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Development and evaluation of a low-fidelity medication administration simulation that generates error as a salient learning experience for first-year nursing students over the long-term

Nurses are taught protocolised checking procedures as the foundation method for safe medication administration practice. However, medication administration occurs in the complex clinical environment and medication administration error is endemic in clinical practice. As a consequence, nurses need further support to administer medications safely. Simulation education is widely used in nurse education and making an error in simulation is one potential method to make salient the importance of protocolised checking procedures in clinical practice. The purpose of this study was to determine if a low-fidelity medication administration simulation which generated error underlined the importance of checking procedures and provided a salient, effective and sufficiently realistic learning experience for nursing students over the long-term. The study was conducted over a three-year period between April 2007 and April 2010. A low-fidelity online medication administration simulation was developed which replicated a hospital-based medication round using paper charts. A preliminary titration study was completed to titrate variables from clinical practice to generate a a ‘right drug, wrong patient’ error was generated if the ‘five rights’ were not applied. In the comparative study, 124 first-year nursing students were randomly allocated to one of three teaching sessions: the simulation session or one of two identical classroom-based sessions in which students made an error external to the simulation but was actively linked to medication administration error. In one of these sessions, participants were informed about the simulation, its underlying theory and rates of error generated. All participants completed a post session questionnaire investigating the impact of their learning experience. In the long-term qualitative interview study, 12 simulation session participants completed qualitative interviews two-years later about their experience of using the simulation. 35% of participants made an error in the simulation. The results of the questionnaire indicated that a combination of the simulation and the classroom-based session comprised the most effective learning format. The majority of qualitative interview study participants considered the simulation and the active experience of error to be a valuable and realistic learning experience. It reinforced the importance of the five rights and the potential risk of error if they are not applied. The active experience of error in the simulation underlined the importance of the five rights and generated affect to provide an effective learning experience which was salient over the long-term. The active experience of error made the simulation sufficiently realistic. Error can make lower-fidelity simulations more realistic and salient over the long-term. Error should be transformed from a useful but passive by-product into an active component of the simulation learning approach.