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. 2026 May 12;104(49):e46222. doi: 10.1097/MD.0000000000046222

The effect of web-based double-eye control program on the prevention of pediatric medication errors of nursing students: A quasi-experimental study

Beste Özgüven Öztornaci a,*, Atiye Karakul b, Esra Ardahan Akgül a, Pinar Doğan a, Hatice Yildirim Sari a, Zümrüt Başbakkal c
PMCID: PMC12689021  PMID: 41366901

Abstract

Background:

Medication errors in the pediatric population are a major patient safety problem, leading to death, disability, or prolonged hospitalization. This study investigated the effect of medication skills training provided to senior pediatric nursing students through simulation and a web-based Double-Eye Control Program (DECP) on students’ pediatric medication error rates.

Methods:

This quasi-experimental one-group pretest–posttest study was conducted using structured, non-participant observation. The outcomes were overall medication error rate and subcategories (preparation, administration, follow-up, and recording). In the pre-intervention stage, students administered medication to a pediatric mannequin according to a scenario. The intervention consisted of simulation training supported by a web-based DECP. No randomization was performed. Post-intervention, students repeated the same scenario using the DECP. Data were analyzed with the Wilcoxon Signed Rank Test, and interrater reliability among 4 observers was assessed using Fleiss’ Kappa.

Results:

The mean overall error rate decreased from 55.37% before the intervention to 13.52% after the intervention. Preparation, administration, follow-up, and recording error rates all significantly decreased (P < .001).

Conclusion:

The web-based DECP integrated with simulation significantly reduced pediatric medication administration errors among student nurses.

Keywords: education, medication error, patient safety, pediatric nursing, simulation

1. Introduction

Medication errors were defined as “any preventable action that could cause or do harm to the patient or inappropriate use of medication while the medication is under the control of the healthcare professional, patient, or consumer” by the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).[1] Medication errors were placed eighth in the 27-item list of adverse occurrences of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)[2] and they can range from mild ailments to significant morbidity for patients and, under certain circumstances, can lead to prolonged hospital stays or even death.[3]

Despite the advancements made in pharmacological research for pediatric patients in recent years, the problem of the availability of suitable medications for children still needs to be resolved and the percentage of medication studies for pediatrics remains below 50%.[4,5] Adjusting adult medication doses for the pediatrics or off-label medication is a common issue.[4] Therefore, children are more exposed to medication errors and it was reported that medication errors were 2 to 3 times higher in children than in adults.[3,6] Most studies have analyzed dosage errors and only a few studies have evaluated errors arising from the medication preparation and administration.[3,7,8] The most common errors arise from the fact that medicines are formulated primarily for adults and the dosage for children must be calculated based on medications intended for adults.[4]

The professional nurse’s function includes medication administration. Nurses have a responsibility to identify and avoid errors because they are situated at the final stage of the pharmaceutical procedure. Medication errors can be decreased by enhancing nurse abilities and medication skills.[9,10] When it comes to developing attitudes and behaviors that adhere to professional standards and enhancing medication abilities, undergraduate nursing education is the most significant intervention for the prevention of medication errors.[11] Medication in children is especially complex for nursing students due to some reasons, such as; the treatment of rare and life-threatening conditions that require medication, the limited therapeutic range of some medications, individual dose adjustment based on physiological factors such as age, body weight, body surface area, liver and kidney function, and maturation of enzyme systems. Due to the difficulty of practising on children who have a fragile structure, students in pediatric nursing clinical practice cannot experience invasive procedures[12–14]

Furthermore, the fact that pediatric patients have higher risks of being exposed to medication errors compared to adults, makes it difficult for students to experience medication in pediatric patients.[10,15–17] The use of simulation provides nursing students with the opportunity to develop their integration and critical thinking skills by experiencing what they have learned theoretically.[18,19] By benefiting from simulation practices, nursing students are expected to be more prepared for clinical practice and succeed more in medication applications for pediatric patients.[16,19,20] Students who receive simulation training before clinical practice gain experience and thus reduce the likelihood of making practice errors due to inexperience.[13,16,21]

The World Health Organization (WHO) also recommends simulation-based training methods and electronic learning in nursing education.[22] Strategies to prevent medication errors vary. However, establishing a clear policy and standard guidelines for the administration of high-risk medications by healthcare institutions and double-eye control of nurses in high-risk medication administration are among the initiatives recommended by WHO.[22,23]

Double-Eye Control Program (DECP) is a web-based decision support system used during medication administration.[24] Using standard medication guidelines and calculating medication dosage, provides nursing students with the opportunity to regulate their own knowledge and calculation outcomes in medication with DECP. With the help of web-based DECP, it will be possible to prevent medication errors by using standard medication guidelines and double-eye control.

