2. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Using technology to support learning at a distance Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning. QUILT Conference on Technology-Enhanced Education George McWhirter

3. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Background: 2004 - Supplementary nurse prescribing established (Wales) 2007 - Independent nurse prescribing Jointly planned, administered and delivered by: Cardiff School of Nursing and Midwifery Studies Welsh School of Pharmacy, Cardiff University - shared learning between nurses and pharmacists (N.B. Now Non-Medical prescribing – all healthcare professions) George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

4. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Pre Nov 2006: Calculations skills for prescribing were: taught in a formal classroom setting 25-30% referred at first attempt (mostly nurses) additional tutorials required at lunchtimes some students required a third attempt problems with setting up calculations & with numeracy high levels of anxiety (refs: Lerwill, 1999; Glaister, 2007) George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

5. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Post Nov 2006: Day 1 – diagnostic assessment and individual feedback Individual student directed to appropriate tutorials Series of PowerPoint ® tutorials with voice commentary available on Blackboard throughout the course Regular support, as required, in person or by e-mail Summative written assessment George McWhirter - New strategy Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

6. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Advantages of strategy: Not being patronising to those who are already highly numerate Allowing flexible access to the materials in college and from home Providing a non-threatening approach for those with high anxiety levels Offering a low technology, low cost solution with minimal lecturer time demand George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

7. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Tutorial design: Calculations modelled using: Logical sequencing using animation Visual mapping using colour Audible explanation using voice commentary - Self test questions with feedback of correct calculation George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

8. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd The tutorials: Conversion between S.I. units of measurement Basic dosage calculations Weight and body surface area related dosage calculations Calculation of supply Calculation of cost Calculation of pump settings George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

9. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd George McWhirter Demonstration Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

10. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Calculations for Prescribers: Pump setting Example: A 50kg woman is to receive an infusion of Dopamine at a dose of 4 micrograms/kg/minute. An ampoule of Dopamine containing 200 mg/5ml was added to 500ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? Step 1: Calculate the hourly dosage the patient should receive in mg/hr Step 2: Use this answer as the “ What we want ” value in the formula for basic dosage calculations to calculate the pump setting

11. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Example: A 50kg woman is to receive an infusion of Dopamine at a dose of 4 micrograms/kg/minute. An ampoule of Dopamine containing 200mg/5ml was added to 500ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? Step 1: Calculate the hourly dosage the patient should receive in mg/hr Prescribed dosage rate= 4 mcg/kg/min = 4 x 50 mcg/min (= 200 mcg/min) = 4 x 50 (=200) x 60 (minutes in 1 hour) mcg/hour = 12000mcg/hour = 12 mg/hour Prescribed hourly dosage rate = prescribed dosage rate x weight x 60 Calculations for Prescribers: Pump setting

12. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Example: A 50kg woman is to receive an infusion of Dopamine at a dose of 4 micrograms/kg/minute. An ampoule of Dopamine containing 200mg/5ml was added to 500ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? (N.B Step 1 answer= 12 mg/hour) Step 2: Use the formula for basic dosage calculations to calculate the pump setting what we want X what it’s in OR prescribed dose X quantity it’s what we’ve got dispensed dose contained in 12 mg/hr x 505 = 30.3 = 30 ml/hr 200 Answer: 30 ml/hr. Calculations for Prescribers: Pump setting

13. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Now test yourself by trying these questions. a) A 100kg man is to receive an infusion of drug X at a dose of 3 micrograms/kg/minute. An ampoule of drug X containing 100mg/5ml was added to 250ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? b) A 25kg child is to receive an infusion of drug Y at a dose of 4 micrograms/kg/minute. An ampoule of drug Y containing 100mg/5ml was added to 500ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? c) A 70kg woman is to receive an infusion of drug Z at a dose of 5 micrograms/kg/minute. An ampoule of drug Z containing 250mg/5ml was added to 500ml of Sodium Chloride 0.9%. At what rate (ml/hr) should the pump be set to give the correct dose? Now click for the next slide to check your answers. Calculations for Prescribers: Pump setting

14. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Outcomes: Results Summary - Pharmacists George McWhirter Diagnostic score / 20 No. of students (n = 13) Average no. of tutorial visits (range) Summative score 2092.6 (0 – 9)20 1943.3 (0 – 7)20 Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

15. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd Outcomes: George McWhirter Diagnostic score / 20 No. of students (n = 17) Average no. of tutorial visits Tutorial visits - range Summative score 2012- 19232 - 320 182163 - 2820 1726617 / 20 1612-20 1515-20 1448.84 - 1520 1323320 1014-18 6114-19 Results Summary - Nurses Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

16. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd George McWhirter Scattergram – Improvement in score v No. of tutorial visits Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

17. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd George McWhirter Tutorial visits – spread over duration of course Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

18. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd George McWhirter Tutorial visits – No. of hits v Hour of day Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

19. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd George McWhirter Tutorial visits – No. of hits v Day of week Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.

20. Cardiff School of Nursing and Midwifery Studies Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd References: Bruner J. S. (1975) Toward a Theory of Instruction. Cambridge. Belknap / Harvard. Collins A., Brown J. S. Newman S. (1989) Cognitive Apprenticeship: Teaching the Crafts of Reading, Writing and Mathematics. In: Resnick L. (ed) Learning and Instruction. Essays in honour of Robert Glaser. New Jersey: Lawrence Erlbaum Associates. Glaister K. (2007) The presence of mathematics and computer anxiety in nursing students and their effects on medication dosage calculations Nurse Education Today; 27: 341-347. Lerwill C.J. (1999) Ability and attitudes to mathematics of post-registration health-care professionals. Nurse Education Today; 19: 319-322. Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers (Online). Available at: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1645 (Accessed 16 January 2009).http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1645 Piaget J (1970) The Science of Education and the Psychology of the Child. New York: Orion Press. Royal College of Nursing (2008) Nurse Prescribing (Online). Available at : http://www.rcn.org.uk/aboutus/wales/from_the_directors_office/nurse_prescribing (Accessed: 16 January 2009). http://www.rcn.org.uk/aboutus/wales/from_the_directors_office/nurse_prescribing Warburton P. and Kahn P. (2007) Improving the numeracy skills of nurse prescribers. Nursing Standard; 21: 28, 40-43. George McWhirter Calculations for Non-Medical Prescribing: The successful development of a flexible, low technology strategy for distance learning.