NURS FPX4020 Assessment 4 Improvement Plan Tool Kit

NURS-FPX4020-Assessment-4-Improvement-Plan-Tool-Kit

Improvement Plan Tool Kit

Medication administration errors are common across the United States (US). The statistics show that over 1.3 million US residents are injured in incidents related to medication administration (Single Care, 2021). A case of medication administration error was highlighted and analyzed at Mass General Brigham (MGH), which highlighted different aspects and specific reasons for the medication error. A plan for implementing new procedures and using technology in the medication administration process has been proposed at MGH. An improvement toolkit has been developed in this assessment for MGH so that the nurses can utilize it to learn more about safe medication practices. The toolkit aims to reduce the security risks at the healthcare organization. 

Resources to Implement Safety Initiatives

Yin, H. S., Neuspiel, D. R., Paul, I. M., Franklin, W., Tieder, J. S., Adirim, T., Alvarez, F., Brown, J. M., Bundy, D. G., Ferguson, L. E., Van Den Anker, J. N., & Verhoef, P. A. (2021). Preventing home medication administration errors. Pediatrics148(6)https://doi.org/10.1542/peds.2021-054666

The research states that medication errors are very common in healthcare practice with liquid medication due to inappropriate medication prescription or measurement. The disposal of used or expired medication, along with providing training to the care providers, is important in reducing errors related to medication. Patient safety is ensured by collective training provided to nurses through in-service sessions leading to an effective reduction in medication errors. The nurses at MGH can use this resource to ensure the correct measurement of liquid medication. The use of resources is most appropriate for complex patients with chronic conditions under the age of 18 years. 

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety11(1), 1–29. https://doi.org/10.1177/2042098620968309

The research provided many tools which helped eliminate errors at the prescribers’ end. The most dominant ones in the systematic review were pharmacist-led medication reconciliation, Computerized Physician Order Entry (CPOE), and prescriber education. The use of technology to digitally write prescriptions was analyzed as the most intuitive tool presented by the resource. CPOE, in this capacity, was recognized as a system to reduce medication errors due to wrong prescriptions. The nurses are less likely to change dosage with low uncertainty in the prescription or handwriting. The digital prescription hence reduces the chance of error. The nurses can use the resource in their daily routine and demand a digital prescription from the medication administrator at MGH to reduce the chances of medication error. 

Vaismoradi, M., Tella, S., Logan, P. A., Khakurel, J., & Moreno, F. V. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health17(6), 1–15. https://doi.org/10.3390/ijerph17062028

According to the research, the patient-safety principles and nurses’ adherence to them are evidence-based ways to eliminate medication errors. The research found that the adherence of nurses, along with the mentioned principles of patient safety, was highly dependent on providers’ knowledge, policies set by providers, skills of nurses, patient support, and the presence of a safety culture. The resource hence indicates that the strong implementation of healthcare policies can enhance the effectiveness of nurses in providing care to patients while also ensuring patient safety. Nurses can use this resource to develop a culture of safety in MGH and by forcing management and boards of directors to create policies for adherence to safety principles. Implementing the resource in either of the presented ways for nurses can eliminate the risk of medication errors at MGH. 

Melnyk, B. M., Tan, A., Hsieh, A. P., Gawlik, K., Engoren, C. A., Braun, L. T., Dunbar, S., Jacob, J. D., Lewis, L. M., Millan, A., Orsolini, L., Robbins, L. B., Russell, C. L., Tucker, S., & Wilbur, J. (2021). Critical care nurses’ physical and mental health, worksite wellness support, and medical errors. American Journal of Critical Care30(3), 176–184. https://doi.org/10.4037/ajcc2021301

The scholarly resource recognized the need for nurses’ health advocacy to improve medication administration. The research found that low medication errors were directly related to positive nurse health, where nurses’ health depended on the workplace culture, providers’ support, and other factors like workload, shift time, and overtime. The resource is highly useful for increasing the understanding of nurses and MGH management regarding safety essentials. The research highlights the factors affecting nurses’ health at MGH, which can increase patient safety at institutions. Nurses can use this resource to gain facilities’ and providers’ attention toward their physical and mental health. According to the resource, the better physical and mental health of MGH nurses will lead to fewer medication errors at the institutions. 