In line with this information, this study was planned to investigate the effect of medication skills training provided to senior pediatric nursing students using simulation and a web-based DECP on students’ pediatric medication error rates.

2. Materials and Methods

2.1. Study design

The study was cross-sectional and a quasi-experimental study with the method of “Pre-Test–Post-Test in One Group.” The data of the study were collected by using a structured, non-participant observation method. The flow diagram of the research is given in Figure 1. This quasi-experimental study was reported in line with the CONSORT guidelines adapted for non-randomized studies.

Figure 1.

Figure 1.

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Research flow diagram.

2.2. Setting and participants

The research was conducted between February and June 2019 over 15 weeks in 2 full-capacity Vocational Skills Laboratories in the Nursing Department of a faculty. All the required equipment were available in this laboratory. Two pediatric mannequins were used in simulation practices.

The population of the research consisted of 95 fourth-year students studying in the Nursing Department of a faculty in the spring semester between the specified dates and who completed the Pediatric Nursing Internship course. The sample of the research consisted of 44 fourth-year students who agreed to participate in the research.

Inclusion criteria were: being a fourth-year nursing student enrolled in the Pediatric Nursing Internship course, having completed the clinical practice component, and volunteering to participate in the study.

Exclusion criteria were: graduation from a nursing secondary school(because graduates of these schools can work as nurse assistants in a health institutions) and working as a nursing assistant in any health institutions.

2.3. Sample size and power analysis

A post hoc power analysis was conducted to evaluate whether the sample size was sufficient to detect the observed difference in medication error rates before and after the educational intervention. Using Cohen’s h to quantify the effect size between 2 proportions, the calculated effect size was 0.935, indicating a large effect according to Cohen’s conventions. Based on this effect size, a 2-tailed test with an alpha level of 0.05 and a total sample size of 44 yielded a statistical power of 0.992. This suggests that the study had a 99.2% probability of detecting a true effect of the observed magnitude, confirming that the sample size was more than adequate to support the statistical conclusions drawn from the data.

Nursing students have limited clinical experience within the scope of pediatric medication application safety. Within the scope of the Pediatric Nursing Course in the third year of the curriculum, the theoretical subject of “medication applications in children” is taught for 4 hours. The subject is not practised in the laboratory. It is not appropriate in terms of pediatric patient safety for students to calculate medication dosage and administer them to pediatric patients alone in the clinics. In the fourth-year of their education, students carry out 96 hours of clinical practice in pediatric clinics for the implementation of the Pediatric Nursing Internship course and work with the nurses of the clinic. In this practice, they are expected to prepare and administer the medications of the patients together with the clinic nurse. This study was conducted with students who completed the clinical practice of the Pediatric Nursing Internship course. The study was conducted with volunteer students outside of class hours and outside the scope of the curriculum programme.

2.4. Materials used in the research

Research data were collected using the Descriptive Information Form and the Medication Observation Form. Web Based Double Eye Control Program (DECP), Baby Qcpr With Skillguide Mannequin, Doctor’s Order Form, Nurse Observation Form, Medication Card, Ampicillin Sulbactam vial, 5, 10, and 20 mL syringes, 100 mL mediflex and infusion set were used in the study.

2.4.1. Descriptive information form

This form included questions about the student’s age, gender, grade point average, willingness to choose nursing as a profession, and previous training in the prevention of medication errors.

2.4.2. Medication observation form

This form was prepared by the researchers and used to evaluate all steps of the medication process (preparation, administration, monitoring, and registration stages).[24] The Kuder Richardson-KR 20 value of the Medication Observation Form used in the study was found to be 0.852.

