Medication Errors-Sample Solution

Introduction

Nationally, medication errors account for more than 3.5 million physician visits, one million emergency department visits and up to 125,000 hospital admissions (da Silva, & Krishnamurthy, 2016). As a result, healthcare barcoding technology is geared towards the prevention of medication administration errors, founded on the premise of the five rights of medication administration. With a focus on preventable medication errors, the barcoding system verifies that the right patient, right drug, right dose, right route and right time, for each patient thereby improving the safety of the patient and increase the accuracy of medication administration. Despite the safety and operational efficiency benefits coupled by an existing bar-code system, reduced use of the technology due to challenges including being understaffed, heavy workloads, nurse burnout, nurse workarounds, lack of adequate training on the technology and non-compliance with CPOE policy are among the factors attributing to the 17% medication error rate in the facility. The project reinforced bar-code technology in the medication delivery process and medication safety education to reduce the medication error rate from 17% to 10% in a geriatric psychiatric unit in 4 weeks.(Medication Errors Essay Example)

A literature search was conducted on the use and adoption of bar code assisted medication administration as well as the link between medication errors and the bar code medication technology. The search used the databases of CINAHL, PubMed, MEDLINE, and PsychINFO from 2010-2020. In Chapter 2, section 2 focused on the theoretical models used in defining the gap and the intervention. Section 3 examined the themes and subthemes in the literature review, tying each theme and subtheme to the gap and interventions of the project. The significance of the project is identified and described in section 4, while section 5 provides a rationale for the quantitative project method, and section 6 discussed the project design.

Theoretical Framework

Donabedian’s theory, the theory of planned behavior and the Normalization Process Theory guided the Quality Improvement Project.  The Donabedian’s conceptual model was used to evaluate and measure improvements to the quality of care by focusing on the components of structure, process and outcomes (Shen et al., 2018). The model is founded on the concept of structure measures influencing process measures, which subsequently affect outcome measures. Donabedian’s model helped link how medication errors (outcome measure) relate to the use of the barcoding technology (process measure), and workflow factors such as nurse burnout (structure outcomes) correlate with improving the quality of care at the facility.(Medication Errors Essay Example)

The theory of planned behavior (TPB) provided a framework for understanding the individual behavior of nurses and predicted the intention of engaging in a behavior at a specific time and place. TPB is founded on the concept that behavioral change achievement relies on motivation, which is the intention and ability, which determines behavioral control (Davies, 2019). TPB provided a model for reinforcing barcoding technology in the medication delivery process and the premise for medication safety education in reducing the rate of medication error. The Normalization Process Theory provided a framework for implementing, embedding and integrating the intervention by focusing on human processes that facilitate the adoption of new practices (May et al., 2018). The conceptual model helped in defining the approaches for reinforcing of barcoding technology in the medication delivery process, medication safety education, ensuring the intervention is accurately embedded into practice and providing sustainable measures for maintaining the practice past the evaluation period.(Medication Errors Essay Example)

Literature review

The three themes that emerged after a systematic review included workarounds in bar-assisted medication administration, nurse compliance with barcode-medication administration technology, and medication administration errors.

Theme 1: Medication administration errors

To understand the problem of medication errors, the research cross-examined the occurrence of medication errors in the clinical setting.

1. Causes of medication errors in the unit; examines the potential causes of medication errors, to determine the factors that contribute to the increased risk of medication errors (Bijlsma, & Taxis, 2017; Othman, & Darawad, 2020).
2. Prevention of medication administration errors; Researched on the approaches implemented to prevent the occurrence of medication errors and why bar-code technology is among the best frameworks for preventing medication errors (Othman, & Darawad, 2020)

• Safety and quality of care; Examined the link between the cause of medication errors across literature and prevention to determine the correlation with patient safety and quality of care (Van Der Veen et al., 2020; Harrington, Clyne, Fuchs, Hardison, & Johnson, 2013)

Theme 2: Workarounds in bar-assisted medication administration

Workarounds in barcoding assisted medication administration is among the critical challenges resulting in high medication error rates. The research included literature examining the nurse workarounds through the themes of;(Medication Errors Essay Example)

1. Taking short cuts during a work task; examined the factors leading nurses to take short cuts during work tasks involving bar-code assisted technology (Leung et l., 2015).
2. Perceived usefulness of bar-assisted medication technology- Researched on the link between the perceived usefulness of barcoded medication technology and workarounds (Harrington, Clyne, Fuchs, Hardison, & Johnson, 2013).

