Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Dr. Jean-A’Layn Franco, DNP, FNP-BC
Practice Mentor
Misty DeCristofaro, MSN, RN
Abstract
Background
Medication administration in the pediatric emergency department is complex and potentially high-risk, particularly for weight-based and critical care medications. Limited access to quick, reliable references for medication preparation and administration may contribute to delays or errors in medication administration, as well as decreased nurse confidence.
Project Goals
- To evaluate the impact of a medication reference card on medication errors, order-to-administration time of medications, as well as perceived nurse confidence.
- To decrease rates of medication errors, improve order-to-administration time of medications, and to improve perceived nurse confidence.
Methods
A badge-sized medication reference card containing frequently utilized, high-risk medications in a pediatric emergency department was created and provided to nursing staff. Participants completed a pre- and post- implementation survey to assess baseline knowledge and perceived confidence of medications contained within the reference card. Medication administration timing data and safety event reports were collected for three months pre-implementation and three months post-implementation.
Results
Baseline knowledge assessment identified a gap in knowledge prior to the intervention, with an average of 58% for correct responses. Post-implementation survey results demonstrated a shift towards higher confidence levels among the identified medications, and overall confidence was reported to be higher by 92.3% of participants. Order-to-administration time of all medication administrations in the pediatric emergency department improved, from late medication rates decreasing from 5.7% to 5.2%. Order-to-administration times for medication contained within the card also improved, from late medication rates decreasing from 15.7% to 14.8%. Medication-related safety events decreased from 15 to 12 events, nursing-related errors decreased from 40% to 25% of reported safety events, and overall severity of reported medication-related safety events decreased, with no events resulting in patient harm being reported in the post-implementation period.
Conclusion
Implementation of a medication reference card was associated with improved nurse confidence, improved order-to-administration times of medications, and improved safety outcomes. This low-cost intervention demonstrates potential to enhance medication safety, workflow efficiency, and nursing knowledge and confidence in a pediatric emergency department.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Lotto, B. (2026). Implementation of a medication reference card in a pediatric emergency department: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.