Reinforcement of Barcoding technology in medication delivery process and medication safety education to reduce medication error: A Quality Improvement Project.

Reinforcement of Barcoding technology in medication delivery process and medication safety education to reduce medication error: A Quality Improvement Project…

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Paper details

THE PROJECT WILL BE WRITTEN ACCORDING TO MY PROJECT TOPIC AND PICOT BELOW. ALL ARTICLES WILL BE PEER REVIEWED ARTICLE LESS THAN 5 YEARS. ATTACHED ARE THE RUBRICS, GUIDELINES AND REQUIREMENTS. NEED SAME WRITER TO FOLLOW THE PROJECT AND HIGHER LEVEL WRITING.

PLEASE ADHERE TO ALL GUIDELINES AND FOLLOW THE TEMPLATE ATTACHED. ATTACH THE COVER PAGE WITH TITLE AND REFERENCE. YOU MAY USE LEWIN THEORY OF CHANGE, DONABEDIAN THEORY AND WATSON THEORY

PICOT: To what degree does the Reinforcement of Barcoding technology in the medication delivery process and medication safety education reduce rate of medication error from 20% to 10% when compared to absence reinforcement among nurses in M&M medical CTR in 4 weeks. A Quantitative analysis.

LITTLE BACKGROUND: The nurses at the M&M unit does not adhere to the use of the barcoding during medication error that’s why the medication rate is high.

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Chapter 1 of the Direct Practice Improvement (DPI) Project is titled “Introduction to the Project” and includes background and other essential information regarding the overall DPI Project design and components.

General Requirements:

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

• Locate the “DPI Proposal Template” located in the PI Workspace of the DC Network.
• Access the textbook “The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing textbook. Chapter 10 of this textbook provides an excellent template for a DNP-focused scholarly project.
• Access examples of DPI projects in the DC network DNP Practice Immersion Space
• 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” to help you develop a draft of the Introduction (Chapter 1) of your DPI Project Proposal. Keep in mind this is an outline and formatting structure; it may be of use to you, but recall that each project will vary in nature and scope, so adaptations to this format may be required. Sections in Chapter 1 include:

1. Chapter 1: Introduction to the Project
2. Background of the Project
3. Problem Statement
4. Purpose of the Project
5. Clinical Question(s)
6. Advancing Scientific Knowledge
7. Significance of the Project
8. Rationale for Methodology
9. Nature of the Project Design
10. Definition of Terms
11. Assumptions, Limitations, Delimitations
12. Summary and Organization of the Remainder of the Project

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Solution

Chapter 1Introduction to Project

The publication of the Institute of Medicine (IOM; 2000)’s report To Err is Human: Building a Safer Healthcare System has helped enhance the safety of healthcare. Medication errors (MEs) are among the critical and prevalent issues affecting the safety and quality of care still in health care today. Preventable medical errors are among the leading causes of medical injuries. 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).

Further reports by IOM show that medication errors are closely associated with poor patient outcomes, with one in 131 outpatient and one in 854 inpatient deaths, and an increased risk for readmission (Bijlsma, & Taxis, 2017). Besides costs exceeding $40 billion annually, medication errors are associated with psychological and physical pain, decreased patient satisfaction, and growing distrust in the healthcare system (Bijlsma et al., 2017).

These early medical and medication error statistics published in the IOM report did not go unnoticed in writing of the Patient Protection and Affordable Care Act (ACA; 2010). Within the ACA (2010), a committed focus exists on ensuring the quality of care patients receive through medical error reduction, application of the best evidence in clinical practice and incorporation of information technology.

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Moreover, the ACA (2010) encourages data collection, analysis, and evaluation of care processes so as to redesign systems in order to reliably improve patient safety. Finally, the importance of quality improvement efforts in combination with patient safety clinical training for health care professionals was prominent throughout the ACA (2010).

