SP2 A study to assess how nurses use the paediatric medusa monographs and identify areas for improvement
Authors: Nanna Christiansen , Heather Calvert , Adeeba Zaman 
Published: January 2018

Aim

The Injectable Medicines Guide (IMG), also known as Medusa, is a web-based resource which contains over 400 monographs for medicines given by the intravenous (IV) route.1 Since 2013 paediatric specific monographs have been developed and many of these are now used in paediatric units across the UK.

The aim of this study was to assess the usability of the Medusa monographs from the paediatric nurse perspective.

To understand how paediatric nurses use monographs and what problems they encounter.

To assess nurses perceptions of the monographs and the website.

To identify areas for improvement.

Method

A mixed-mode survey was distributed to paediatric nursing staff, both electronically using Qualtrics and by paper. Data was collected over a 2 week study period across 3 paediatric hospitals.

The survey consisted of open and closed questions. Open questions allowed comprehensive responses to be obtained and capture any areas of improvement. Likert scale based questions were used in order to determine the perceived importance of issues highlighted in a previous orientation study. SPSS statistical software was used for analysis of the survey.

Results

Sixty nurses completed the survey and 34 nurses (60%) stated that they were overall satisfied with the monographs. Of the 60 participants, 54 (90%) reported that they use Medusa as a first line resource for IV administration but only 34 (58%) use it prior to every intravenous medicine they administer. Most nurses access the monographs on line (n=50; 86%), followed by using a printed copy in the patient record (n=33; 57%).

Looking at the content of the monographs, 36 nurses (61%) agreed that the dilution instructions were clear while 17 (29%) disagreed. Only 32 nurses (54%) felt that the reconstitution instructions were clear and 33 nurses (56%) agreed that the monographs were easy to follow.

Eleven nurses (19%) found the monographs too detailed, and 20 nurses (34%) found Medusa more time-consuming to use compared to other resources. This was thought to be due to problems with access and the need to refer to other resources, such as local guidelines and the BNFc as dosage information is not provided in the monographs. The majority (n=50, 84%) of nurses agreed that the monographs should include dosage information. The distribution of this was hospital dependent, with the hospital providing the highest number of survey responses having used in house monographs with dose information previously.

Conclusion

The Medusa monographs are used as a first line resource for IV administration and received an overall satisfaction rate of 60% by nurses. While the clarity of instructions, layout and the time-consuming nature of the monographs are definite areas of improvement, the greatest concern is the exclusion of medication doses. Improvements in layout are needed based on this feedback and easier access to dosing information should be considered.

Reference

Keeling S, Burfield R. The injectable medicines guide website. Br J Nurs 2010;19:25–28.