Nurses' knowledge of high-alert medications: instrument development and validation.

AIM: This paper is a report of the development and validation of an instrument to measure nurses' knowledge of high-alert medications and to analyse known administration errors.
BACKGROUND: Insufficient knowledge is a factor in nurses' drug administration errors. Most errors do not harm patients, but incorrect administration of high-alert medications can result in serious consequences. Sufficient knowledge about high-alert medications is vital.
METHOD: 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 analyse known administration errors. Snowball sampling and descriptive statistics were used.
FINDINGS: 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 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.
CONCLUSION: The questionnaire was valid and reliable. Evidence-based results strongly suggest 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. Further research to validate the instrument is needed.