Improvement Plan Tool Kit

Medication errors and drug administration are considered to be adverse discrepancies in patients’ health as well as healthcare settings. It is believed that there is a great amount of time and resources being spent on solving Medication errors. In the US, almost 15% of hospitals’ resources are believed to be spent on resolving such errors, totalling the cost of $42 billion (WHO, 2019).  Recent studies showed that various healthcare providers, especially nurses, have an important role to play in preventing medication errors. The collaboration between pharmacists and nurses has proven to be an important factor in preventing medication discrepancies (WHO, 2019). This report’s objective is to present organized information on preventing medication errors. The annotated bibliography presented here will give real-time data and information on preventing medication errors and providing an effective improvement plan tool kit.

Elements of Successful Quality Initiative

This paper is important in terms of summarizing all of the related work of the past 2 decades in a single place. It summarizes the recent works done on human-simulation-based learning to reduce medication errors. It describes that simulation-based learning is identified as a potential tool for reducing medication errors but the best practices for healthcare specialists are yet to be chosen. This review is based on the literature presented at Medline in 2000-2015. It has excluded technology-based simulation and technical skills learning to solely focus on the best practices for healthcare specialists. Out of 21 studies, that were observed, a few showed simulation-based learning as more effective than the instructional learning process. 

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

It has shown that lack of long-time assessments and real-time data have been the problems in identifying specific results. However, the elements that are necessary for simulation-based learning are well-identified with the help of this review. These elements include framework designing, undertaking, and sensible assessment. This review concludes that the integration of specific human factors can make the simulation more effective and will strongly help in enhancing the learning skills of nursing and other healthcare specialists by providing them with hands-on practice without getting into a real-world scenario. Hence, preparing better for such kinds of emergencies (such as iatrogenic risk).

This article shows real-time data and a research project that focuses on medication error reduction. It shows that almost 8000 American people die annually due to medication discrepancies. Seeing such adverse effects of medication errors (MEs), it utilizes methods of lean six sigma (LSS) technology in tackling the ME issues. The direct action methodology followed includes LSS Define, Measure, Analyze, Improve, Control (DMAIC). Data obtained, showed that there is a 66.66% reduction in ME as the number of ME incidents decreased from 6 to 2 per 20,000 inpatient days per month from Apr 2018 to Aug 2019. It has also been stated that communication between pharmacy technicians and the management of hospital pharmacies has also been improved. As the study was conducted in a specific setting (a teaching hospital in Thailand), it cannot be generalized. This study is important in understanding how action research can improve patients’ health, reduce ME incidents and promote better collaboration between patients and healthcare specialists. 

Factors Leading to Patient Safety Risks with Specific Examples

This systemic review describes the impact of frequent alarms on nursing specialists. As in ICU (intensive care units), nurses have to monitor the patients for 24 hours, use of frequent alarms can prove tiresome for nursing specialists. To check this hypothesis, a study was conducted across various online databases and 7 papers were finalized. Data were analysed both qualitatively and quantitatively. 389 nurses were tested from the given data, and all of them were working in different intensive care units (ICU). Out of seven, 2 studies judged the research qualitatively while the other 5 present quantitative data by utilizing the healthcare technology foundation (HTF) questionnaire method. 

ICU nurses stated that alarms are very frequent and can lead to reduced care of patients and trust in alarm systems. Nurses also stated that being overburdened with responsibilities and frequent alarms can cause excessive burnout and reduced efficiency in working. Operating modern equipment is time taking and nurses can dedicate less time to patients due to it. A monitoring system is absent for the overlook of alarm rings. This systemic review highlights the burden created due by excessive alarms and addresses the immediate solution to the alarm fatigue problem. 

This review explains the connection between physician burnout, patient safety and career growth globally. Its importance is due to the direct involvement and crucial role of efficient performance of physicians in patient care and treatment. Different databases were searched for this research including Medline, PsycINFO, CINAHL, and Embase. 170 articles and 239,246 physicians were observed in this study. Data showed that burnout led to a four times decrease in job satisfaction, three times more career regret, turnover was threefold, small yet significant productivity effect and crucial damage to career development. These issues were seen more in physicians of age 25-29 and 30-39. Many trainee physicians were found regretting their career choice and patient safety incidents were also associated more with these trainee physicians. 