Safety Improvement in Medication Administration and Risks Reductions

Lima, K. P., Mata, D. A., Loureiro, S. R., Crippa, J. A., Bolsoni, L. M., & Sen, S. (2019). Association between physician depressive symptoms and medical errors. JAMA Network Open2(11)https://doi.org/10.1001/jamanetworkopen.2019.16097

The research identified that the doctors’ or physicians’ health was as important as nurses’ health. The results indicated that the positive symptoms of depression in physicians increased the likelihood of medication errors at healthcare institutions. The workplace factors like the low culture of safety, low nurse competence, and low respect among the medical team were identified to induce depression in physicians that caused medication errors. The resource highlights that nurses should have high competence and respect for their seniors in the medical team to increase the mental well-being of each member. The resource can be used through team-building activities at MGH, improving the mental well-being of physicians and nurses and reducing the risk of medication administration. 

McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Collins, G. H., Clancy, M., Sheehy, A., Denieffe, S., Bergin, M., & Savage, E. (2019). Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. Journal of Nursing Management27(3), 491–501. https://doi.org/10.1111/jonm.12727

The research stated that electronic documentation for prescriptions and nurse interventions reduces medication and documentation errors at healthcare institutions. The resource also defined that nurse training was a mandatory element for successfully implementing electronic nursing documentation to reduce medication errors at healthcare institutions. The resource is important for nurses as it addresses the primary need for safety improvement. The resource makes it important for nurses to use electronic documentation to improve their functioning across the workplace, improving their safety by reducing the number of falls. The nurses at MGH can use this resource to increase their safety at the workplace, which is directly associated with the culture of safety at the healthcare institution and patient safety. The improved safety of nurses at the workplace will increase the safety culture, leading to low medication errors at MGH. 

Alqenae, F. A., Steinke, D., & Keers, R. N. (2020). Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review. Drug Safety43(6)https://doi.org/10.1007/s40264-020-00918-3

The research analyzed the prevalence of medication errors and adverse drug events in the past 30 years. The analysis showed that almost all medication errors were reported post-discharge. The research identified that the period from the secondary care provision to the discharge was the most critical, as most medication errors happened in this period. The nurses can enhance their focus on the period of patient care after secondary prescription and before discharge to enhance care. The nurses at MGH can use this resource to understand the care period in which medication errors are most likely to occur and be extra careful towards the prescribed medication, patient safety, and drug administration in this specific period to reduce medication errors. The resource also helps nurses identify the possible mistakes in the given period that caused medication errors. 

Menon, N. K., Shanafelt, T. D., Sinsky, C. A., Linzer, M., Carlasare, L., Brady, K. J. S., Stillman, M. J., & Trockel, M. T. (2020). Association of physician burnout with suicidal ideation and medical errors. JAMA Network Open3(12)https://doi.org/10.1001/jamanetworkopen.2020.28780

Work stress, workload, and burnout were reported to be significantly associated with the possibility of medication error. All healthcare professionals, including doctors, physicians, and nurses, were included in the study. The resource presented that the healthcare institutions did not evaluate the capacity of the physical domain of each nurse or medical staff before issuing the overtime. The resulting burnout was the primary reason for the increased medication errors at healthcare institutions. The resource report that nurses should not consider overtime as a potential opportunity to further their careers unless they can handle the additional workload. The nurses at MGH need to analyze their limits before burnout and avoid taking shifts that can create burnout in them to reduce medication administration. Medication errors at healthcare institutions can be reduced significantly by avoiding overtime work or putting an additional workload on individual nurses or other team members at the healthcare institution. 

