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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. QUILT Conference on Technology-Enhanced Education. George McWhirter. Background:

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QUILT Conference on Technology-Enhanced Education

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  1. 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. QUILT Conference on Technology-Enhanced Education George McWhirter

  2. 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) Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

  3. 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) Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

  4. Post Nov 2006: 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 Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. - New strategy George McWhirter

  5. 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 Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

  6. 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 Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

  7. 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 Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

  8. Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. Demonstration George McWhirter

  9. 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 Calculations for Prescribers: Pump setting

  10. 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 50mcg/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 Calculations for Prescribers: Pump setting

  11. 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 wantXwhat it’s in ORprescribed doseXquantity it’s what we’ve got dispensed dosecontained in 12 mg/hrx505 = 30.3 = 30 ml/hr 200 Answer: 30 ml/hr . Calculations for Prescribers: Pump setting

  12. 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. Calculations for Prescribers: Pump setting

  13. Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. Outcomes: Results Summary - Pharmacists George McWhirter

  14. Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. Results Summary - Nurses Outcomes: George McWhirter

  15. 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 George McWhirter

  16. Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. Tutorial visits – spread over duration of course George McWhirter

  17. 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 George McWhirter

  18. 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 George McWhirter

  19. 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 calculationsNurse 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. Calculations for Non-Medical Prescribing:The successful development of a flexible, low technology strategy for distance learning. George McWhirter

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