The Joint Commission (TJC; 2019) was not far behind the ACA in recognizing patient safety risks associated with the medication administration process and potential adverse outcomes that can ensue when performance gaps are not identified early, and policies evaluated.

Further, TJC emphasized reinforcement of a framework for health care organizations to effectively and safely deliver medications that iterates very basics of medication administration the five Rs: Right patient; right drug; right dose; right route; and right time.

The 2008 Sentinel Event Alert, Safely implementing health information and converging technologies, included 13 recommended strategies, two of which pertinent to the Direct Practice Improvement (DPI) project which include an examination of “workflow processes and procedures for risks and inefficiencies” (p. 2) and ensure well-designed education for all health care professionals using the technology with emphasis of the benefits for both patients and health care staff (TJC, 2008).

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A variety of technological advances have emerged since the IOM’s 2000 report to improve patient safety such as clinical decision support in the electronic health record (ERH) with the implementation of computerized physician the order entry (CPOE) and point of care medication administration through bar-coding technology (Bates & Singh, 2018; Wright et al., 2018).

With the intention of maximizing safety and optimizing quality, bar-coding medication administration (BMCA) has been implemented and mandated in medication administration across the United States (Bijlsma et al., 2017). According to the 2017 Leapfrog Hospital Survey, found that among the nearly 2,000 reporting hospitals, almost all (98.7 percent) have a BCMA system connected to an electronic medication administration record, yet only 34.5 percent entirely meet all four requirements for implementing the technology effectively (Leapfrong Group, 2018).

However, the nurses at the M&M psychiatric unit do not adhere to the use of the barcoding during medication administration leading to medication error rates that is relatively high at 17%. The direct improvement project focused on reducing the medication error rates by reinforcing the use of BMCA during medication administration.

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The effective use and adoption of the BMCA system leads to safer medication administration coupled with lower hospital costs, improved quality and higher patient satisfaction. Studies show that the implementation of BMCA also has implications on nurse workflows as it reduces the time spent on medication related activities by 25% (Booth, et al., 2017).

For BCMA to be effective in M&M against preventing medication error, nurses must adhere to utilizing barcode scanning device during the time of medication administration. Despite 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.

Besides, challenges associated with human-machine interface interactions such as lack of adequate training and attitudes that influence perceived usefulness and understanding, limit the competence of nurses in utilizing BMCA (Booth et al., 2017). Reinforcing the use of BMCA in medication administration reduces the medication error rates in the unit, thereby improving safety in the facility.

The DPI project implemented a BMCA reinforcement framework that emphasized on the use of bar-code technology in the medication delivery process by training on the use and usefulness of the technology and medication safety education (Darawad, Othman, & Alosta, 2019).

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The project assessed the current compliance rates among nurses through the Harrington Bar-Code Medication Administration Evidence-Based Checklist tool, used in pre-intervention and post intervention (Davies, 2019). Clinical records were applied to determine medication error rates pre and post intervention and quantitative analysis was conducted on the variables to determine the effect of the intervention. The DPI project was conducted at the M&M unit of a geriatric psychiatric facility.

Background of the Project

The process of medication is complex and requires strict adherence from the point of ordering to administration. Studies indicate 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 and IOM estimates that 25% to 95% of the medication errors are preventable (Davies, 2019).

Evidence based practice supports the use and adoption of BMCA system in the administration of medication of prescribed medication. Some of the critical issues identified early in the adoption and integration stages includes 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.

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The inpatient acute psychiatric unit, which was the clinical setting for the evidenced based practice quality improvement project that partakes in the implementation of BMCA to improve quality of care and patient safety during medication administration. The unit is a 30 bed, psychiatric unit that BCMA has been implemented since 2013. Though from direct observation and current reports identified by their system revealed that the unit are delinquent with the bar-coding scanning process.

