Week 1 Discussion
I think spiritual values do influence the decision to maintain academic integrity because otherwise, it would be hypocrisy. If one claims to be a spiritual being but cheats their way through life, then the question becomes who do we actually think we’re fooling? It is necessary to stay true to oneself and to choose the proper thing to do even when no one’s looking, to me, that’s the true definition of integrity. I also believe one must constantly work at or renew their spiritual beliefs because we’re all human without perfection so, at times will’s get weak and we envision success by taking the easier way out such as cheating on a test or taking credit where it isn’t due by putting our names on others’ work, committing infractions known to us as plagiarism but causing greater damage to the soul. We must remember every good thing worth having requires putting in the work required to achieve those goals. The constant struggle within to always do the right thing is understandable but, if we nourish the positivity more than we nourish the negativity, making the appropriate decisions become second nature and the struggle to make the desirable choices are lessened. It’s a greater sense of appreciation to know the goals achieved were achieved honestly and through hard work. When one puts in honest work, the process is respected!
My experience with my leadership so far has been mostly positive. There was one instance that I will never forget when this executive leader, who is supposed to hold one of the highest positions in the hospital, came to visit our unit during our morning huddles. We discussed the new staffing method the hospital is about to implement, known as the NHPPD (Nursing actual Hours Per Patient Day) method. Of course, questions about patient acuities came up. Our unit is known for caring for acute medical psyche geriatric patients and is the designated acute medical-surgical- COVID unit. Our concern, of course, is patient acuities. The presenter did not answer many of our questions directly or clearly. Finally, the executive leader said, “If you are not happy with the staffing method, the door is open for you.” For us staff, it simply means shut up and suck it up, or you may be free to resign. I understand that being a leader is stressful, and you may not be able to please everybody, but still, you are being looked up to, and your knowledge, decisions, and attitude as a leader your subordinates are following as an inspiration. Patience is a virtue. A leader should be a force to calm down and bring balance. People look up to you for answers and solutions if there is an issue. Clearly, that leader did not show patience or compassion to her staff.
DQ1 Based on the PICOT you developed for NUR-550, summarize the change initiative you will be proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format.
DQ2 Discuss the role of EBP in your specialty area of practice. Compare and contrast the role and implementation of EBP in your specialty with another advanced registered nurse specialty.
The occurrence of medication administration errors hinders effective attainment of quality and safe patient care and outcomes. Medication administration errors are significant safety issue in health care sector, especially when there are different crises affecting healthcare and quality outcomes. The susceptibility of patients to medication administration errors increase with reduced number of healthcare workers against an increase in demand for services due to several factors. Medication administration errors (MAEs) increase the length of stay for critically ill patients and cost of care. Studies demonstrate that leveraging health information technologies that include barcode scanning and other interventions can reduce and prevent the occurrence of these events, especially among the critically ill patients. The purpose of this literature review is to offer a comparison of the articles that supports the evidence-based practice project of using health information technology to reduce the occurrence of medication administration errors among the critically ill patients. The review also identifies the methods used to search the literature and synthesizes it for effective understanding and use for the selected eight articles.
PICOT Statement
The use of health information technology can reduce and prevent the prevalence of medication administration errors (MAEs) among critically ill patients. The use of interventions like barcode scanning and electronic dispensation ensures that human errors that occur during medication dispensation are reduced or minimized, especially the critically-ill patients in different health settings.
PICOT Question for the Evidence-Based Practice Project
Among the critically ill patients (P), does the integration of health information technology (I) compared to conventional medication administration process (C), lead to a reduction in medication administration errors (O) during patient’s stay (T)?
Search Methods of the Literature
Effective search of articles comprises of using appropriate approaches and terms that align with the topic of interest. In this assignment, I employed different yet related strategies to search for the articles that support the EBP project. These included using institutional library to get databases of journals and their published peer-reviewed articles. I used terms like “peer review” and “scholarly works” about medication administration errors. Through these approaches, I obtained the articles that I used in providing this literature review as they support my EBP project. I also ensured that the article meet the criteria of being published within the last five years and are relevant to the nursing context and use.
Synthesis of Literature
Article 1
The first article is by Alotaibi and Federico (2012) who discuss the impacts of health information technology on patient safety. Through a review of present scientific evidence on the effects of health information technologies on improving patient safety, the authors demonstrate the effectiveness of these interventions in reducing medication administration errors. Their findings support the implementation of health information technology to reduce medication errors and mitigate adverse events while increasing compliance to established guidelines in nursing practice. The article supports the PICOT as it shows the interventions that can be used to improve quality care and enhance overall patient safety. The article also supports the PICOT by showing the time frame that facilities can use to attain the benefits of these interventions.
