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Medication errors are one of the primary causes of patient mortality and morbidity and a costly problem in hospitals. Although healthcare organizations have endeavored to reduce medication errors by using several tools and techniques. It is important for healthcare sectors to employ an appropriate process excellence methodology to reduce the number of medication errors and to prevent them, which will save costs and quality of care. Six Sigma is one of the most powerful methodology widely adopted by many health care companies today. The authors argue that this methodology are equally applicable in reducing errors within the medication process.
Six Sigma use appropriate tools from their toolboxes to improve medication process. This paper will present the benefits, challenges, and tools and techniques of Six Sigma in reducing medication errors. The paper is valuable for healthcare practitioners and professionals as a guideline to achieve the optimal benefit of Six Sigma DMAIC implementation to prevent medication errors. Moreover, the paper also provides a greater awareness for senior managers and medical directors in hospitals about the role of Six Sigma and its associated tools and techniques in tackling medication errors.
Therefore, the present study was undertaken by the researcher with aim to assess the effectiveness of Six Sigma training module on knowledge and skills of nurses regarding prevention of medication errors at selected hospitals of Pune city.
A quantitative research approach was adopted for the study with Non-equivalent pre-test post-test control group design. The independent variable of the study was Six-sigma training module and dependent variables were knowledge and skills of staff nurses regarding prevention of medication errors. The study was conducted at Sahyadri hospital Pune, Maharashtra, India. Non-probability purposive sampling technique was used to obtain an adequate size (208) of sample and they were assigned to the groups (control & experimental). Every odd number was allotted to control group and every even number was allotted to experimental group. The sample comprised of 104 participants in each experimental and control group.
To obtain necessary data for the study, the tools developed and used for data collection were a structured knowledge questionnaire, and skills assessment check list. Research tool was divided in three sections. Structure questionnaire had two Sections (section I consisted of 7 items concerned with socio demographic data including the code no. and section 2 comprised of 42 knowledge questions).
The skill assessment checklist is divided into 2 parts- Part A included 18 items, having 4- point checklist based on hospital work area/unit and staff strength. Part B includes 12 items based on working sty of nurses in hospital, organizational behavior and communication with staff work in hospital.
The collected data were organized, analyzed and interpreted in terms of objectives and hypothesis of the study. Both descriptive and inferential statistics were used to analyze the data. The statistical tests employed were mean, standard deviation, ‘t’ test, ‘z’ test, Pearson’s coefficient of correlation and Fisher’s exact test.
The major findings of the study revealed that initially (in pre-test) the experimental and control group didn’t differ in terms of their knowledge level as both falls under the category of average to poor. Similarly, Majority of the samples in pre intervention skill in both experimental and control group had low level of competency. The mean post-test knowledge score of the experimental group was significantly higher than their mean pre- test knowledge score. Majority of staff nurses i.e., 86.5 % had good knowledge (Score 29- 42) and no one belongs to poor knowledge (Score 0-14). In post intervention skill, in experimental group majority of staff nurses i.e., 92.3% had high level of competency (Score 61-90), 7.6 % had average level of competency (Score 31- 60) and none of the participant had poor level of competency (Score 0-30).
The Six-sigma training module has improved the knowledge of staff nurses regarding prevention of medication errors in experimental group as evident by ‘t’ value 23.03 with 103 degrees of freedom and corresponding p<0.05 which shows that there is a strong evidence against the null hypothesis.
The Six-sigma training module has improved the skills of staff nurses regarding prevention of medication errors in experimental group as evident by ‘t’ value 22.6 with 103 degrees of freedom and corresponding p<0.05 which shows that there is a strong evidence against the null hypothesis.
The pre-intervention knowledge and skills of staff nurses regarding prevention of medication error were tested for correlation, where it was found that the correlation was weakly negative but significant as evident by Pearson’s correlation coefficient formula and the value was found to be -0.255. Strength and significance of this correlation was tested using t-test with value 75.6 with 206 degrees of freedom at p>0.05 (0.710). This was evident that statistically there is a weak correlation between pre intervention knowledge and skills of staff nurses regarding prevention of medication errors.
The post-intervention knowledge and skills of staff nurses regarding prevention of medication error were tested for correlation, where it was found that the correlation was weakly positive as evident by Pearson’s correlation coefficient formula and the value was found to be 0.32. Strength and significance of this correlation was tested using t-test with value 35.4 with 206 degrees of freedom at p<0.05 (0.032). This was evident that statistically there is a weak positive correlation between post intervention knowledge and skills of staff nurses regarding prevention of medication errors.
Fisher’s exact test was used to test the association between knowledge regarding prevention of medication error and socio-demographic variables. It was found that that except experience of staff nurses rest all the demographical variables were not associated with the knowledge. The same demographic variables were also tested for association with the skills of staff nurses and found that that except experience and age of staff nurses rest all the demographical variables were not associating with the practice.
On the basis of the study the final conclusions have been drawn that the staff nurses possess low level of knowledge and low competency skills in pre intervention which were significantly raised in Post- intervention period. Those who were exposed to Six-sigma skill training module were significantly attained more knowledge and high level of competency regarding prevention of medication errors than those who were not exposed to the Six-sigma skill training module. That concludes that there is a gap in the training given to them. The staff nurses though assumed to be well trained as per the qualification mandates still requires an updates and trainings rather than the traditional lecture cum discussion methods.