Introduction
The purpose of this assessment is to complete the stages in the EBP process, translating the research into practice. Y?ou will be developing a policy or procedure to address a patient safety issue in a healthcare setting. Incorporate information from prior assessment where appropriate.
Scenario
As the Director of Clinical Operations and Nursing Excellence, it is your responsibility to ensure that the best practices and protocols are implemented and sustained at the medical center. The next step is to translate the evidence into practice. Policy development is an important final step. Without a formal policy or guideline, it is likely the change will not become permanent. Policies and procedures standardize care which in turn, improves patient safety.
Instructions
Create a new policy for the medical center based on evidence, ?using the
Hospital Policy Template [DOCX]
.
Review the template before you begin filling in each section, and gather any materials or documentation you will need.
In the Subject/Title of Policy section of the Hospital Policy Template [DOCX], type the name of the policy.
In the Purpose section, explain the purpose of the policy in 1-2 short paragraphs. Include the following:
Summarize the patient safety issue.
Explain the gap or a problem in a health care or public health situation that caused the issue.
Use supporting evidence from the literature to show how it determined the need.
Explain how the evidence was gathered.
Include your revised PICO(T) question.
Explain why it was necessary to take action with the development of this policy.
In the Population Affected by the Policy section, identify and describe the populations affected by the change and how the scope of the problem was determined.
Scope is the extent of the problem, or how wide-sweeping the issue is for the target population and the community.
Describe the target population to be addressed by an intervention in enough detail that it is clear what population is included or excluded.
In the Definitions section, create definitions that explain the industry specific terms used throughout the document needed for the understanding of the policy.
Explain the terms in a manner that is descriptive to non-industry personnel.
In the Policy Statement section, create a policy statement in a 3-5 sentence paragraph that includes the following:
State the organization’s declaration of the plans giving a timeframe and scope of the policy implementation.
Explain the organization’s intentions or goal regarding the patient safety issue.
Clearly describe the policy plans, explaining that this is a quality improvement project based on evidence-based practices to address a specific patient safety issue.
In the Procedure section, elaborate on the step-by-step procedure that was outlined in the policy statement above in enough detail that one could replicate the process based on your description alone.
Information needs to be clear and easy to read. Avoid using wordy paragraphs.
Describe all the processes involved. This section could be in a numbered list or a detailed flowchart. Include the following:
All participants with their specific responsibilities listed.
Step-by-step description of the logistical flow of how the policy is to be implemented.
Instructions for completing each step.
Any supplies that may be needed.
If a protocol or guideline already exists for your patient safety issue, use additional guidelines and literature to revise and create a procedure using your own words.
1
Medications Safety Intervention Evaluation
Name
Institution
Course
Professor
Date
2
Medications Safety Intervention Evaluation
The proposed project is the reduction of medication errors through the use of barcode
medication administration (BCMA) and electronic medication administration records (eMAR).
The evaluation of this project will determine whether the BCMA and eMAR are effective means
of reducing errors and whether their implementation in this specific setting was effective. Two
instruments supported by the evidence will be used to determine project effectiveness. The
Medication Safety Climate (MSC) questionnaire and Medication Error Index will be the two
tools used for assessment. This paper presents the evidence-based instruments to be used in
project evaluation in medications errors reduction and their suitability for this specific project
based on current evidence.
The Medication Safety Assessment Instruments
The MSC questionnaire and the Medication Error Index will be used to evaluate the
effectiveness of the interventions in this project. The MSC questionnaire was developed by
Kantilal et al. (2015) in a study by adapting the Safety Attitudes Questionnaire and the Hospital
Survey on Patient Safety Culture (HSOPSC). The questionnaire evaluates 9 qualitative items
including teamwork, safety climate, job satisfaction, stress recognition, perceptions of
management, working conditions, management support in medication safety, feedback and
communication, and organizational learning (Kantilal et al., 2015). The questionnaire has
internal reliability ranging from 0.64 to 0.9 with 8 of the 9 items having reliability of more than
0.7 (Kantilal et al., 2015). The second tool is the Medication Error Index which was developed
by the National Coordinating Council for Medication Error Reporting and Prevention (NCC
MERP). The error index classifies errors depending on severity. Initially developed by Hartwig
(1991), it has been adopted and used by numerous organizations including the Institute for Safe
3
Medication Practices (ISMP). The index categorizes errors from category A (no error) to
category I (error and death). It is a quantitative measure of the error type and harm caused.