Article 2
The second article by Barakat and Franklin (2020) focuses on the effects of using barcode medication administration (BCMA) on nursing practice activity and workflow. The authors use a qualitative study design in two surgical wards at a large acute facility in London. Through observations, the authors found that BCMA increased the nursing workflow, patient verification and efficiencies in medication administration. The authors are emphatic that the use of barcode and other health information technologies can enhance care delivery by minimizing occurrence of medication administration errors. The article supports the PICOT as it addresses how nurse practitioners handling critically ill patients can use technology-based interventions to enhance workflow and increase efficiencies aimed at mitigating MAEs.
Biostatistics is the study of biological phenomena through the application of statistical modeling, methodologies and processes. The value of biostatistics is significant to public health and preventive medicine. Biostatistics uses mathematical, scientific, and social approaches that allow the monitoring of disease trends and offering interventions to prevent future infections and disease. Biostatistics study diseases, disorders, and health risks related to certain behaviors related to local environment Scwaid, 2017). The implication is that biostatistics offers the foundation of epidemiological research. Therefore, population health research needs statistics that can help providers and researchers develop interventions to prevent occurrence of disease conditions.
Epidemiology is more than the study of population health as it entails the application of knowledge attained by the studies to community-centered practice. Therefore, epidemiology plays a significant role in researching and addressing population health challenges by allowing researchers and practitioners to apply the scientific knowledge and outcomes to solve health population issues (Villeneuve et al., 2020). The implication is that epidemiology is a critical component of evidence-based practice interventions and their application in clinical settings before being translated to communities to enhance population health outcomes. researchers and providers use epidemiological approaches in disease surveillance to identify hazards and public health risks with the aim of preparing the population for better prevention and primary health.
Epidemiology and biostatistics are essential to the evidence-based practice proposal as they will enhance data collection and use of interventions to attain its stated goals. Epidemiology describes the health status, identifies risks and analyzes the interactions between health and various hazards while biostatistics studies diseases, disorders and interventions (Schwaid, 2017). Therefore, they will help attain the goals of the proposal by providing required data and improved understanding of the status of the different populations.
References
Schwaid, G. (2017). Epidemiology and Biostatistics. Board Review in Preventive Medicine and
Public Health, 79–185. doi: 10.1016/B978-0-12-813778-9.00003-7
Villeneuve, P. J., Paradis, G., & Muhajarine, N. (2020). Always better together: The Canadian
Journal of Public Health and the Canadian Society for Epidemiology and Biostatistics. Canadian Journal of Public Health, 111(3), 305-307. https://doi.org/10.17269/s41997-020-00362-x
Article 3
The third article is by Alomari et al. (2020) which evaluates the effectiveness of nurse-based interventions in reducing medication errors in pediatric wards. The authors investigate the effects of using bundled interventions to reduce medication administration errors. The author also focused on enhancing nurses’ perspective of medication administration process. Using a quantitative research approach in their selected settings, the authors shows through phased action research that these interventions, including use of health information technology, can reduce medication errors by over 60%. The authors emphasize that these benefits are not impacted by tan increase in the number of patients and prescribed medications. The article supports the PICOT question and statement as it shows the duration and interventions that can be implemented by nursing staff and other professionals to reduce and prevent the occurrence of medication administration errors.
Article 4
The fourth study by Devin et al. (2020) focuses on the effects of health information technologies in reducing prescribing errors in hospitals. The authors also focus on behavioral change techniques linked to HIT implementation that can reduce occurrence of medication errors. using a qualitative approach in different settings, the authors show that HIT prescribing reduces medication errors, especially prescribing errors. The authors’ findings emphasize the need for providers to integrate different approaches to ensuring that medication errors do not occur during the entire medication process. The article supports the EBP PICOT statement as it integrates the use of health information technology as a critical intervention to reducing medication administration errors.