Despite the presence of bar-code technology in the facility, nurses use workarounds that increase the risk of medication errors. Bates and Singh (2018) reckon that despite of the development and adoption of highly effective intervention for medication safety, inconsistent implementation and practice continue to adversely affect their impact. In particular a psychiatric unit nurses’ failure to effectively use the technology limit its effectiveness in reducing rates of medication errors.

According to Othman and Darawad (2020), the sequence of using BMCA begins with scanning of self-ID, obtain medications, scan medication bar-code, scan patient ID band, give medication to patient and lastly document administration. However, only 39% of nurses followed the procedure as recommended in administering medication (Harrington, Clyne, Fuchs, Hardison, & Johnson, 2013).

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Consequently, nurses create workaround practices such as directly administering medications without scanning the patient and the medication, increasing the risk of medication administration errors. Workarounds are defined as observed or desired behaviors that vary from organizationally prescribed or intended procedure (Othman & Darawad, 2020).

In BMCA use, workarounds occur due to either omission of process steps, performing the steps out of order or unauthorized process steps. Nurses apply workaround practices to alienate perceived workplace hindrances and challenges or reduce time spent of medication. The causes of nurse workaround practices are attributed to the challenges associated with human-machine interfaces, organizational policies, patient-affiliated circumstances or environment-related factors (Harrington et al., 2013).

Assessments of the acute psychiatric unit triggers comprises of non-compliance and workaround practices due to an increase in workload, being understaffed, frequent interruptions, lack of adequate education/training on the use of bar-coding technology, and non-compliance with CPOE policy. Perceived usefulness, understanding of the potential hazards of non-compliance and safety measures education, are also critical in determining the level of nurse compliance (Leung et al., 2017).

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Reinforcing the use of BMCA system in the medication delivery process and conducting medication safety education on the perceived usefulness of the system and potential hazards of non-compliance, will help reduce preventable medication administration errors.

Problem Statement

Nurse non-adherence to the guidelines and procedures of barcode medication administration systems increases the risk of medication errors. The M&M acute psychiatric unit currently has a medication error rate of 17%. The DPI focused on reducing the medication error rates by improving bar-coding compliance during the medication delivery process via medication safety education (Leung et al., 2017).

BMCA will be used in addition to nurse’s critical thinking to eliminate the medication errors adequately. The DPI worked to eliminate nurse workaround practices and shortcuts to accurate application of BMCA, with the goal of decreasing medication errors. Medication errors are a key impediment to safe healthcare and a key hindrance to better patient outcomes and satisfaction rates (Shen et al., 2018).

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The problem of non-adherence is to set medication administration guidelines and recommendations on BMCA application directly impacts medication errors rates by increasing the risk of preventable errors (Shen et al., 2018). Geriatric patients in the acute psychiatric unit face multi-comorbidities, and have an elevated vulnerability to medication errors.

Potential hazards of medication errors may increase costs, length of hospital stay, and readmission rates, while decreasing patient satisfaction with care and the patient’s psychological well-being during treatment (Leung et al., 2017). Nurses using workaround practices fail to fulfil the commitment of a healthcare professional to effectively use the tools useful in treatment and management of disease to provide safe and highly competent care.

Despite prevalence of non-compliance to BMCA system application as recommended, few measures have focused on reinforcing the system’s use in medication administration. The DPI tied reinforcing BMCA use to medication safety education and training and medication error rates in a geriatric psychiatric unit (Shen et al., 2018).

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While research shows that bar-coding technology is a critical technology in medication administration, it was not known if or to what degree the reinforcement of the use of bar-coding technology in medication administration process would impact the medication error rate when compared to the absence of reinforcing and emphasis on its use among geriatric psychiatric nurses (Leung et al., 2017).

Purpose of the Project

Non-adherence to set guidelines in BMCA subsequently affects the ability of nurses to deliver safe and quality care. The contemporary nursing continuum acknowledges the frontline position of nurses, and is inclined to utilizing the position to continuously improve the quality of care. Safety and patient satisfaction are key attributes of quality care giving and directly correlate to reduced medical costs, readmission rates and length of admissions (Shen et al., 2018).

