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Nurses may find themselves in various situations where usual equipment is not available and manual calculation skills are needed, such as in disasters. Nurses require continuing education regarding dosage calculation skills to build confidence and ensure effective and safe patient care.
A disaster is a sudden manmade or natural calamity that causes great loss of life, damage, or hardship (Dictionary. com, n.d.). In 2017, weather-related disasters cost the United States $306 billion, almost double the amount in 2016 (Bowden, 2017). Although 2017 was the deadliest year for weather-related disasters in the United States, experts warn disasters will become more frequent and severe as the climate warms (Irfan & Resnick, 2018; The Data Team, 2017).
Nurses are essential and obligated responders to all types of disasters (American Nurses Association, 2010; Pourvakhshoori, Norouzi, Ahmadi, Hosseini, & Khankeh, 2017). Nurses often calculate drug dosages and infusion rates during power outages and with limited or no cellular phone service during disasters (Vandevanter, Raveis, Kovner, McCollum, & Keller, 2017). In these situations, nurses may be required to perform quick calculations without smartphone applications and smart infusion devices ordinarily used to prevent errors. The purpose of this article is to provide a user-friendly problem-solving approach for nurses to use to calculate drug dosages and infusion rates manually with confidence during disasters. A review of common computational methods also is provided.
Problem-Solving Approach
Nurses commonly make conversion, computation, and conceptual errors when calculating drug dosages and infusion rates (Hurley, 2017). Memorizing conversions or keeping a list of conversions within reach can reduce conversion errors. Use of calculators can reduce computation errors. However, accurate manual calculation of drug dosages and infusion rates requires nurses to conceptualize and compute problems correctly. Conceptualizing a problem involves understanding what the nurse is being asked to do and preparing the calculation to obtain the correct answer (Wright, 2013). Conceptual errors are more serious because these processes determine computational method used, answer obtained, and nurse's evaluation of the answer's clinical appropriateness.
Fleming, Brady, and Malone (2014) evaluated nurses' (n=124) competency in medication calculations at the start of their employment at several hospitals. They found the most common calculation errors occur with drip rates (mean score 36%), then metric conversion (mean score 64%). Errors in dosage calculations were...