Article 5
The fifth article by Zadvinski et al. (2018) explores the experience of nurses working with health information technology over time in their facilities. Using a longitudinal qualitative study design, the authors demonstrate the effects of nurses embracing technologies in a medical-surgical unit for a period of 18 months. The findings show that personal and organizational issues impact the adoption of HIT. The findings show that change of perception of these technologies is essential in attaining their intended benefits to the organization and patient safety goals. The article supports the PICOT statement as it shows that implementing health information technologies requires time for quality outcomes. Leveraging organizational policies and enhances the ability of nurses to adopt and use these technologies to enhance patient safety and quality outcomes.
Article 6
The study by Naidu and Alicia (2019) aims at evaluating the use of barcode medication administration and electronic medication administration records (e-MAR), outcomes, practice and policies and their effects on nurses in the medication administration duties in their nursing practice areas. Through an annotated literature review, the authors’ findings demonstrate that compliance to these interventions enhance patient safety and reduces reported medication administration errors. The use of these practices and policies also improves the efficiency of the BCMA system. The article is essential as it supports the PICOT by discussing the use of the health information technologies as interventions to reducing and preventing the prevalence of medication administration errors.
Article 7
The study by Jheeta and Franklin (2017) focuses on the how hospital electronic prescribing and medication administration system can enhance medication administration safety. Through an observational design, the authors show that implementation of these interventions encourages the occurrence of certain errors but also mitigates others. The implication is that using these interventions helps in reducing errors and enhancing patient safety. The article supports the PICOT statement as it emphasizes the need to use effective interventions and encourage their applications among all stakeholders in healthcare systems.
Article 8
The article by Härkänen et al. (2019) provides an analytical perspective of reported medication errors and their associated mortality in England and Wales for a period of nine years. The authors analyze medication errors in acute care that lead to death, identify the used drugs and describe the associated characteristics of the medication administration errors. Their findings show that most of deaths occurring due to medication administration errors happen in inpatients and among patients aged over 75 years with errors of omission being the most common form. The article supports the PICOT as it shows that medication errors occur due to several factors and should be addressed through integration of health information technologies.
Comparison of the Articles
The most prevalent issue in all these articles is the adoption of different health information technologies in mitigating and reducing the occurrence of medication administration errors (MAEs). Using an evidence-based practice approach, most of the articles demonstrate the effectiveness of having protocols and policies that supplement the use of technology in healthcare settings among healthcare workers. A majority of these articles use systematic reviews as they are considered the best level of evidence, especially in EBP projects. These reviews provide different interventions that healthcare providers can use to integrate health information technologies and reduce and prevent the occurrence of medication administration errors.
The main themes in these articles include use of medication administration processes, medication administration errors’ occurrence, the role of healthcare workers in embracing these interventions, and the effectiveness of the approaches to reduce medication administration errors. Some of the articles like the one by Jheeta and Franklin (2017) don not emphasize the effectiveness of health information technology in mitigating MAEs. However, the article emphasizes the need to have a multifaceted approach to the use of technologies to enhance care delivery. Each of the article has its unique shortcomings and areas not addressed. However, a common theme also emerges about the need to conduct further research to validate the outcomes and effectiveness of health information technology approaches to reduce and prevent medication administration errors, especially in acute care settings. Each of the article does not contain any controversy as the researchers complied with established guidelines to enhance validity and reliability.
Suggestions for Future Research
A majority of these articles recommend the need for further research on different aspects of the topic. The authors are categorical that while their studies offer evidence based on their research, it is imperative to conduct more studies on different aspects of these technologies to ascertain their overall effectiveness in addressing the issue under consideration (Alomari et al., 2020; Alotaibi & Federico, 2017). Gaps in effective research illustrating the interactions among various interventions and outcomes may require more approaches for better implementation of suggested approaches.
Conclusion
Medication administration errors (MAEs) remain a core concern in attaining better patient safety levels in different care settings. These events affect the quality of care and safety, especially for critically ill patients in hospitals who die for other causes other than their afflicted conditions. Therefore, stakeholders need interventions that leverage the best practices to reduce and prevent the occurrence of these events. The findings from these articles demonstrate the need for nurses and other healthcare workers to implement evidence-based practice interventions to reduce medication administration errors (MAEs). The selected articles show the need for enhance patient care and safety for better outcomes.