• Role of nursing administration: Focused on the role nurse administration plays in nurse workarounds (Van Der Veen et al., 2018)

Theme 3: Human-machine interface in relation to medication errors

1. Nurse level of understanding of Barcoding technology; the link between the ability to use barcoding technology and medication errors (Darawad, Othman, & Alosta, 2019).
2. Adequacy of barcoding equipment and information: Examined the presence of supporting material on the use and adoption of barcoding technology and the potential outcomes (van der Veen et al., 2020).

• Training on the use of barcoding technology: Focused on the education levels and the impact of training nurses on the use of barcoding technology on medication administration errors (Booth, Sinclair, Strudwick, Hall, Tong, Loggie, & Chan, 2017).

Significance of the Project

The quality improvement project aims at reducing medication errors within the unit to 10%, thereby contributing to patient safety and optimizing the quality of care. The project focuses on reinforcing the adoption of an already existing framework, subsequently improving the operational efficiencies of the barcoding technology in the system. The project also addresses a gap consistent across the organization and helps alleviate the high risks, and costs associated with medication errors.(Medication Errors Essay Example)

Project Methodology

The project used a quantitative approach to conduct the research. The method allows the project to apply descriptive statistics in conducting a systematic and empirical investigation. The methodology helped define associations between variables of the project leading to a better understanding of the gap and the implications of the intervention.

Project Design

The project used a meta-analysis design to conduct the research. The design enabled the QIT project to examine the findings of independent studies and assess the effectiveness of the intervention. The meta-analysis enabled the research to estimate the effect of the intervention while analyzing the sustainability factors.(Medication Errors Essay Example)

References

Bijlsma, M., & Taxis, K. (2017). Association between Workarounds and Medication Administration Errors in Bar Code-Assisted Medication Administration: Protocol of a Multicenter Study. JMIR research protocols, 6(4), e74-e74.

Booth, R. G., Sinclair, B., Strudwick, G., Hall, J., Tong, J., Loggie, B., & Chan, R. (2017). Strategies through clinical simulation to support nursing students and their learning of Barcode Medication Administration (BCMA) and Electronic Medication Administration Record (eMAR) technologies. In Health Professionals’ Education in the Age of Clinical Information Systems, Mobile Computing and Social Networks (pp. 245-266). Academic Press.

Darawad, M. W., Othman, E. H., & Alosta, M. R. (2019). Nurses’ satisfaction with bar-code medication‐administration technology: Results of a cross‐sectional study. Nursing & Health Sciences, 21(4), 461-469.

Da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of community hospital internal medicine perspectives, 6(4), 31758. https://doi.org/10.3402/jchimp.v6.31758

Davies, S. L. (2019). Using the Theory of Planned Behavior to Implement a Multi-Modal Fall Reduction Plan (Doctoral dissertation, Grand Canyon University).

Harrington, L., Clyne, K., Fuchs, M. A., Hardison, V., & Johnson, C. (2013). Evaluation of the use of bar-code medication administration in nursing practice using an evidence-based checklist. JONA: The Journal of Nursing Administration, 43(11), 611-617.

Leung, A. A., Denham, C. R., Gandhi, T. K., Bane, A., Churchill, W. W., Bates, D. W., & Poon, E. G. (2015). A safe practice standard for bar-code technology. Journal of patient safety, 11(2), 89-99.

May, C. R., Cummings, A., Girling, M., Bracher, M., Mair, F. S., May, C. M., & Finch, T. (2018). Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implementation Science, 13(1), 80.

Othman, E. H., & Darawad, M. W. (2020). Nurses’ Compliance with Bar-code Medication Administration Technology: Results of Direct Observation of Jordanian Nurses’ Practice. CIN: Computers, Informatics, Nursing, 38(5), 256-262.

Shen, M., Chen, S., Liu, X., GAO, J., Xiaohua, W. U., Hongzhen, X. U., & Zhu, J. (2018). Establishment of evaluation pediatrics nursing-sensitive quality indicatorssystembasedon Donabedian’s structure-process-outcome theory. Chinese Journal of Practical Nursing, 34(26), 2035-2041.

Van der Veen, W., Taxis, K., Wouters, H., Vermeulen, H., Bates, D. W., van den Bemt, P. M., & Vasbinder, E. C. (2020). Factors associated with workarounds in barcode‐assisted medication administration in hospitals. Journal of Clinical Nursing.

Van Der Veen, W., Van Den Bemt, P. M., Wouters, H., Bates, D. W., Twisk, J. W., De Gier, J. J., … & Ros, J. J. (2018). Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. Journal of the American Medical Informatics Association, 25(4), 385-392.

Xie, N. (2017). Nurses’ perceptions of bar code medication administration best practices to increase bar code scanning rates in a mental health setting.