Medication errors identified with this form were determined according to whether the nurses followed the 10 correct rules (correct drug, correct dose, correct patient, correct time, correct route of administration, correct medication form, correct medication management, correct record, correct response, and correct information) in the preparation and administration of medications. In addition, it is also checked whether the nurse calculates the amount of medication according to the dosage and safe dose range and whether it is in accordance with the Drug Administration Skill Steps in DECP prepared according to the literature.[25–27]

2.4.3. Double-eye control program (DECP)

This is a web-based decision support system used during the medication process. It allows the user to check their own information and calculations and compare them with the information and calculations given by the programme. It was prepared by a web designer and programmer. DECP is compatible with smartphones, tablets, and computers. By reviewing the literature[28–32] the Medication Guidelines, which included the preparation, medication and post-medication monitoring of high-risk medications, and which were created separately for each medication, were uploaded to the program by the researchers. Expert opinions were obtained to ensure the scope and content validity of the medication guidelines. The drug information uploaded into the software was evaluated by a team of 5 experts consisting of faculty members from the Faculty of Medicine Department of Pharmacology and Faculty of Pharmacy. Fleiss’s Kappa (K) analysis was performed for content validity. The result of the analysis was determined as perfect agreement with 0.86 agreement. After the content validity was ensured, the pilot implementation of the program was used for 15 days by 10 pediatric nurses working in the pediatric clinics of 2 university hospitals in the same province outside the hospital where the study was conducted. Opinions were collected from pediatric nurses about the general use of the program. Thematic analysis of these opinions (open-ended comments) revealed that the program was easy to use and easy to enter patient data (age, body weight and drug dose information) and was useful in reducing medication errors. An information meeting was held for the students regarding the use of the web page and the program. On the homepage of www.decpro.net, there is a field for the users to login to the program with their username, and their unique password.[24]

On the website’s interface, a student must enter data such as the age, weight, medications, and dosage ordered by the patient’s physician. Once all this data is entered, the program calculates the dose of medication to be administered and whether the dosage obtained is within the safe dosage range for the patient. On the other interface of the program, the researchers upload medication instructions. With this interface, students access all pharmacological information about especially high-risk medications (indications, contraindications, interacting medications and fluids, fluids to be used for diluting, medication route, medication pace, etc) and information that will enable the medication to be carried out in a standard way.

In each medication administration, the nursing student using the programme must first make calculations with his/her own existing information, determine the dosage to be administered, the type and volume of diluent required to dilute the medication, and the infusion time of the medication. Then the DECP creates a patient-specific medication administration guideline using the patient’s medication, dose, age and body weight. The nursing student will compare this information with his/her previous knowledge and thus perform a second control (double-eye control) recommended for the prevention of medication administration errors. This process should be done for each medication to be administered to the patient and double-eye control of each medication should be ensured. In practice, the gold standard is the manual calculation made by the student herself or himself.

2.4.4. Baby Qcpr with skillguide mannequin

The mannequin is child-sized, full-body, and suitable for use in first-aid training. Ventilation and chest massage can be performed at completely realistic values. The neck and chin are movable and airway patency can be tested. Carotid pulses can be monitored manually on the mannequin. The face of the mannequin is in the form of a mask and can easily be changed by hand. In the module with an indicator to be supplied with the mannequin, there are warning lights such as a green-red color that will display their accuracy during artificial respiration, heart massage, correct hand position, and rapid artificial respiration. However, the mannequin does not give any signal in case of high doses of medication.

2.5. Data collection

The students were divided into 7 groups and each group was evaluated in 2 sessions (2 weeks), 2 weeks apart. In the first week, before the implementation of DECP, students’ error rates during drug administration to the pediatric manikin were determined by observation technique. The time for students to practice the scenario is approximately 10 to 15 minutes.

In the practice 2 weeks later, students were told how to use DECP. During this process, students were asked to enter the programme to receive information about the medication during the observation that day. After DECP was started to be applied, error rates during medication were determined by the re-observation technique.

A total of 4 trained researchers conducted the observations independently to ensure reliability of data collection. All data were recorded on paper-based observation forms during simulation sessions. The data were later entered into an electronic database by 2 independent researchers and cross-checked for accuracy.

