Leslie Catalano

Scholarly Project Advisor: Marilyn A. Prasun, PhD, CCNS, CNL, CHFN, FAHA
Carle BroMenn Medical Center Endowed Professor
Mennonite College of Nursing at Illinois State University

Affiliated Organization where the project occurred: Lincoln Land Community College, Springfield, IL

Any Funding you received for the Project: None

External Dissemination of the Project:

• Faculty Meeting, May 14, 2025
• Submitted to Journal of the Organization for Associate Degree Nursing

Introduction/Problem

Medication errors continue to occur in hospital settings each year (Illinois Department of Public Health, 2023; United States Food & Drug Administration, 2019). Nursing students are at a particularly high risk of making medication errors during clinical rotations due to limited knowledge and skills related to safe medication administration (Silvestre & Spector, 2023). External factors such as distraction and fatigue also contribute to these errors (Gunes et al., 2020; Kim & Lee, 2022; Shohani et al., 2018). To improve student success and promote patient safety, this project explored the use of simulation, a ten-rights of medication administration checklist, “Passing Medication” badges, and quiet zones as strategies to reduce medication errors.

Methods

This quality improvement (QI) initiative was implemented in an associate degree nursing (ADN) transitional program using pre- and post-intervention surveys. Two cohorts were created in the transitional ADN second semester: Cohort A and Cohort B. In Fall 2024, data was collected from Cohort A, including weekly evaluations, compliance with the ten rights of medication administration, and patient satisfaction surveys.

In Spring 2025, Cohort B participated in three simulations related to safe medication administration. During these activities, a pre- and post-intervention Medication Safety Knowledge Assessment (MSKA) was administered to evaluate learning. An observation tool, the Medication Safety Critical Element Checklist (MSCEC), was also used during simulation experiences to assess students’ strengths and areas needing improvement.

Students received education on the ten rights of medication administration and were provided with a checklist to use as at clinical as a reminder. They were also educated about the risks of distraction during medication administration and given “Passing Medication” badges to reduce side conversations. Quiet zones were established to reduce distraction during medication preparation.

Following these interventions, weekly evaluations, checklist compliance, and patient satisfaction surveys were measured again and compared with Cohort A data.

Findings

The MSKA results demonstrated an improvement in medication safety knowledge after the simulation activities. The MSCEC showed students were successful in hand hygiene and medication preparation but needed improvement in confirming patient allergies and taking verbal or telephone orders from providers.

Weekly evaluations suggested an improvement in students' ability to safely administer medications in clinical settings. However, compliance with the ten-rights checklist declined, with many students failing to provide education or advice during medication administration. Patient satisfaction scores also declined, possibly due to reduced communication during medication administration.

Practice Implications

Overall, this QI project suggests that simulation-based education, combined with tools such as the ten-rights checklists, “Passing Medication” badges, and quiet zones, may help reduce medication errors and near misses while improving nursing student success. As a pilot study further research with a larger sample is recommended. Additionally, this project highlighted the need for future education focused on improving communication with patients and providers during medication administration.