Best Practices for Medication Administration to Reduce Patient Safety Risks

Jung, S. Y., Hwang, H., Lee, K., Lee, H.-Y., Kim, E., Kim, M., & Cho, I. Y. (2020). Barriers and facilitators to implementation of medication decision support systems in electronic medical records: Mixed methods approach based on structural equation modeling and qualitative analysis. JMIR Medical Informatics8(7)https://doi.org/10.2196/18758

The Medication Decision Support System (MDSS) is effective in increasing the effectiveness of the medication administration protocols at healthcare institutions if its implementation in the Electronic Health Record (EHR) is sustainable and accurate. The use of MDSS was evaluated through EHR at healthcare institutions, resulting in different limitations hindering the positive results for patient safety. The research proposed that the nurse training for using EHR and MDSS was essential for reducing the medication errors and adverse events resulting from these medication errors. The resource encourages nurses to participate in safety improvement initiatives and pieces of training to increase their skill levels to operate EHR in all of its evolved forms. Nurses at MGH can use the resource by effectively learning the new EHR implemented to support the medication administration protocols at the institution. Nurses should also report the EHR application at MGH using this resource if the interface is complex and incomprehensible. 

Nanji, K. C., Garabedian, P. M., Shaikh, S. D., Langlieb, M. E., Boxwala, A., Gordon, W. J., & Bates, D. W. (2021). Development of a perioperative medication-related clinical decision support tool to prevent medication errors: An analysis of user feedback. Applied Clinical Informatics12(5), 984–995. https://doi.org/10.1055/s-0041-1736339

Clinical Decision Support Systems (CDSS) were provided as an evidence-based measure for preventing medication errors at healthcare institutions. The resource analyzed that implementing CDSS can eliminate prescription errors or lack of competencies in medication administration processes. The research proposed that technical involvement in medication administration ensured patient safety, which eliminates the chances of human error through alerts. The research also proposed that EHR was an effective system for reducing medication errors resulting from dosage-related errors. Nurses can increase patient safety by using EHR or CDSS with the appropriate level of training. Nurses at MGH can use the resource to review possible errors resulting in the functioning of EHR or CDSS at the institution and avoid them to reduce medication errors and increase patient safety. 

Koyama, A. K., Maddox, C.-S. S., Li, L., Bucknall, T., & Westbrook, J. I. (2019). Effectiveness of double checking to reduce medication administration errors: A systematic review. BMJ Quality & Safety29(7), 595–603. https://doi.org/10.1136/bmjqs-2019-009552

The resource identified that double-checking the patient medication information before administering it can significantly reduce the chances of error in medication administration. The results indicated that extra care in reading prescriptions and administering medication could save nurses from the burden of medication errors and increase the effectiveness of patient safety at healthcare institutions. Double-checking is evidence-based quality intervention according to the resource that can significantly reduce medication errors at any healthcare institution. Nurses can understand the importance of medication administration and the associated protocol standards in reducing medication administration errors. Nurses at MGH can review the information provided by the medication administrator and prescribers before medicating patients to reduce the chances of medication errors. 

Han, Y., Kim, J.-S., & Seo, Y. (2019). Cross-sectional study on patient safety culture, patient safety competency, and adverse events. Western Journal of Nursing Research42(1), 32–40. https://doi.org/10.1177/0193945919838990

The research analyzed nurses’ perceptions and the internal structure and culture of the healthcare institutions to find factors that contributed to medication errors. The results indicated that the culture of safety and nurses’ positive perception of patient safety effectively reduced medication errors. The research also proposed that regular activities like in-service sessions and pieces of training were important in developing a culture of safety that positively influence patient safety at healthcare institutions. Nurses can increase their understanding of the safety culture and its importance in ensuring patient safety by using the information provided by this resource. The increase in the nurses’ understanding of the culture of safety also reduces the medication errors resulting from them. The nurses at MGH can participate in the planned in-service session for training and information to develop a perception of patients’ and other colleague nurses’ safety and occupational health. Nurses in this capacity are also critical resources for developing a culture of safety at MGH, contributing to patient safety and reducing medication errors.  

