MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF NURSING RESEARCH PROPOSAL TITLE

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

RESEARCH PROPOSAL
TITLE: KNOWLEDGE ON DRUG ADMINISTRATION AND DOSAGE CALCULATION AMONG UNDERGRADUATE NURSING STUDENTS AT MUHAS.
NAME: ISAKA HAROUN MLIMBO
REG NO: 20115-04-08723
PROGRAM: BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: DR TECLA
COURSE COORDINATOR: DR. LILIAN MSELLE

18 JUNE 2018

TABLE OF CONTENTS
TITLE—————————————————————————————————- —-i
CHAPTER ONE: INTRODUCTION ——————————————————————–1
1.1.Background———————————————————————————————–1
1.2. Problem statement————————————————————————————–2
1.5. Objectives—————————————————————————————— —–3
1.5.1. Broad objectives——————————————————————————– —–3
1.5.2. Specific objectives—————————————————————————– —-3
1.6. Research question————————————————————————————-4
1.7. Research hypothesis———————————————————————————–4
1.8. Conceptual framework of the study—— ———————————————————–5
1.7.1. Description of the conceptual framework of the study——————————————6
1.7.2. Independent and dependent variables———————————— ———————–6
CHAPTER TWO: LITERATURE REVIEW———————————————————-7
REFERENCES———————————————————————————————10

CHAPTER ONE: INTRODUCTION
1.1. Background
The administration of medication or drugs is a complex process that consists of participation of three professionals: physician, nurse and pharmacist (Abdullah, Mohammed, & Ismail, 2014) . Safety considerations are paramount in drug administration (Savage, 2015). Nurses common notion has been that the nurses’ involvement in medication management is quite simple: giving the Right patient the Right drug in the Right dose and Right administration form at the Right time (Feleke, Mulatu, ; Yesmaw, 2015).

It is becoming increasingly difficult to fully maintain patients’ safety during the process of drug administration (Alemu, Belachew, & Yimam, 2017).This is due drug administration errors which are caused by several factors. Drug administration errors are caused poor dosage calculation skills, administration of wrong drug, wrong route, wrong patient, inappropriate speed of administration of drugs, and wrong documentation (Feleke et al., 2015; Savage, 2015)

A systematic review on medication errors in Middle Eastern countries report revealed that incidence rates were between 11% to 90% (B. et al., 2016). Similarly in South East Asian countries revealed that the error rates were between 15.2% to 88.6% (Salmasi, Khan, Hong, Ming, & Wong, 2015) .In Indonesia incidence of medication errors were 20.4% ,Drug administration error were most frequent medication errors identified 59% where errors in documentation were the most common form of drug administra¬tion errors (Ernawati, Lee, & Hughes, 2014).this statistics prove that knowledge on drug administration is inadequate.

In Africa drug administration error have been reported in Ethiopia on a study conducted on 2014 where the incidence was 56.4 %, The majority of errors (87.5 %) was due to documentation error, (Feleke et al., 2015).

In a study conducted in Durban South Africa revealed that 24% of staff members were unable to complete all medical calculations correctly, while 44% were unable to answer three or more questions correctly (Gokhul, Jeena, & Gray, 2016). This statistics shows low knowledge on dosage calculation among staff members.

In East Africa, a study conducted in Kisii hospital showed that medication errors rate was 75.8 % (Nanyama & Pharm, 2014) the most frequent type of drug administration errors were due documentation errors 73.9 which support the finding obtained in the studies conducted in Indonesia and Ethiopia (Ernawati et al., 2014; Feleke et al., 2015; Nanyama & Pharm, 2014), This statistics suggest that knowledge drug administration is low and nurses to do not follow 10 Rights of drug administration.

In Tanzania, little is known about the level of knowledge on drug administration and dosage calculation among nurses and students because few studies were conducted .a study conducted in St.john University revealed that dose-calculation skills were inadequate in nursing staff who participated in a dosage calculation test. In an educational audit, Tanzanian nurses and nursing students also experienced difficulties with mathematically calculating medication dosages (Savage, 2015).

1.2. Problem statement
Knowledge on the administration of IV medications was average was over 50% of the nurses did not understand that the rate of slow bolus IV medication administration should be longer than one minute, and specific to the types of medications ( Shamsuddin & Shafie, 2012).

Inadequate knowledge on drug administration results to drug administration errors which are the most prevalent cause of Medication errors which is the worldwide problem. Drug administration errors accounts about 56.4 % where majority of errors 87.5 % was due to documentation error, followed by technique error 73.1 % and time error 53.6 % .Drug administration involves administering drug at the wrong time (24.0%), dosage errors (16.8%), and administering drug to the wrong patient (13.8%). (Fathi et al., 2017; Feleke et al., 2015)

Drug administration errors are among the top common causes of injuries to the hospitalized patients (Alemu et al., 2017).The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay (Feleke et al., 2015).