Literature and Comparison
The two instruments have been used in various studies which share similarities with the
proposed project. The MSC questionnaire, for instance, has been used by Tarrahi et al. (2023)
who evaluated medications safety climate among healthcare professionals. The study reported
64.1% positive responses to the questionnaire, indicating a moderate level of medication safety
climate (Tarrahi et al., 2023). This study is different from the proposed project because it simply
evaluates staff perception of medications safety climate but no intervention to reduce errors. The
Medication Error Index was used by Fahmy et al. (2018) who compared the tool to the Dean and
Barber method. The NCC MERP index identified that 88% of the errors could be classified as
category C whereby errors reach patient but unlikely to cause harm. Fahmy et al. (2018) is
different from the current study because there is no intervention. However, the current study
could effectively deploy both MSC and NCC MERP because the evaluation will focus on the
safety culture and severity of errors.
Rationale for the Instruments
The two instruments have been selected because they focus on two aspects of the
medications safety intervention. The MSC questionnaire focuses on the staff perceptions of
safety in the organization. Therefore, it will provide qualitative data on how staff view
medications safety. The NCC MERP focuses on the severity of errors witnessed. Severity of
errors can be used to determine whether the intervention has caused a significant change in
medications safety. Combining the two methods will provide a holistic evaluation of medications
safety in the organization.
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Conclusion
Medications safety evaluation will determine the effectiveness of the BCMA and eMAR
in reducing errors. The select tools are the MERP index and the MSC which have been proved as
reliable and valid in previous research. Although studies using the tools are different from the
current project, they present similar measures that can be evaluated to determine effectiveness of
the interventions. This evaluation will determine whether the interventions have made the
healthcare medication administration process safer. The evaluation tools are crucial instruments
useful in assessing safety and effectiveness of evidence-based interventions.
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References
Fahmy, S., Garfield, S., Furniss, D., Blandford, A., & Franklin, B. D. (2018). A comparison of
two methods of assessing the potential clinical importance of medication errors. Safety in
Health, 4(1), 1-4. https://doi.org/10.1186/s40886-018-0071-3
Hartwig, S.C., Denger, S.D., & Schneider, P.J. (1991). Severity-indexed, incident report-based
medication error-reporting program. Am J Hosp Pharm 48, 2611-2616.
https://pubmed.ncbi.nlm.nih.gov/1814201/
Kantilal, K. and Auyeung, V. and Whittlesea, C. and Oborne, A. (2015). Medication safety
climate questionnaire: Development and psychometric analysis. Journal of Health
Science, 3(1), 1-10. http://dx.doi.org/10.17265/2328-7136/2015.01.001
Tarrahi, M. J., Farzi, S., Farzi, K., Shahzeydi, A., Saraeian, S., Moladoost, A., & Pebdeni, A. S.
(2023). Medication safety climate from the perspectives of healthcare providers: A crosssectional study. Journal of Education and Health Promotion, 12(1), 195.
https://doi.org/10.4103/jehp.jehp_1096_22
PATIENT SAFETY ISSUE: MEDICATION
ERRORS
MARCOS J CARVAJAL BERMEJO
SCHOOL OF NURSING AND HEALTH SCIENCES, CAPELLA UNIVERSITY
NURS-FPX8030 EVIDENCE-BASED PRACTICE PROCESS FOR THE
NURSING DOCTORAL LEARNER
DR. FAISAL ABOUL-ENEIN
JULY 3RD, 2023
1
PRESENTATION OUTLINE
1. Patient safety issue- Medication errors in medical unit
2. Internal evidence- Dashboard data and anecdotes
3. External evidence- Literature
4. Organizational priority
5. Quality improvement project- Technology advances
Patient safety is a crucial aspect of every healthcare
organization, and their staff have a professional and ethical
responsibility to promote the highest level of safety. This
presentation outlines a patient safety issue: the increase in
medication errors in the Baptist Hospital South Florida
medical in-patient unit. It also presents internal and external
evidence, relying on internal dashboard data, trends, and
current literature on this issue. I then explain why
medication errors are a priority patient safety issue in the
organization and propose tech-based quality improvement
intervention to address the issue.
