Investigation And Analysis On Recognition Of High-alert Medications Of Physician's Advice Among Clinical Nurses From Grade Three And First-class Hospital In Chongqing Municipality

ObjectiveTo investigate the recognition of physicians' advice about high-alert medications among clinical nurses from grade three and first-class hospitals in Chongqing Municipality,and to analyse relevant training requirements by analyzing the influencing factors of nurses' recognition of physicians' advice of high-alert medications,and the training program that meet the demand of nurses' recognition of physicians' advice of high-alert medications.The purpose was to provide some valuable reference for taking effective training program by nursing managers and thus promoting the improvement of nurses' recognition of physicians' advice,as well as improving patient safety.MethodsThis study applied a self-designed questionnaire,which was developed according to Delphi technique.The questionnaire included general data(10 items),self-designed tests about the nurses' recognition of physicians' advice about high-alert medications(12 items)and training requirements of effectively improving the recognition of physicians' advice(3 items).3029 clinical nurses with Practicing Nurse Certificate were randomly involved in this study,who were all formal employees in 8 grade three and first-class hospitals in Chongqing during the survey.The database was established using the Epi-data 3.1 software,and SAS version 9.2(SAS Institute Inc,Cary,NC)was applied to sorting,cleaning,and analyzing the data in the present study.Analysis of variance,Rank-sum test and SNK test were employed to describe and test the results.Results1 More than 90% of the nurses in the study can correctly recognize the physicians' advice of adrenaline hydrochloride injection,10% potassium chloride injection,deslanoside injection,sodium nitroprusside for injection and concentrated sodium chloride injection.In addition,the accuracy rate of diazepam injection test,amiodarone hydrochloride injection test and dopamine hydrochloride injection test was very low,compared with other test.The accuracy rate of dopamine hydrochloride injection test was only 28.55%.2 In the study,nurses' recognition of physicians' advice of high-alert medications in gender,department,working time and annual income was statistically significant.However,the difference in education,technical title,administrative rank,participation in teaching work,hospital nature,and age had no statistical significance.(1)Male and female clinical nurses' recognition of physicians' advice of high-alert medications was statistically significant.Female nurses got higher score than male nurses(P<0.10).(2)For clinical nurses who have worked for different period of time,the recognition of physicians' advice of high-alert medications was statistically significant.The nurses who have worked for 11 to 30 years got higher score than the nurses who have worked for less than 1 year(P<0.10).(3)For clinical nurses from different departments,the recognition of physicians' advice of high-alert medications was statistically significant.The nurses from internal medicine,surgery,emergency and ICU got higher score than the nurses from the operating room.And the nurses from other departments got higher score than the nurses from obstetrics and gynecology(P<0.10).(4)For clinical nurses with different annual income,the recognition of physician's advice of high-alert medications was statistically significant.The nurses whose annual income is 50,000-100,000 yuan got higher score than the nurses whose annual income is less than 50,000 yuan(P<0.10).3 80% of the nurses were able to recognize 11 out of the total 24 wrong advices.But only 6.88% of the nurses chose the correct cause for the wrong advice the adrenaline hydrochloride injection dose error,24.65% of the respondents chose the correct cause for the wrong advice the dopamine hydrochloride injection dose error,31.79% of the respondents chose the right cause for the wrong advice the concentrated sodium chloride injection dose error.4 The clinical nurses in the study chose the training program for improving the recognition of physicians' advice.Over 50% of the nurses thought that students clinical practice,pre-job training,training within the first year of work and irregularly training in the following years were the important training period;Over 50% of the nurses thought that theory teaching,case-based learning,situational teaching,practical operating and teaching rounds were the effective forms;and over 50% of the nurses thought that theoretical knowledge related to physicians' advice,basic knowledge of nursing,specialty knowledge,knowledge of laws and regulations and pharmacological knowledge were the important training content.Conclusion1This study objectively revealed recognition level of high-alert medications by clinical nurses from grade three and first-class hospitals in Chongqing was not high and a certain percentage of the nurses couldn't correctly choose the right advice for most common indications,and also couldn't choose the cause of the wrong advice correctly.2 Clinical nurses from grade three and first-class hospital in Chongqing with different characteristic had different abilities of recognition of high-alert medications.3 It is recommended that standardized advice recognition management organizations should be set up and standard training plan should be considered to promote nurses' professional identity,consequently improving patient safety.