The stages of the research, which was planned in 3 stages, were provided below:

2.5.1. Pre-intervention stage

The students who took part in the study filled out the personal information form before the simulation training. They were made aware of the details of the scenario. To avoid information contamination among the students, it was ensured that they did not communicate with students who had not yet practised with DECP. The students were informed not to exchange information about the research with each other and a contract was signed. Then the students gathered in an classroom and were directed 1 by 1 to the 2 laboratories where the simulation would take place according to the order on the student list. Data were collected by the researcher utilizing the Medication Observation Form and observation method. It was aimed to determine the errors made by the students while administering the medications to the pediatric mannequin. Since the students would be evaluated with the same scenario after the intervention, no feedback was given about their errors in the application before the intervention.

2.5.2. Intervention stage

The intervention consisted of the implementation of DECP, which included standard medication guidelines created by the researchers after identifying the most common errors in pre-intervention observations. Students’ use of the webpage and the application was observed throughout the research process. After the application with DECP, students were given feedback individually about which steps they made mistakes.

2.5.3. Post-intervention stage

While the students were administering the medications in the scenario using DECP on a pediatric mannequin, data were collected by the researcher using the Medication Observation Form.

2.6. Study variables

The primary outcome variable was the overall medication error rate. Secondary outcome variables were the error rates in 4 domains: preparation, administration, follow-up, and recording. Each medication error type was defined according to the 10 rights of medication administration and the steps outlined in the Medication Observation Form. Independent variables included students’ demographic characteristics such as age, gender, grade point average, and previous training in medication error prevention.

2.7. Statistical analysis

The SPSS 26.0 (IBM, New York) application was used to analyze the data. Participants’ demographic information was given as percentages and numbers. The dependent groups were compared to one another using the Wilcoxon Signed Rank test. Since there were 4 observers in the evaluation of interrater reliability, Fleiss Kappa analysis[33] was used. In the study, the interrater reliability was determined as 0.794, and significant reliability was determined.[34]

3. Results

The mean age of the students was 21.88 ± 1.08 and the mean overall grade point was 2.73/4 ± 0.27. About 70.5% of the students were women. About 59.1% stated that they chose the nursing profession willingly and 72.7% did not receive any training on medication errors (Table 1).

Table 1.

Sociodemographic characteristics of participants (n = 44).

Characteristics Mean ± SD
Mean age (±SD) 21.88 ± 1.08 (min: 20 max: 25)
Grade point avarage (±SD) 2.73 ± 0.27 (min: 1.96/4 max: 3.20/4)
n Percentage (%)
Sex
 Female 31 70.5
 Male 13 29.5
Choosing the nursing profession willingly
 Yes 26 59.1
 No 18 40.9
Training on medication errors
 Yes 12 27.3
 No 32 72.7
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% = percantage, n = number, SD = standard deviation.

When students’ medication errors were examined before and after the DECP, overall medication error rates decreased significantly from 55.37% before the intervention to 13.52% after the intervention (P < .001). Similar statistically significant decreases were observed in preparation, administration, follow-up, and recording error rates (all P < .001; Table 2).

Table 2.

Mean rates of incorrect drug administration before and after the use of web-based double control program.

Mean rates of medication errors Before intervention After intervention Wilcoxon signed ranks test P
% %
Mean rates of overall medication error 55.37 13.52 −5780 <.001
Mean rates of drug preparation error 45.68 12.37 −5723 <.001
Mean rates of medication administration error 63.62 15.91 −5559 <.001
Mean eates of medication follow-up error 55.7 11.35 −4315 <.001
Mean rates of medication recording error 84.1 11.4 −5657 <.001
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% = percantage, P = significance level.

Table 3 shows the error rates in the steps of medication preparation, medication administration, follow-up, and recording before and after the intervention. Considering the medication preparation error rates, it was found that the decrease in the pre-intervention and post-intervention error rates was statistically significant in correct medication control (P < .001), EXP date control (P < .001), dosage control (P < .001), safe dosage control (P < .001), diluent choice (P < .001), determining the concentration of the medication (P < .001), and labeling the medication (P < .001), which are among the sub-steps of the medication preparation process (Table 3).

Table 3.

Distribution of error rates according to error types before and after the use of web-based double control program.