2
BAPTIST HEALTH SOUTH FLORIDA
It is the largest healthcare organization in the region
and operates numerous hospitals, medical centers, and
outpatient facilities across South Florida.
Baptist Health South Florida is a non-profit healthcare
organization headquartered in Coral Gables, Florida. It is the
largest healthcare organization in the region and operates
numerous hospitals, medical centers, and outpatient
facilities across South Florida.
3
PATIENT SAFETY ISSUE
Medication errors- Medications not administered or taken
as required
Examples: Wrong patient, dose, route, timing, omission
Occur on different levels from prescription to
administration
Errors may cause harm to patient
Medication errors occur when medications are not
administered or taken as required. Errors may include the
wrong patient being medicated, wrong dose, route, timing,
and even medication omission. These errors occur on many
levels, from when a prescription is written to the issuing of
the medication, preparation, and the actual administration.
This may result in harm to the patient who takes the
medication.
4
INTERNAL EVIDENCE
Hospital dashboard- performance dashboard for entire
hospital
• 2 major injurious errors, 20% increase in error rates in 6
months
Anecdotes- Interviews with 5 nurses, 10 patients
• Increased error incidence & reduced care quality
The internal sources of evidence of medication errors are
the hospital dashboard and anecdotes from patients and
healthcare professionals. The medical center maintains a
performance dashboard with summaries of performance
measures. In the last six months, there have been two
significant errors causing patient injury, and in general, all
errors (regardless of the harm caused) increased by 20%
compared to the previous six months. This data captures all
reported errors and involves all the organization’s patients.
Patient and staff anecdotes have also shown that there is an
increase in rates of errors. 5 nurses from the medical unit
were interviewed, and all reported committing or witnessing
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a medication error in the past few months. Patients involved
in such errors have also reported poor quality of care. 10
patients were interviewed.
5
EXTERNAL EVIDENCE
Medication incidents in 6%-12% (Escrivá Gracia et al., 2019)
100,000 hospitalizations, 5% of hospitalized patients ADEs
(PS Net, 2019)
High incidence & prevalence errors, ADEs
Publications based on nationwide research
External evidence has been obtained from peer-reviewed
literature. One study established that incidents in healthcare
involving medications occur in 6% to 12% of patients.
Secondly, a publication by the Patient Safety Network of the
Agency for Healthcare Research and Quality (AHRQ)
identifies that around 100,000 hospitalizations are caused by
adverse drug events, and about 5% of hospitalized patients
experience an adverse drug event. These statistics indicate a
very high incidence and prevalence of medication errors and
adverse drug effects, proving this is a significant patient
safety issue in healthcare.
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ORGANIZATIONAL PRIORITY
Heavy impact on patients & organization
Result in injury, fatalities
Example: Previous error leading to 3-day ICU admission
Staff & organization paid penalties & damages
Medication errors are an organizational priority basically
because they have a significant impact on the safety of
patients and the healthcare organization as well. For
instance, patients may experience injury and even death due
to these errors. One of the significant reported errors in the
past six months resulted in the patient’s injury and
admission to the ICU for three days. The medical center had
to pay for damages, and the nurse was penalized. Such
events devastate the patient and family and can even lead to
death. In addition to safeguarding the safety of patients,
addressing medication errors will also protect staff and the
organization from liability and penalties.
7
QUALITY IMPROVEMENT PROJECT
Barcode medication administration (BCMA) & electronic
medication administration records (eMAR)
1. Scan medications retrieved
2. Prepare medications
3. Scan patient tag & compare details
4. Reduced errors & cognitive load (Mulac et al., 2021)
The proposed quality improvement project is the
implementation of barcode medication administration
technologies to be linked with the current electronic
medication administration records (eMAR) system in place.