References

Alqenae, F. A., Steinke, D., & Keers, R. N. (2020). Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review. Drug Safety43(6)https://doi.org/10.1007/s40264-020-00918-3

Han, Y., Kim, J.-S., & Seo, Y. (2019). Cross-sectional study on patient safety culture, patient safety competency, and adverse events. Western Journal of Nursing Research42(1), 32–40. https://doi.org/10.1177/0193945919838990

Jung, S. Y., Hwang, H., Lee, K., Lee, H.-Y., Kim, E., Kim, M., & Cho, I. Y. (2020). Barriers and facilitators to implementation of medication decision support systems in electronic medical records: Mixed methods approach based on structural equation modeling and qualitative analysis. JMIR Medical Informatics8(7)https://doi.org/10.2196/18758

Koyama, A. K., Maddox, C.-S. S., Li, L., Bucknall, T., & Westbrook, J. I. (2019). Effectiveness of double checking to reduce medication administration errors: A systematic review. BMJ Quality & Safety29(7), 595–603. https://doi.org/10.1136/bmjqs-2019-009552

Lima, K. P., Mata, D. A., Loureiro, S. R., Crippa, J. A., Bolsoni, L. M., & Sen, S. (2019). Association between physician depressive symptoms and medical errors. JAMA Network Open2(11)https://doi.org/10.1001/jamanetworkopen.2019.16097

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety11(1), 1–29. https://doi.org/10.1177/2042098620968309

McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Collins, G. H., Clancy, M., Sheehy, A., Denieffe, S., Bergin, M., & Savage, E. (2019). Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. Journal of Nursing Management27(3), 491–501. https://doi.org/10.1111/jonm.12727

Melnyk, B. M., Tan, A., Hsieh, A. P., Gawlik, K., Engoren, C. A., Braun, L. T., Dunbar, S., Jacob, J. D., Lewis, L. M., Millan, A., Orsolini, L., Robbins, L. B., Russell, C. L., Tucker, S., & Wilbur, J. (2021). Critical care nurses’ physical and mental health, worksite wellness support, and medical errors. American Journal of Critical Care30(3), 176–184. https://doi.org/10.4037/ajcc2021301

Menon, N. K., Shanafelt, T. D., Sinsky, C. A., Linzer, M., Carlasare, L., Brady, K. J. S., Stillman, M. J., & Trockel, M. T. (2020). Association of physician burnout with suicidal ideation and medical errors. JAMA Network Open3(12)https://doi.org/10.1001/jamanetworkopen.2020.28780

Nanji, K. C., Garabedian, P. M., Shaikh, S. D., Langlieb, M. E., Boxwala, A., Gordon, W. J., & Bates, D. W. (2021). Development of a perioperative medication-related clinical decision support tool to prevent medication errors: An analysis of user feedback. Applied Clinical Informatics12(5), 984–995. https://doi.org/10.1055/s-0041-1736339

Single Care. (2021, May 2). Medication errors statistics. The Checkup. https://www.singlecare.com/blog/news/medication-errors-statistics/#:~:text=The%20cost%20of%20medication%20errors

Vaismoradi, M., Tella, S., Logan, P. A., Khakurel, J., & Moreno, F. V. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health17(6), 1–15. https://doi.org/10.3390/ijerph17062028

Yin, H. S., Neuspiel, D. R., Paul, I. M., Franklin, W., Tieder, J. S., Adirim, T., Alvarez, F., Brown, J. M., Bundy, D. G., Ferguson, L. E., Van Den Anker, J. N., & Verhoef, P. A. (2021). Preventing home medication administration errors. Pediatrics148(6)https://doi.org/10.1542/peds.2021-054666

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