Date of Award

2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Richard Fehring

Second Advisor

Margaret Bull

Third Advisor

Claudia Nassaralla

Abstract

The purpose of this study, guided by Donabedian's structure-process-outcome model, was to evaluate if a cognitive-behavioral education intervention would decrease medication transcription errors among professional nurses when admitting patients 65 years of age or older on 5 or more prescribed medications to a hospital. The conceptual framework for this study is derived from Donabedian's structure-process-outcome health model. The premise suggests improving the structure or process of a system can improve health outcomes. My intervention (cognitive behavioral education), specifically influences the process of medication history obtainment which improved medication error score. In this study, a randomized intervention design was used where professional nurses were asked to complete a medication admission list on patients' 65 years of age or older on 5 or more prescribed medications. Medication error scores were calculated by advanced practice nurses who were trained on medication reconciliation. A second medication list was obtained from the nurses after an intervention group was provided with a cognitive-behavioral education intervention. The control group completed admission medication lists as usual. The medication error score was compared between the intervention and control group. There was no significant difference in medication error score for the pre-test control (M=3.54, SD=3.51) and pre-test intervention groups (M=3.54, SD=2.89), t=.00, df= 50, p = 1.00, (two-tailed). An independent-samples t-test was conducted to compare the medication error score for the post-test control and post-test intervention groups. There was a statistically significant decrease in medication error score from the post-test control group (M=3.23, SD 3.34) to the post-test intervention group, (M=.69, SD=1.49), t=3.54, df=50, p=.001 (two-tailed). Professional nurses are responsible for admission medication lists in many hospital systems. By improving the process by which nurses obtain medication lists medication errors are reduced and patient safety improved.

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