Over the years, the integration of technology has been dedicated to improving operational efficiencies in care while maximizing safety, and optimizing quality (Leung et al., 2017). Each technology-led improvement relies on the ability of end-users, health care professionals, to effectively adopt and implement the system for better outcomes. Following guidelines and recommendation is critical in addressing the underlying problems and consequently improving the quality of care.

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Improving adherence to BMCA use narrows down influencing the factors hindering effective use and creating frameworks to support sustainable use of the technology in clinical settings (Othman & Darawad, 2020). Education and training were identified and applied to influence nurse attitudes to BMCA such as perceived usefulness, ease of use, and the capabilities to effectively use BMCA during medication administration.

Medication safety education also focused on creating awareness on the potential hazards of nurse workaround practices and emphasizing on the use of correct guidelines and procedures when applying BMCA (Othman & Darawad, 2020). Through the reinforcement, the project reduced the medication error rates.

The DPI addresses a clinical issue that affects most of the healthcare facilities using BMCA systems. The successful implementation of the intervention provides evidence to support effective and safe nurse practices while optimizing nurse performance and workflows (Leung et al., 2017). The purpose of this quantitative quasi-experimental project was 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 acute psychiatric unit in Milford, CT over four weeks.

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Clinical Question(s)

Reinforcement of BMCA in a clinical setting optimizes the use of technology to address the prevalence of medication errors. In the DPI, the focus is on influencing nurses to accurately implement and use BMCA system to minimize the risk for medication administration errors (Leung et al., 2017). The independent variable in the research is the education intervention, while the dependent variable is the medication error rates on the unit.

The clinical question for the DPI project was: To what degree does the implementation of reinforcement of bar-code technology in the medication administration process impact medication errors when compared to the absence of reinforcement among nurses in M&M medical center?

From the clinical question, clinical PICOT question was formulated with the nurses in the acute psychiatric unit being the population, reinforcement of bar-code medication administration technology education as the intervention, compared to maintaining the current approach of zero reinforcement and emphasis on following recommended steps for BMCA (Othman & Darawad, 2020). The expected outcomes are a decline in the medication error rates from the current 17% to 10% within a period of four weeks.

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The decline indicates the success of the intervention in addressing the problem of poor compliance to BMCA use and application recommendation. To measure the effectiveness of this DPI project, the psychiatric nurse scans compliance rates prior to and after the reinforcement of the intervention was compared to assess if improvement had occurred.

The PICOT question is (P) Among nurses in M&M medical CTR, (I) reinforcement of bar-code technology in the medication delivery process and medication safety education, (C) compared to the absence of reinforcement to reduce medication error rate from (O) 17% to 10%, (T) over a period four weeks?

Advancing Scientific Knowledge

At the core of the project is the change in behavior of nurses and paradigm shift to compliance to set guidelines on BMCA use. The Donabedian’s theory and the Normalization Process Theory guided the Direct Improvement Project and helped verse the transition pre to post intervention. 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 (Donabedian, 1996).

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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 (Ayanian & Markel, 2016). 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. The DPI helped understand how normalization theory can be used alongside TPB and the Donabedian’s theory to provide a rationale, culture behavior and provide a framework for sustained implementation.

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. For the BCMA to function adequately to prevent medication errors, the unit medication needs to be scanned with bar-code system and the patient’s bar-coded armband.

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Otherwise, this creates opportunity for the nurses to make medication error. 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 in the unit and helps alleviate the high risks, and costs associated with medication errors (Othman, & Darawad, 2020). Upon implementation, the intervention will alienate nurse workarounds, consequently improving nurse workflows by up to 25% (Othman, & Darawad, 2020).

The potential results have an effect on critical determinants of patient outcomes, safety and quality of care (Othman, & Darawad, 2020). The implication ranges from reduced readmission rates due to medication errors, lower costs and increased patient satisfaction.