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

This meta-analysis is important in terms of determining poor functioning and less sustainability of healthcare settings associated with physician burnout. It showed that burnout causes a decrease in career growth, endangers patient safety and lowers the professionalism of physicians. The physicians in training or residency are the main victims of burnout, this reviews states that it is essential for healthcare companies to implement reality-based strategies to mitigate burnout conditions, especially in emergency units and medication centres. 

This review shows therapeutic problems as one of the main causes of drug-related problems. It says that from manufacturing to prescription, negligence in therapeutics can cause potential damages. It focuses on LASA (look alike/sound alike) technique and FAR (high-risk drugs) for therapeutic error prevention.

According to this review, most of the errors occur during drug administration, drug prescription due to improper interpretation and drug posology due to LASA problems. Alongside healthcare specialists, patients should also be tentative in understanding prescription times and interpretation. Nurses should keep a check on patients who take medicines of similar packaging. Specific attention to children is required to avoid toxicological problems by the ingestion of the wrong medicines by children. 

Organizational Interventions to Promote Patient Safety

A pharmacist-led medication reconciliation (MR) was done to observe the role of MR in patient care and safety. This study is important in understanding whether MR can promote better healthcare or not. After careful observation of discharging patients, no significant data was taken which can show the results of MR-led processes in promoting better healthcare facilities. However, the data showed that there is a need for standardization of MR processes and also it gave new insights to improve further MR-led processes in promoting patient safety. 

This review summarises data from previous literature on EHRs. It describes that while no action research was done, however, some patients from different hospitals were contacted for interviews. It describes the importance of EHRs in high-income countries and provides new insights into how these systems can be implemented in middle-income and low-income countries. Moreover, this study is crucial in understanding what kind of meta-analysis and systemic review is needed to provide data about the latest HER systems.

This review summarizes the use of computerized clinical decision support systems (CDSS) to promote better healthcare across high-income countries. It emphasizes the fact that with all the advancements in CDSS, whether it is its association with electronic medical records or computerized workflows, there are still unknowns that show risks associated with CDSS. This is a state-of-the-art review which focuses on potential setbacks, pitfalls and harms of CDSS and shows us how these pitfalls can be improved with better plan-making policies. 

Role of Nurses in Care

This review is essential in addressing the fear of medication error reporting by nurses, cultural setbacks and face-saving issues. Data received after interviewing 569 junior and mid-senior level registered nurses showed that face-saving and medication error reporting fear were 14.63 and 18.62, respectively. It is mainly said to be associated with career setback fear and cultural fear as more Chinese nurses were the victim of this. If a healthcare company wants to reduce medication errors, this review strongly states that it is not possible without reducing these issues first.

This article describes the role of nurses in medication administration in nursing homes and describes what should be the exact role of nurses in nursing homes to promoting better healthcare among patients and reduce medication errors. This review highlights the following needs of nurses in nursing homes; a need for competence, invisible leadership, varying available competence and staff stability. Moreover, it also describes what nurses should not be doing to a reduction in their work efficiency. Hence, it is a great resource to understand the exact role of nurses in medication administration at nursing homes.

This book is significant in highlighting the role of nurses in proper medication administration. Its importance is due to the “five rights” mentioned in it. ‘Right patient’ means that specific medication for a specific patient, ‘Right drug’ describes that administered and prescribed medications should be the same, ‘Right route’ is in form of an oral, muscular or veinous route for medication to affect for its desired time, ‘Right time’ describes the exact time writer in the prescription of medicine, and ‘Right dose’ referring to potential harms of incorrect dosages.

Hence, this book has a large repository for understanding the role of nurses in medication and can be of very good use. It also describes concerns like poor reading of warnings by junior-level nurses due to poor lit issues and lack of confidence. 

