The Modified Medication Administration Safety Assessment Tool (Modified MASAT)

Return to Foundations RELEASE Lab homepage

ORGANIZERS

ABSTRACT

An estimated 7,000 to 9,000 deaths related to medication administration errors (MAE) occur each year in the United States (Tariq et al., 2022). Additionally, there is an economic impact estimated at $42 billion USD annually (Donaldson et al., 2017). Imparting consistent safety processes for medication administration to student nurses, and evaluating their performance with a standardized measure, is an integral part of nursing education (Sears et al., 2010). A review by Sulosaari et al. (2012) described the difficulty that both nursing students and initial licensure nurses have with the complex processes of medication safety and presumed a connection to higher incidence of MAE in hospitalized patients.

Goodstone and Goodstone (2013) developed a set of metrics to use in simulation-based experience (SBE) known as the Medication Administration Safety Assessment Tool (MASAT). The continued prevalence of MAE and the resultant deaths make it vital to evaluate learners on the specific safety tasks of medication administration. Research has shown that up to 80% of senior nursing students were unable to successfully perform the tasks of medication administration without encountering MAE (Schneidereith, 2021). A modification of the MASAT to include current evidence-based safety steps, including a validation of this tool using Clinical Faculty as research participants, was initiated June 2023.

PHASE 1

The project began with obtaining permission from the original authors to update the instrument to modern clinical standards. The initial update (now referred to as Phase 1) recruited expert nursing faculty (n = 3) for collaboration in the research required for instrument development and validation. In Phase 1, the faculty were tasked with developing items to address each complex step of the medication administration task. The revised item list gives a stepwise process for learners to follow and utilizes objective performance measures (OPM) to improve medication safety and establish a safety protocol in the process. The Modified MASAT was adapted to a 20-item binary scoring instrument, which was then evaluated by faculty participants (n = 28). Each item was rated on a Likert style scale of 1 to 5 (with 5 being the highest) for relevance to the medication administration safety processes. The benchmark of 4.0 was established as the 80% indicator. The Phase 1 results indicated that 19 of 20 components averaged a rating of 4.50+, with only one component rated at 4.44. All items were retained in the instrument.

PHASE 2

Phase 2 of the project investigated the results of faculty participants (n = 28) grading video recorded simulated student performances (n = 12) using the new Modified MASAT instrument. Phase 2 of Modified MASAT development asked faculty participants (n = 28) to use the instrument to score four simulation scenarios, each recorded by 3 different simulated students, for a total of 12 videos scored by each faculty participant. The Phase 2 results displayed in Appendix E indicate that the instrument demonstrates strong validity and reliability in both scenarios 2 and 3, alpha of .80 (W = .486, p < .001) and 0.81 (W = .481, p < .001) respectively, and moderate reliability in scenario 1 with an alpha of .72 (W = .406, p < .001). The high level of variability in scenario 4 (α = .783, W = .221, p < .001) is likely attributed to several factors including the use of technology in the simulation that may be unfamiliar to some faculty, the use of embedded error in the scenario that was not identified by some faculty, and the limitations of video recording for viewing precise measurement of liquid medication volumes.

PHASE 3

Phase 3 begins in Spring 2025, and will investigate use of the instrument with student participants in simulated medication administration. Clinical faculty members will function as study personnel rather than participants. Faculty will be provided with training to ensure that they fully understand the technology, the instrument, and the simulation scenario(s). Investigators will focus on testing the Modified MASAT in live simulations with students, faculty observers, and simulated patients. The team will consider correlations between the use of safety technologies (academic electronic health records, and medication scanning) and MAE rates. In addition to this, a factor analysis will be performed to evaluate the individual items on the instrument.

---

REFERENCES

---