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Strategy Submission

Medication Variance Report: Authentic Assessment Exercise


Jean Yockey



Associate Professor



The University of South Dakota


Competency Categories:

Quality Improvement, Safety

Learner Level(s):

Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN

Learner Setting(s):


Strategy Type:

General Strategy

Learning Objectives:

Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals.

Demonstrate effective use of strategies to reduce risk of harm to self and others.

Communicate observations or concerns related to hazards and errors to patients, families and the health care team.

Examine human factors as well as commonly used unsafe practices.

Participate appropriately in analyzing errors and designing system improvements.

Foster collaborative partnerships between academic and service settings.

Strategy Overview:

The goal of the strategy is to allow an authentic assessment of the consequences of a medication error. This exercise is completed individually if a student enters an incorrect response to a dosage calculation question on unit exams.
Decreasing medication errors are a major goal of health care institutions. In this activity, a learner meets individually with a faculty member each time a dosage question on a unit exam is answered incorrectly. A variance form from an area institution is adapted for use in the learning setting. Faculty guide learners to consider: • The identification of gaps in dosage calculation knowledge • The importance of reflecting on dosage calculation for reasonableness, i.e. “Does this answer make sense?” • The potential outcomes of a dosage error • The professional communication protocols to follow should a dosage error be made • Accountability for each medication dosage administered

Submitted Materials:

Additional Materials:

Evaluation Description:

This experience does not affect the learner’s exam or course grade, but it does emphasize the consequences of dosage calculations that are wrong. The initial consequence of completing a variance report signifies the importance of any dosage error, in any setting. While the original activity is based on short answer exam questions, the activity can also be used with multiple choice questions. During the 1:1 learner and faculty interaction, both qualitative and quantitative data can be used to assess the activity. Qualitative questions that students have responded to include:

  1. What would be the impact to a client if this error were made in the practice setting?
  2. What preparation will you do to prevent a similar error in the future?
  3. What is your responsibility in administering medications as a student nurse?
  4. What have you learned from this experience?

Quantitative data includes tracking of the number of repeat errors, the specific type of calculation error (conversion, decimal point, etc), and the communication process that would need to be followed in the practice setting (contact charge nurse, notify physician, inform client and client family, etc.).

Outcomes of this experience include: 1. Increased awareness of the actual outcome of dosage errors. 2. The importance of quality improvement tracking devices to prevent future dosage errors. 3. Learner accountability for the dosage calculations that they perform. 4. Collaboration with faculty to identify knowledge gaps in dosage calculation. 5. Learner awareness of communication pathways. 6. Verbalized statements of the need for greater caution when calculating even routine medication doses. 7. Increased accuracy on unit exams for dosage calculation questions.

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