Barcode medication administration (BCMA) is a technology
whereby scanners are used to identify medications and
patients. The patient tag will have a code, and the code is
matched with that on the medication’s containers. When
the nurse picks the medication, they will use a handheld
scanner connected to the eMAR to check the identity and
correct medication details such as route, amount, and
timing. After preparing the medications, the nurse will scan
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the patient’s tag to ensure it matches the identity of the
medications. This technology has been associated with better
medication safety and reduced cognitive load, as nurses need
to remember specific patient details, especially when
attending to many patients.
8
PROJECT CONT’D
Improved patients’ safety
• Reduce medication administration errors e.g. nurses’
errors due to workload (Schroers et al., 2021)
Cost savings & liability
• Fewer errors, reduced liability claims
The project’s expected outcomes include better patient
safety and reduced costs in the organization. Barcode
medication administration will reduce errors, specifically
those occurring during medication administration. These
errors may be attributed to nurses’ handling a heavy
workload which may lead to increased error susceptibility.
With fewer medication administration errors, patients’
safety is improved. Nurses’ liability for adverse medication
events, the organizational costs associated with treatment,
and claims for error incidents are also reduced.
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CONCLUSION
Medication errors prevalent in the in-patient medical unit
Increase in the past six months
Proposal: Barcode scanners linked with eMAR
Outcomes anticipated: Better patient safety, reduced
costs & liability
Medication errors are a significant patient safety issue in the
medical center, specifically in the in-patient medical unit.
Evidence shows a significant increase in errors in the past six
months, contributing adversely to patients’ safety. The
proposed approach is the implementation of barcode
scanners linked with the eMAR for the medication
administration process. These can reduce the rates of errors
and the impact on the organization in costs and liability.
10
REFERENCES
Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and
drug knowledge gaps among critical-care nurses: A mixed multi-method study. BMC
Health Services Research, 19(1), 1-9. https://doi.org/10.1186/s12913-019-4481-7
Mulac, A., Mathiesen, L., Taxis, K., & Granås, A. G. (2021). Barcode medication
administration technology use in hospital practice: A mixed-methods observational
study of policy deviations. BMJ Quality & Safety, 30(12), 1021-1030.
http://dx.doi.org/10.1136/bmjqs-2021-013223
Patient Safety Net. (2019, Sept. 7). Medication Errors and Adverse Drug Events. Agency for
Healthcare Research and Quality. https://psnet.ahrq.gov/primer/medication-errors-andadverse-drug-events
Schroers, G., Ross, J. G., & Moriarty, H. (2021). Nurses’ perceived causes of medication
administration errors: A qualitative systematic review. The Joint Commission Journal on
Quality and Patient Safety, 47(1), 38-53. https://doi.org/10.1016/j.jcjq.2020.09.010
11
1
PRISMA Diagram Assignment
Student name
Registration number
Unit name
Instructor
Date
2
Search Process Description
The patient safety issue under investigation is medication errors in the medical unit.
Medication errors can lead to harmful patient consequences, including adverse drug events,
prolonged hospital stays, and increased healthcare costs (England et al., 2020). Therefore, to
address this issue, the EBP/QI project aims to explore the effectiveness of implementing barcode
scanning technology compared to manual medication administration in adult patients admitted to
the medical unit. Moreover, the research question in the PICO(T) format is as follows: In adult
patients admitted to the inpatient medical unit, does the implementation of barcode scanning
technology compared to manual medication administration reduce the occurrence of medication
errors and improve patient safety and outcomes?
Thus, numerous sources of evidence highlight or prove the existence of this problem and
provide potential solutions to the problem. As a result, a literature search was conducted in this
assignment to identify these sources that help solve the PICOT question. The first step in the
process was to select an appropriate health-related database. Therefore, the literature search was
conducted solely on the PubMed database using keywords like “Medication errors and Barcode
scanning.” Eight hundred thirty-three articles were then found that were published within the last
five years. This was the starting point in the literature search.
More filters were then included, including only articles that contained full text
and that used randomized controlled designs as the study design. Thus, only 38 articles met this
criterion. However, these articles were still many. Hence, the literature search proceeded to
screen both the headings and abstracts of 15 articles that were relevant to the topic. Out of the 15
screened articles, seven were eliminated, and only eight were now screened for full text. Four
3
more articles were then eliminated that needed to meet the inclusion criterion. Hence, articles
that were selected for inclusion in the qualitative literature synthesis included;
i.