Nurse educators should be active in identifying issues that affect patient safety, involved in monitoring and developing policies and guidelines, and be conversant with the clinical realities so that relevant issues are addressed, comprehensive total quality management programmes must and to ensure that all students who qualify to become practicing nurses are competent in drug administration and dosage calculation (Savage, 2015). Mathematical competency and dosage calculation skills play an important role in safe drug administration ,should be acquired during the school years (Özyaz?c?o?lu et al., 2018)

It is very important to conduct this study in Tanzania so as to identify the factors associated with the knowledge on drug administration and dosage calculation, and to compare them with the factors mentioned in the literature. Also many studies conducted based on the knowledge on drug calculations and few studies have been conducted in Tanzania so little is known about the knowledge of drug administration and dosage calculations.

1.4. Research goal
To reduce drug or medication administration errors and promoting patient safety.

1.5. Objectives
1.5.1. Broad objectives
The objective of this study is to determine the knowledge on drug administration and dosage calculations among undergraduate nursing students at MUHAS before March 2019.

1.5.2. Specific objectives
1. To assess the level of knowledge regarding drug administration among undergraduate nursing students at MUHAS.
2. To assess the level of knowledge regarding dosage calculations among undergraduate nursing students at MUHAS.
3. To find out the association between the year of study and the level of knowledge regarding drug administration and drug dosage calculation among undergraduate nursing student at MUHAS.

1.6. Research question
1. What do the undergraduate student nurses know about Drug administration and dosage calculations?
2. Is the any relationship between the year of study and the level of knowledge on Drug administration and Dosage calculations?

1.7. Research hypothesis
1. Undergraduate nursing students with good clinical attendance are more likely to have more knowledge on Drug administration and dosage calculation than those with poor attendance.
2. Undergraduate nursing students with more clinical experience are more likely to have more knowledge on Drug administration and dosage calculation.

1.8. Conceptual framework of the study
This conceptual framework has been constructed with reference to different literatures that describe the factors affection the knowledge on drug administration and dosage calculations.

Social demographic data

1.7.1. Description of the conceptual framework of the study
The figure above shows both dependent and independent variables of the study. The dependent variable is knowledge on drug administration and dosage calculation. The independent variables are social demographic factors and university curriculum, special training attendance, year of study, mathematical skills, and experience. Therefore, the independent variables have a direct influence on the dependent variable, whenever the social economic factors and university curriculum, special training attendance, year of study, mathematical skills, and experience are stable the level of knowledge on drug administration and dosage calculation increases. Hence Drug administration errors are reduced and patient safety is increased.

1.7.2. Independent and dependent variables
The independent variables of this study are social-economic factors such as Age, sex, marital status and other factors such as university curriculum, clinical attendance, class attendance, year of study, special training , mathematical skills, student to staff interactions, and working experience(In-service). The dependent variable of this study is the knowledge on drug administration and dosage calculations.

CHAPTER TWO: LITERATURE REVIEW
Overview
An audit educational in study of St.john University aimed at conducting an educational audit on drug dose calculation learning in a Tanzanian school of nursing. A total of 268 registered nurses and nursing students in two year groups of a nursing degree programme were the subjects for the audit; they were given a pretest, then four hours of teaching, a post-test after two weeks and a second post-test after eight weeks .it was found that there was significant improvement in the first pretest. A study revealed that dose calculations skills were in adequate among staff nurses (Savage, 2015). This suggests that knowledge on drug administration and dosage calculation is in adequate.

Knowledge on medication administration
According to a study conducted on 4 head nurses and 242 staff nurses (246 totals) in Universiti Kebangsaan Malaysia Medical Centre to determine knowledge levels of nurses with regards to preparation and administration of IV medications. It was found that Mean correct scores for knowledge among head nurses and staff nurses were 12.5 ± SD 2.1 and 10.3 ± SD 2.6 respectively ,Less than 50% of respondents obtained correct answers for calculation and dosing of IV medications (Shamsuddin & Shafie, 2012) .Indicating average knowledge drug administration.

A descriptive research study conducted at the different Critical and Intensive Care Units at El-Manila Specialty Hospitals affiliated to Cairo University , Sample consists of sixty bedside male and female nurses who are working in the different Critical and Intensive Care Units. Study aimed to assess the nurses’ knowledge and practices about administration of medications via nasogastric tube (NGT) among critically ill patients at Cairo University Hospitals. Majority of the studied sample were females, married and having diploma qualification as well, more than two third of them their age ranged between 26 – 45 years. More than half of them had more than 10 years of experience. It was found that all of them scored less than 75% which mean were having an unsatisfactory level of knowledge and practices (Abdullah et al., 2014).

Knowledge on dosage calculation
Study aimed at compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2) Underwent a multiple choice test in pharmacology, drug management and drug dose calculations. It was found that the knowledge among the nurses was found to be superior to that of the students: 68.9% and 61.5% correct answers, respectively, (p