Development and evaluation of nursing practice guidelines for administering high-alert medications in patients with post open-heart surgery at surgical intensive care unit
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Abstract
Abstract
This research and development study aimed to develop and evaluate nursing practice guidelines for the administration of high-alert medications in post–open-heart surgery patients in a surgical intensive care unit. The guidelines were developed based on the evidence-based framework of the National Health and Medical Research Council (NHMRC) and implemented in two phases: guideline development and effectiveness evaluation. Participants included 11 registered nurses who completed a four-month specialized short course in cardiac postoperative nursing and 30 patients who had undergone open-heart surgery. The guidelines were validated for content with a Content Validity Index (CVI) of 0.91. Research instruments included questionnaires assessing nurse satisfaction (Cronbach’s α = 0.87), perceived ease of use (α = 0.89), feasibility of implementation (α = 0.97), and nurse knowledge assessed using the Kuder-Richardson Formula 20 (KR-20 = 0.83). Data were analyzed using descriptive statistics and the Wilcoxon Signed Ranks Test.
The developed guidelines comprised three core components: (1) assessment of prescribed high-alert medications for intravenous administration, (2) nursing practices for administering multiple high-alert medications concurrently via intravenous routes, and (3) evaluation and monitoring of clinical outcomes, including the occurrence of medication-related adverse events and complications. Following implementation, all participating nurses reported high satisfaction levels, perceived the guidelines as easy to use, and were able to apply them in practice. Post-intervention knowledge scores were significantly higher than pre-intervention scores (p < .01). Notably, no patients experienced medication-related complications. These findings indicate that the guidelines contributed to improving the quality and safety of high-alert medication administration and demonstrate potential for broader application in other postoperative surgical populations.
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