice daily. What is the expected

time of onset of action after oral administration of the drug?

a) Within 1/2 hour

b) Within 1 hour

c) Within 2 hours

d) Within 4 hours

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14 A client has been prescribed with Inj.adrenaline 0.1mcg/kg/minute. Order is

to take 4mg adrenaline in 50ml of 5% dextrose solution.What is the flow rate in

milliliters per hour if weight of the client is 80kg?

a) 2ml/hour

b) 4ml/hour

c) 5ml/hour

d) 6ml/hour

15) A client is receiving 25,000 units of heparin in 50ml of 5% dextrose solution

at a rate of 1.2 ml/hr. What heparin dose is the patient receiving?

a) 600units/hour

b) 800units/hour

c) 1000units/hour

d) 1200units/hour

Answer key:-

1(a), 2(b), 3(d), 4(a), 5(d), 6(c), 7(a), 8(c), 9(c), 10(c), 11(b), 12(a), 13(b), 14(d),

15(a).