Reinforcement of Barcoding technology in medication delivery process: Direct Practice Improvement (DPI) Project Proposal Chapter 2 – Literature Review

Reinforcement of Barcoding technology in medication delivery process: Direct Practice Improvement (DPI) Project Proposal Chapter 2 – Literature Review…

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Direct Practice Improvement (DPI) Project Proposal Chapter 2 – Literature Review

Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesis of the literature in the Literature Review (Chapter 2) defines the key aspects of the learner’s scholarly project, such as the problem statement, population and location, clinical questions, variables or phenomena (if relevant to the project), methodology and design, purpose statement, data collection, and data analysis approaches. The literature selected must illustrate strong support for the learner’s practice change proposal.

ARTICLES WITHIN THE PAST 5 YEARS OLD

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate the “DPI Proposal Template” in the PI Workspace of the DC Network.
• Locate the Develop a Literature Review assignment you completed in DNP-820.
• Locate the “Research Article Chart” resource in the DC network Course Materials.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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Directions:

Use the “DPI Proposal Template” and the “Develop a Literature Review” assignment from DNP-820 to develop a draft of a literature review (Chapter 2) for your DPI Project Proposal. The literature review (Chapter 2) is required to be a minimum of 20-25 pages including a minimum of 50 scholarly citations.  You have already completed some of this review in previous courses. No less than 85% of the articles must have been published in the past 5 years. Articles selected must provide strong, reliable support for the proposal.

Use the following DPI proposal template’s criteria to create your draft Literature Review (Chapter 2):

1. Access and review the DPI Project Template for Chapter 2 criteria
   • Sections of this Chapter include:
     • Introduction to the Chapter and Background to the Problem
     • Theoretical Foundations
     • Review of Literature including Themes and Sub-themes
     • Summary
2. Using the Clinical Question/PICOT question components, identify at least two themes which will organize the literature review .
3. Identify at least three subthemes that relate to each theme (six subthemes total).
4. Identify at least three empirical or scholarly articles related to each subtheme (18 articles total). At least one article must demonstrate a quantitative methodology.
5. Use the “Research Article Chart” resource as a guide to: (a) analyze and synthesize the literature into your paper, (b) state the article title, (c) identify the author, (d) state the research question(s), (e) identify the research sample, (f) explain the research methodology, (g) identify the limitations in the study, (h) provide the research findings of the study, and (i) identify the opportunities for practice implementation. For scholarly, nonempirical articles, state the article title and author, and provide a brief contextual summary of the article.

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Solution:Reinforcement of Barcoding technology in medication delivery process

Chapter 2: Literature Review

Introduction

Patient safety is one of the critical concerns of contemporary healthcare systems. Medication errors (M.E.s) are associated with patient harm and could lead to morbidity, hospitalization, increased healthcare costs, and, in some cases, death. Estimates indicate that 6% of all hospitalizations are drug-related, with the cost implications being nearly $40 billion annually.

With up to 50% of all drug-related errors being preventable, technological advances such as computerized physician the order entry (CPOE) and point of care medication administration through bar-coding technology (BCMA) have been formulated to align the medication administration process. BMCA was developed and adopted to maximize safety and optimize the quality of care by streamlining the medication delivery process to adhere to the five rights of medication. Nurses’ frontline position makes them the best suited to implement BMCA to reduce the occurrence of M.E.s effectively.

This chapter analyzes and discusses available research on reinforcing bar-code medication administration (BCMA) system use, BCMA nurse workaround practices, nurse compliance to BMCA recommendations, and medication errors. The chapter provides a comprehensive analysis of the problem and the gap. The chapter then describes the research’s theoretical models, Donabedian’s theory, and the normalization process theory.

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An analysis of literature on BCMA conception and use then follows, relating the system to the critical issue of medication errors. The chapter then extensively examines existing literature on BCMA implementation, reinforcement, and use, nurse workarounds, nurse compliance to BCMA procedures, and medication administration errors. Lastly, the chapter includes a discussion on literature rated to methodology and instrumentation used in the research.

The purpose of this direct practice improvement (DPI) project is to determine if or to what degree the reinforcement of bar-code medication system among nurses would impact the rates of a medication error when compared to the absence of reinforcement among nurses in an acute psychiatric unit in Milford, CT over four weeks.