References
Alomari, A., Sheppard-Law, S., Lewis, J. & Wilson, V. (2020). Effectiveness of Clinical Nurses’
interventions in reducing medication errors in a pediatric ward. The Journal of Clinical Nursing, 29(17-18): 3403-3413. https://doi.org/10.1111/jocn.15374
Alotaibi, Y. K. & Federico, F. (2017). The impact of health information technology on patient
safety. Saudi Medical Journal, 38(12):1173-1180. doi: 10.15537/smj.2017.12.20631
Barakat, S. & Franklin, B. D. (2020). An Evaluation of the Impact of Barcode Patient and
Medication Scanning on Nursing Workflow at a UK Teaching Hospital. Pharmacy (Basel), 8(3):148. doi: 10.3390/pharmacy8030148
Devin, J., Cleary, B. J. & Cullinan, S. (2020). The impact of health information technology on
prescribing errors in hospitals: a systematic review and behavior change technique analysis. BMC Systematic Reviews, 9(275). https://doi.org/10.1186/s13643-020-01510-7
Jheeta, S. & Franklin, B. D. (2017). The impact of a hospital electronic prescribing and
medication administration system on medication administration safety: an observational study. BMC Health Services Research, 17(547). https://doi.org/10.1186/s12913-017-2462-2
Härkänen, M., Vehviläinen-Julkunen, K., Murrells, T., Rafferty, A. M., & Franklin, B. D.
(2019). Medication administration errors and mortality: Incidents reported in England and Wales between 2007 ̶ 2016. Research in Social and Administrative Pharmacy, 15(7), 858-863. https://doi.org/10.1016/j.sapharm.2018.11.010
Naidu, M. and Alicia, Y.L.Y. (2019). Impact of Bar-Code Medication Administration and
Electronic Medication Administration Record System in Clinical Practice for an Effective Medication Administration Process. Health, 11, 511-526. https://doi.org/10.4236/health.2019.115044
Zadvinskis, I. M., Smith, J. G., & Yen, P. Y. (2018). Nurses’ experience with health information
technology: Longitudinal qualitative study. JMIR medical informatics, 6(2), e38. doi: 10.2196/medinform.8734
NUR590 Evidence Based Practice Project
Week 2 Discussion
DQ1 Do you foresee any issues with implementation of your project? Identify stakeholders who could assist in supporting you, and any theoretical frameworks (organizational change, leadership, role-specific) or models that could help you adapt.
DQ2 What strategies will you use in your new practice as an advance registered nurse to review and critique literature pertinent to your practice?
NUR590 Evidence Based Practice Project
Week 3 Discussion
DQ1 What levels of evidence are present in relation to research and practice, and why are they important regardless of the method you use?
DQ2 What factors must be assessed when critically appraising quantitative studies (e.g., validity, reliability, and applicability)? Which is the most important? Why?
NUR590 Evidence Based Practice Project
Week 4 Discussion
DQ1 What are some of the obstacles or barriers to implementing EBP in nursing? Provide a rationale for your answer. Since there are numerous topics on the issue, it is not appropriate to repeat one that has already been mentioned unless providing new information.
DQ2 Ensuring the protection of human subjects is necessary when conducting research projects. What are some methods that can be used to protect personal rights of someone in one of the groups that is labeled as vulnerable? Consider how a patient’s values and your own clinical judgment must be considered before applying the evidence in clinical decision making for an individual patient.
NUR590 Evidence Based Practice Project
Week 5 Discussion
DQ1 Identify the components of implementing your evidence-based practice project. What has been the most difficult component, and why? What do you think has gone well? Provide one piece of advice you would give to a colleague about the implementation process.
DQ2 Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. This could range from support of the evidence-based project proposal to communication gaps. How could you address these problems?
NUR590 Evidence Based Practice Project
Week 6 Discussion
DQ1 When reviewing the literature and different types of evidence for your project, what gaps in the findings did you encounter? How could these gaps influence other researchers?
DQ2 What is the difference between statistically significant evidence and clinically significant evidence? How would each of these findings be used to advance an evidenced-based practice project?
NUR590 Evidence Based Practice Project
Week 7 Discussion
DQ1 Identify the audience for your EBP proposal and discuss strategies for disseminating the proposal.
DQ2 How will you ensure that all appropriate audiences receive information about research and EBP initiatives?
NUR590 Evidence Based Practice Project
Week 8 Discussion
DQ1 Post a rough draft of your “Evidence-Based Practice Presentation.” The purpose of this draft is to get feedback from your peers. Identify at least two areas you would like specific feedback for improvement.
Peers are encouraged to also comment on anything they feel is successful or could be further improved. Review all of the presentations, but provide critical commentary for at least one other posted presentation.
DQ2 The EBP process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.
