QUILT Conference on Technology-Enhanced Education
Using technology to support learning at a distance
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low
technology strategy for distance learning.
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Background:
2004 - Supplementary nurse prescribing established (Wales)
2007 - Independent nurse prescribing
Jointly planned, administered and delivered by:
• Cardiff School of Nursing and Midwifery Studies
• Welsh School of Pharmacy, Cardiff University
- shared learning between nurses and pharmacists
(N.B. Now Non-Medical prescribing – all healthcare professions)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Pre Nov 2006:
Calculations skills for prescribing were:
• taught in a formal classroom setting
• 25-30% referred at first attempt (mostly nurses)
• additional tutorials required at lunchtimes
• some students required a third attempt
• problems with setting up calculations & with numeracy
• high levels of anxiety (refs: Lerwill, 1999; Glaister, 2007)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Post Nov 2006: - New strategy
• Day 1 – diagnostic assessment and individual feedback
• Individual student directed to appropriate tutorials
• Series of PowerPoint® tutorials with voice commentary
available on Blackboard throughout the course
• Regular support, as required, in person or by e-mail
• Summative written assessment
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Advantages of strategy:
• Not being patronising to those who are already highly
numerate
• Allowing flexible access to the materials in college and
from home
• Providing a non-threatening approach for those with high
anxiety levels
• Offering a low technology, low cost solution with minimal
lecturer time demand
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Tutorial design:
Calculations modelled using:
• Logical sequencing using animation
• Visual mapping using colour
• Audible explanation using voice commentary
- Self test questions with feedback of correct calculation
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
The tutorials:
• Conversion between S.I. units of measurement
• Basic dosage calculations
• Weight and body surface area related dosage
calculations
• Calculation of supply
• Calculation of cost
• Calculation of pump settings
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Demonstration
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Prescribers: Pump setting
Example: A 50kg woman is to receive an infusion of Dopamine at a dose of
4 micrograms/kg/minute. An ampoule of Dopamine containing 200 mg/5ml was
added to 500ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
Step 1: Calculate the hourly dosage the patient should receive in mg/hr
Step 2: Use this answer as the “What we want” value in the formula for
basic dosage calculations to calculate the pump setting
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Calculations for Prescribers: Pump setting
Example: A 50kg woman is to receive an infusion of Dopamine at a dose of
4 micrograms/kg/minute. An ampoule of Dopamine containing 200mg/5ml was
added to 500ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
Step 1: Calculate the hourly dosage the patient should receive in mg/hr
Prescribed dosage rate = 4 mcg/kg/min
= 4 x 50 mcg/min (= 200 mcg/min)
= 4 x 50 (=200) x 60 (minutes in 1 hour) mcg/hour
= 12000mcg/hour
= 12 mg/hour
Prescribed hourly dosage rate = prescribed dosage rate x weight x 60
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Calculations for Prescribers: Pump setting
Example: A 50kg woman is to receive an infusion of Dopamine at a dose of
4 micrograms/kg/minute. An ampoule of Dopamine containing 200mg/5ml was
added to 500ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
(N.B Step 1 answer= 12 mg/hour)
Step 2: Use the formula for basic dosage calculations to calculate the pump setting
what we want X what it’s in
what we’ve got
OR prescribed dose X quantity it’s
dispensed dose
contained in
12 mg/hr x 505 = 30.3 = 30 ml/hr
200
Answer: 30 ml/hr
.
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Calculations for Prescribers: Pump setting
Now test yourself by trying these questions.
a) A 100kg man is to receive an infusion of drug X at a dose of 3 micrograms/kg/minute.
An ampoule of drug X containing 100mg/5ml was added to 250ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
b) A 25kg child is to receive an infusion of drug Y at a dose of 4 micrograms/kg/minute. An
ampoule of drug Y containing 100mg/5ml was added to 500ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
c) A 70kg woman is to receive an infusion of drug Z at a dose of 5 micrograms/kg/minute.
An ampoule of drug Z containing 250mg/5ml was added to 500ml of Sodium Chloride 0.9%.
At what rate (ml/hr) should the pump be set to give the correct dose?
Now click for the next slide to check your answers.
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Outcomes:
Results Summary - Pharmacists
Diagnostic
score
/ 20
No. of
students
(n = 13)
Average no.
of tutorial
visits (range)
Summative
score
20
9
2.6 (0 – 9)
20
19
4
3.3 (0 – 7)
20
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Outcomes: Results Summary - Nurses
Diagnostic score
/ 20
No. of students
(n = 17)
Average no. of
tutorial visits
Tutorial visits
- range
Summative score
20
1
2
-
20
19
2
3
2-3
20
18
2
16
3 - 28
20
17
2
6
6
17 / 20
16
1
2
-
20
15
1
5
-
20
14
4
8.8
4 - 15
20
13
2
3
3
20
10
1
4
-
18
6
1
14
-
19
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Scattergram – Improvement in score v No. of tutorial visits
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Tutorial visits – spread over duration of course
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Tutorial visits – No. of hits v Hour of day
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
Tutorial visits – No. of hits v Day of week
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter
Calculations for Non-Medical Prescribing:
The successful development of a flexible, low technology
strategy for distance learning.
References:
•
Bruner J. S. (1975) Toward a Theory of Instruction. Cambridge. Belknap / Harvard.
•
Collins A., Brown J. S. Newman S. (1989) Cognitive Apprenticeship: Teaching the Crafts of Reading, Writing and
Mathematics. In: Resnick L. (ed) Learning and Instruction. Essays in honour of Robert Glaser. New Jersey:
Lawrence Erlbaum Associates.
•
Glaister K. (2007) The presence of mathematics and computer anxiety in nursing students and their effects on
medication dosage calculations
Nurse Education Today; 27: 341-347.
•
Lerwill C.J. (1999) Ability and attitudes to mathematics of post-registration health-care professionals. Nurse
Education Today; 19: 319-322.
•
Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers (Online).
Available at: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1645 (Accessed 16 January 2009).
•
Piaget J (1970) The Science of Education and the Psychology of the Child. New York: Orion Press.
•
Royal College of Nursing (2008) Nurse Prescribing (Online). Available at :
http://www.rcn.org.uk/aboutus/wales/from_the_directors_office/nurse_prescribing (Accessed: 16 January 2009).
•
Warburton P. and Kahn P. (2007) Improving the numeracy skills of nurse prescribers. Nursing Standard; 21: 28,
40-43.
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
George McWhirter