Error type Before intervention After intevention McNemar test P
n % n %
Preparation time error 2 4.5 1 2.3 0.000 1.000
Correct drug control error 22 50.0 5 11.4 15.059 <.001
Expiration date control error 39 88.6 10 22.7 27.034 <.001
Aseptic technical error in preparation 4 9.1 1 2.3 0.800 .375
Dose/dosage control error 12 27.3 2 4.5 8.100 .002
Safe dose control error 39 88.6 15 34.1 20.346 <.001
Diluent choice error 14 31.8 3 6.8 7.692 .003
Determining the concentration of the drug error 17 38.6 1 2.3 14.063 <.001
Labeling the drug error 32 72.7 11 25.0 14.815 <.001
Authentication error 19 43.2 2 4.5 13.474 <.001
Administration route control error 6 13.6 1 2.3 3.200 .063
Failure to check the application path 26 59.1 3 6.8 17.926 <.001
Drug adherence control 40 90.9 9 20.5 29.032 <.001
Vital signs control before and/or after medication 36 81.8 15 34.1 16.000 <.001
Failure to use aseptic technique in practice 30 68.2 4 9.1 24.038 <.001
Infusion pace control 39 88.6 15 34.1 22.042 <.001
Adverse effect follow-up error 23 52.3 4 9.1 15.429 <.001
Extravasation follow-up error 26 59.1 6 13.6 18.050 <.001
Registration error 37 84.1 5 11.4 30.031 <.001
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% = percantage, n = number, P = significance level.

Considering the medication error rates; it was determined that the decrease in pre-intervention and post-intervention error rates was statistically significant in the sub-steps of authentication (P < .001), medication adherence control (P < .001), vital signs control before and/or after medication (P < .001), using aseptic technique in practice (P < .001), infusion pace control (P < .001).

Before the intervention, 52.3% of the students made an adverse effect follow-up error and 59.1% made an extravasation follow-up error, while only 9.1% made an adverse effect follow-up error and 13.6% made an extravasation follow-up error after the intervention. While the recording error rate before the intervention was 84.1%, the recording error rate after the intervention was 11.4%. These reductions in follow-up (P < .001) and recording (P < .001) error rates were found statistically significant.

4. Discussion

In this study, which was conducted to examine how medication skills training for nursing students using simulation and the Web-Based Double Eye Control Program; it was found that medication error rates decreased significantly after the intervention, indicating the effectiveness of DECP in reducing errors. All students in this study were senior (fourth-year) nursing students. The fact that students made a significant percentage of preparation and medication errors during the study revealed how little progress was achieved in enhancing students’ medication abilities through the nursing training we typically gave.

It is widely acknowledged that simulation practices are beneficial for teaching nursing skills and offer nursing students the opportunity to improve their theoretical learning by experiencing and creating satisfaction and self-confidence in them.[16–21,35,36] In a study conducted in Turkey, 64.10% of the nursing students stated that they did not want to work as pediatric nurses and 67.80% of them were worried about harming the child by misapplication.[15] The use of simulation in nursing education provides an opportunity to increase patient safety, transfer learning to the clinical environment, and improve communication skills, clinical judgment, and decision-making by providing a risk-free atmosphere where students can participate in the drug administration process without fear of harming patients.[16,17,21,35] In studies, it has been determined that students’ medication administration competencies increased with simulation-based applications,[17] medication errors decreased significantly,[36] and medication errors decreased in communication and patient safety case studies.[35]

Prevention of medication errors is important in terms of ensuring patient safety.[3,9] Nursing students’ lack of knowledge about medication administration is the main reason for making medication errors.[37] Developing and using technology-based solutions such as smartphone applications by nursing educators to prevent medication errors has a positive effect on the prevention of medication errors.[38,39]

The effectiveness of traditional or technology-based double-eye control in preventing medication errors is also valued.[24,38,40] It is encouraging to see that students’ errors were significantly reduced when a simulation application and a web-based medication administration control programme were used in this study to perform a double-eye control.