England, E., Deakin, C. D., Nolan, J. P., Lall, R., Quinn, T., Gates, S., Miller, J., O’Shea,
L., Pocock, H., Rees, N., Scomparin, C., & Perkins, G. D. (2020). Patient safety incidents
and medication errors during a clinical trial: experience from a pre-hospital randomized
controlled trial of emergency medication administration. European Journal of clinical
pharmacology, 76(10), 1355–1362. https://doi.org/10.1007/s00228-020-02887-z
ii.
Schmidt-Mende, K., Hasselström, J., Wettermark, B., Andersen, M., & BastholmRahmner, P. (2018). General practitioners’ and nurses’ views on medication reviews and
potentially inappropriate medicines in elderly patients – a qualitative study of reports by
educating pharmacists. Scandinavian Journal of primary health care, 36(3), 329–341.
https://doi.org/10.1080/02813432.2018.1487458
iii.
Jessurun, J. G., Hunfeld, N. G. M., Van Rosmalen, J., Van Dijk, M., & Van Den Bemt, P.
M. L. A. (2021). Effect of automated unit dose dispensing with barcode scanning on
medication administration errors: an uncontrolled before-and-after study. International
journal for quality in health care: journal of the International Society for Quality in
Health Care, 33(4), mzab142. https://doi.org/10.1093/intqhc/mzab142
iv.
Farhat, A., Al-Hajje, A., Lang, P. O., & Csajka, C. (2022). Impact of Pharmaceutical
Interventions with STOPP/START and PIM-Check in Older Hospitalized Patients: A
Randomized Controlled Trial. Drugs & Aging, 39(11), 899–910.
These articles were retained because of their relevance to the study topic, use of a
randomized controlled design which provides level-one evidence, and the fact that they were
present in full text for easier reference.
4
References
England, E., Deakin, C. D., Nolan, J. P., Lall, R., Quinn, T., Gates, S., Miller, J., O’Shea, L.,
Pocock, H., Rees, N., Scomparin, C., & Perkins, G. D. (2020). Patient safety incidents
and medication errors during a clinical trial: experience from a pre-hospital randomized
controlled trial of emergency medication administration. European Journal of clinical
pharmacology, 76(10), 1355–1362. https://doi.org/10.1007/s00228-020-02887-z
5
Appendix
PRISMA Diagram Flowchart
Identification
Records Identified through the
“Pubmed” database published between
2018 and 2023
(n = 833)
Records after selecting only articles
that have full-texts present and are
Randomized Controlled Design
Records excluded
(n = 23)
Screening
Records excluded
(n = 15)
(n = 7)
Full-text articles assessed for eligibility
Included
Records screened (title and abstract)
Eligibility
(n = 38)
(n = 8)
Studies included in the qualitative
synthesis
(n = 4)
Full-text articles excluded (n = 4)
Hospital Policy Template
(Under each heading, write the information needed for the section. Once each section is
completed, delete all instructions in parentheses.)
Subject/Title of Policy:
Purpose:
(1–2 short paragraphs. Include the following:
•
Summarize the patient safety issue. Explain the gap or a problem in a health care or
public health situation that caused the issue.
•
Use supporting evidence from the literature to show how it determined the need. Explain
how the evidence was gathered.
•
Include your revised PICO(T) question.
•
Explain why it was necessary to take action with the development of this policy.)
Population Affected by the Policy:
(2–3 sentences. Describe the target population to be addressed by an intervention in enough
detail that it is clear what population is included or excluded.)
Definitions:
(Explain any industry specific terms used throughout the document needed for the
understanding of the policy. Define in a manner that is descriptive to non-industry personnel.)
Policy Statement:
(3–5 sentence paragraph. Include the following:
•
State the organization’s declaration of the plans, giving a timeframe and scope of the
policy implementation.
•
Explain the organization’s intentions or goals regarding the patient safety issue.)
Procedure:
(Elaborate on the step-by-step procedure that was outlined in the policy statement above in
enough detail that one could replicate the process based on your description alone.)
References:
1
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