While the evidence demonstrates the benefits of exiting technology such as BMCA systems during medication administration in the verification of medication and the five rights, the technology is only as effective as the end-user (Berdot et al., 2016; Hassink, Essenberg, Roukema, & van den Bemt, 2013; Maaskant et al., 2015).

Nurses bear the responsibility of ensuring adherence to the five rights of medication delivery and medication error prevention; however, circumvention of bar-coding medications occurs more often than should due to several factors including being understaffed, heavy workloads, nurse burnout, nurse workarounds, lack of adequate training on the technology and non-compliance with set guidelines.

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A literature search was conducted on the use and adoption of BCMA as well as the link between medication errors, nurse workarounds, and the bar code medication technology. The search used the databases of the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsychINFO from 2010-2020.

The search terms used included bar-code medication administration, workarounds, medication errors, medication administration, nurse compliance, normalization process theory, and Donabedian’s theory. Terms, medication errors, and medication administration were searched independently and together. The search included qualitative, quantitative, and mixed-method studies to understand the problem and its causes and also determine approaches of reinforcing BCMA sustainably.

Background

Medication errors are a leading cause of medical injuries and contribute to an increase in health care costs, length of stays, readmission rates, and reduce patient satisfaction rates (Assiri et al., 2019). 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). Among geriatric populations, the risk of medication errors is high and associated with visits to the emergency department, hospitalization, and adverse outcomes.

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Davies (2019) shows that up to 50% of medication errors occurring in the ordering and prescribing stage are readily identifiable compared to errors in the administration phases that are less identifiable. Despite a high risk of harm, errors occurring during the medication administration phase are preventable. With one-third of the errors occurring in the administration phase, nurses are in the frontline in the mitigation of medication errors.

Over the years, the prevention of medication administration errors has been founded on the premise of the five rights of medication administration: right patient, right drug, right dose, right route, and right time. Different strategies, including medication-error analysis, computerized physician order entry (CPOE) systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, and standardizing medication-use processes, have been applied to curtail the problem of medication errors (Berdot et al., 2016; Gates et al., 2019).

With a focus on preventable medication administration errors, the bar-coding system verifies that the five rights for each patient, thereby improving the safety of the patient and increase the accuracy of medication administration. First implemented by Eastern Kansas Health Care System and Colmery-O’Neil Veteran Medical Center in Topeka, Kansas, from 1999 to 2001, the United States Department of Veterans Affairs indicated that the system was effective in reducing medication administration errors, managing inventory, streamlining billing, and saving time at the bedside (Coyle & Heinen, 2015).

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Smetzer, Baker, Byrne, and Cohen (2010) examined the use and adoption of BCMA system in the administration of medication of prescribed medication and noted that BCMA created a safety barrier between the nurse and the patient, allowing the nurse to confirm the patient’s identity, name, dose, time and form of medication delivered.

The Collaborative Healthcare Patient Safety Organization (CHPSO) annotates that BCMA was developed to decrease errors related to the unauthorized drug, wrong form, wrong dose, wrong route, extra dose, and omission (Agency for Healthcare Research and Quality, n.d.). However, effective reduction of the errors relates to the effective adoption of BCMA in consideration of nursing workflows since nurses spend 25% of their time on medication-related tasks.

Besides, early analysis of the impact of implementing BMCA showed that BMCA improved care quality by reducing reliance on memory, increasing access to information, and increasing compliance with best practice (Coyle & Heinen, 2015). However, some of the critical issues identified early in the adoption and integration stages include incorporating the input end-users (nurses), adequate training and education on the use of the system, workflow issues, and perceived usefulness and importance to nurses.

On workflows and the efficiencies of BMCA, Cain, and Haque (2008) note that minimal inconveniences such as the need to scan the patient’s wrist lead to workflow workarounds as the nurse attempts to make their work more efficient. The perceived negative correlation between technological processes and efficient workflows lead nurses to alternate workflows that are informal, reliant on the nurses’ memory and overlook decision-support safeguards implemented by the BMCA system (Cane & Haque, 2008).

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Even though the facility implemented BMCA in 2013, the activities of nurses mirror workflows identified in research as some document before medication to more dangerous actions such as giving medication before scanning. Nurses’ failure to effectively use the technology limits its effectiveness in reducing rates of medication errors. It is imperative to examine the problem of non-adherence to set BCMA adoption and the use of nurse workaround practices in medication administration…

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