When the mistakes made by the student nurses during the medication preparation stage were examined, the lowest error rate was the medication preparation time and the rate of preparation following the aseptic technique (Table 3). The aseptic technique is performed almost flawlessly as an application that students learn and apply from the first year they enroll in school, and learn by doing. In the study of Azar et al, the timely preparation and administration of the medication were the steps with the fewest mistakes. The highest error rate was in controlling the expiration date and safe dosage of the medication. Errors in the pediatric population have been found to account for approximately 50% of dosage errors.[41]

Among the errors made by the students during the medication stage, the highest error rates were; not controlling medication adherence, not checking vital signs before and/or after medication, and medication dosage errors (Table 3). Medication adherence is an important issue, especially for multiple medications and requires nurses to know about medications.[42] Due to the existence of a large variety of medications and active substances, nurses cannot know the adherence status of all medications. Therefore, having a resource that nurses can refer to while administering medications, such as DECP, allows premedication control. Another important problem identified in this study was that the medication dosage error was high before the intervention. It’s crucial to understand how pediatric medication is calculated differently from adult medication. To deliver very small medication dosages, the nurse must calculate and possess the requisite arithmetic skills and abilities.[43] The tenfold medication error is the most typical error during this dose calculation. According to studies, medication dose errors are the most frequent errors in pediatric medicine.[44–46] Students making mistakes may be related to the incomplete development of their psychomotor skills. DECP can be beneficial in lowering medicine dosage errors. Providing double-eye control in medications in pediatric clinics is an error prevention strategy recommended by WHO and applied in many countries, but double-eye control cannot be performed in every pediatric clinic due to working conditions and a lack of medical staff. In today’s world, with the introduction of technology in all areas of life, especially in the undergraduate education process, the availability and applicability of a web-based clinical decision support system, which is one of the digital technologies, is seen as an effective way in student learning. At the same time, this study combines both simulation and digital technology to support skill learning. The use of a web-based DECP in the clinical field after graduation also reduces the risk of error.

5. Limitations

Data were gathered for this study using the pretest–posttest method. After the simulation, the error rate was reduced, but no clinical observation was done to see if it was a permanent case or not. The research was open to all students, but there was a low percentage of involvement because it was conducted outside of class hours and students did not want to spend extra time. In addition, the fact that the mannequin used in the study did not give any signal in case of high doses of medication use is among the limitations of the study.

6. Conclusion

It was shown in previous studies that simulation is effective in nursing education. In this study, a simulation application was used in pediatric patient groups, which are known to be very fragile and difficult to tolerate errors, due to the difficulty of students experiencing medication, and the effectiveness of the DECP, which is a medication decision support system, was evaluated. Based on this study, which shows that DECP is effective in reducing medication errors in nursing students, it is recommended that decision support systems such as DECP and simulation practices be transformed into a standard practice in nursing students’ education on medication and dose calculations. In addition, the long-term effects of DECP can be observed in clinical practice.

Acknowledgments

The authors would like to thank nursing students for their participation in this study.

Author contributions

Conceptualization: Beste Özgüven Öztornaci, Hatice Yildirim Sari, Zümrüt Başbakkal.

Data curation: Beste Özgüven Öztornaci, Atiye Karakul, Esra Ardahan Akgül, Pinar Doğan.

Formal analysis: Esra Ardahan Akgül, Hatice Yildirim Sari.

Methodology: Beste Özgüven Öztornaci, Hatice Yildirim Sari.

Software: Esra Ardahan Akgül.

Supervision: Beste Özgüven Öztornaci, Hatice Yildirim Sari, Zümrüt Başbakkal.

Visualization: Beste Özgüven Öztornaci.

Writing – original draft: Beste Özgüven Öztornaci, Atiye Karakul, Esra Ardahan Akgül, Pinar Doğan, Hatice Yildirim Sari, Zümrüt Başbakkal.

Writing – review & editing: Beste Özgüven Öztornaci, Atiye Karakul, Esra Ardahan Akgül, Pinar Doğan, Hatice Yildirim Sari, Zümrüt Başbakkal.

Abbreviations:

DECP
Double-Eye Control Program
WHO
World Health Organization

I confirm the corresponding author has read the journal policies and submit this manuscript in accordance with those policies.

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Izmir Katip Çelebi University Clinical Research Ethics Committee (IRB no. 2018/391 date: November 14, 2018). The researcher informed students about the aim of the study and obtained written consent forms.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

How to cite this article: Özgüven Öztornaci B, Karakul A, Ardahan Akgül E, Doğan P, Yildirim Sari H, Başbakkal Z. The effect of web-based double-eye control program on the prevention of pediatric medication errors of nursing students: A quasi-experimental study. Medicine 2025;104:49(e46222).

Simulation is an important tool for students to gain clinical experience in pediatric care. The use of web-based decision support systems such as DECP reduces the risk of medication errors and can be integrated into nursing education.

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