This review describes nurses’ decision-making, practising and perceptive information towards medication administration. It describes 26 medication-related interruptions with a total of 56 interruptions. It describes potential factors for medication errors and presents effective solutions. According to this study, an understanding of the complex working environments of nurses and cognitive workload management is necessary for preventing MEs. Also, the involvement of patients in safe medication is a good strategy for nurses.

 References

Bucknall, T., Fossum, M., Hutchinson, A. M., Botti, M., Considine, J., Dunning, T., Hughes, L., Weir‐Phyland, J., Digby, R., & Manias, E. (2019). Nurses’ decision‐making, practices and perceptions of patient involvement in medication administration in an acute hospital setting. Journal of Advanced Nursing, 75(6), 1316–1327.

https://doi.org/10.1111/jan.13963 

Fernandes, B. D., Almeida, P. H. R. F., Foppa, A. A., Sousa, C. T., Ayres, L. R., & Chemello, C. (2020). Pharmacist-led medication reconciliation at patient discharge: A scoping review. Research in Social and Administrative Pharmacy, 16(5), 605–613.

https://doi.org/10.1016/j.sapharm.2019.08.001 

Hanson, A., & Haddad, L. M. (2021). Nursing Rights of Medication Administration. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK560654/

Hodkinson, A., Zhou, A., Johnson, J., Geraghty, K., Riley, R., Zhou, A., Panagopoulou, E., Chew-Graham, C. A., Peters, D., Esmail, A., & Panagioti, M. (2022). Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ, 378(8352), e070442.

https://doi.org/10.1136/bmj-2022-070442

Lewandowska, K., Weisbrot, M., Cieloszyk, A., Mędrzycka-Dąbrowska, W., Krupa, S., & Ozga, D. (2020). Impact of alarm fatigue on the work of nurses in an intensive care environment—A systematic review. International Journal of Environmental Research and Public Health, 17(22), 8409.

https://doi.org/10.3390/ijerph17228409

Li, E., Clarke, J., Neves, A. L., Ashrafian, H., & Darzi, A. (2021a). Electronic Health Records, interoperability and patient safety in health systems of high-income countries: A systematic review protocol. BMJ Open, 11(7), e044941.

https://doi.org/10.1136/bmjopen-2020-044941

Marovino, E., Morgillo, A., Mancino, N., Di Feo, V., & Genito, E. (2022). Therapeutic Error: Types and Prevention Strategies and Focus about “Look Alike/Sound Alike” and “High Risk” Drugs. Journal of Pharmaceutical Research International, 34(48A), 9–16.

https://doi.org/10.9734/jpri/2022/v34i48a36409

Medication safety in transitions of care. (2019). World Health Organization.

https://apps.who.int/iris/bitstream/handle/10665/325453/WHO-UHC-SDS-2019.9-eng.pdf

Odberg, K. R., Hansen, B. S., & Wangensteen, S. (2018). Medication administration in nursing homes: A qualitative study of the nurse role. Nursing Open, 6(2), 384–392.

https://doi.org/10.1002/nop2.216

Sarfati, L., Ranchon, F., Vantard, N., Schwiertz, V., Larbre, V., Parat, S., Faudel, A., & Rioufol, C. (2018). Human-simulation-based learning to prevent medication error: A systematic review. Journal of Evaluation in Clinical Practice, 25(1), 11–20.

https://doi.org/10.1111/jep.12883

Sutton, R., Pincock, D., Baumgart, D., Sadowski, D., Fedorak, R., & Kroeker, K. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(1), 1–10.

https://doi.org/10.1038/s41746-020-0221-y

Trakulsunti, Y., Antony, J., Dempsey, M., & Brennan, A. (2020). Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study. International Journal of Quality & Reliability Management, 38(1), 339–362.

https://doi.org/10.1108/ijqrm-10-2019-0334

Yang, R., Pepper, G. A., Wang, H., Liu, T., Wu, D., & Jiang, Y. (2020). The mediating role of power distance and face-saving on nurses’ fear of medication error reporting: A cross-sectional survey. International Journal of Nursing Studies, 105, 103494.

https://doi.org/10.1016/j.ijnurstu.2019.103494