Despite growing literature on the use of technological solutions for clinical issues such as medication errors and patient falls, few studies examine the long-term application of the systems in line with the compliance of end users. Current literature on Health IT use and integration dictates that it is imperative to establish monitoring and evaluation frameworks to assess the compliance to set guidelines of use (Baiden, 2018). The DPI project contributed to the design and implementation of an intervention to ensure sustainable integration of technology-led solutions.

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The intervention can also be used in the implementation and reinforcement of other health IT integrations in the clinical settings. The intervention is particularly effective as it creates a framework for behavioral change by addressing underlying attitudes and providing a path for continuous quality improvement. With the increase in Health IT in nurse workflows, the project provided a framework for effective system implementation and the approaches to address implementation challenges.

The conceptual framework of the project provided a pathway for assessing, improving and empowering nurses’ abilities in performing technology related tasks. Besides improving health informatics, the project examined a gap that affects most health IT system post implementation.

Rationale for 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. Quantitative research examined the relationship among variables to identify statistically significant relationships based on objective measurement and observation.

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In the methodology, the criteria for key research is significance, researchability, feasibility and the interest.
On medication errors and potential change, the research obtained the data from clinical records on the number of medication errors in the facility throughout the four weeks of intervention. Pre-intervention numbers were recorded, and change monitored during the intervention and after the intervention.

In data analysis, Descriptive statistics described the sample characteristics and variable results. Mean, and the standard deviation was used to examine nurse compliance with Bar-code medication systems. Spearman correlation test was used to identify correlations between compliance and satisfaction with the BMCA system, perceived usefulness, training and understanding of the systems, and ease of use and the medication error rates in the facility.

Nature of the Project Design

The project used a quantitative quasi-experimental design to conduct the research. The design enabled the DPI project to examine the findings of independent studies and assess the effectiveness of the intervention. The quasi-experimental design allowed the researcher to manipulate the independent variable, but the subjects are not randomized (Xie, 2017).

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This allows the independent variable to be measured, observed and manipulated, unlike most research designs. The framework makes quasi-experimental design a non-randomized, pre-post intervention framework. This fits to the DPI project which doesn’t allow randomization, is applied to a specific location in a hospital, and has a small sample size.

The quasi-experimental approach is best suited for the research focused on medical informatics as it allows evaluation and monitoring of pre and post intervention outcomes. Moreover, quasi-experimental are highly effective because they evaluate the real-world effectiveness of an intervention implemented by hospital staff, rather than efficacy of an intervention implemented by research staff under research conditions (Van Der Veen et al., 2018). This makes quasi-experimental have a better external validity compared to random controlled trials (RCT) which are considered superior.

The research was conducted at M& M medical center, Milford, CT. The population was of a geriatric psychiatric unit with 30 RN nurses. The sample included nurses within the unit handling patients and medication administration.

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The sample population was recruited through convenience sampling. The participant had to be RNs, working at the selected acute psychiatric unit for at least 6 months and administering medications to patients as part of their daily tasks. Physicians and nursing managers, not directly involved with medication administration and the use of the bar-code medication system, were excluded from the research.

For data collection, the research collected data from nurses using the Harrington Bar-Code Medication Administration Evidence-Based Checklist tool (Harrington et al., 2013). The tool was used pre-intervention and post intervention to determine the nurses’ compliance with bar-code medication administration (Harrington et al., 2020). The Harington evidence-based BCMA checklist evaluates administrative, clinical, and technological aspects of BCMA policies, procedures, and utilization.

The checklist provides a basis for assessing the compliance of nurses pre-intervention and post-intervention as it assess best practices. Kelly, Harrington, Matos, Turner, and Johnson (2016) utilize the checklist and determine that all the checklist items are relevant to the practice environment and consistent with current literature. Hence, to effectively measure practice integration and evaluate BMCA use, the DPI use the Harrington Bar-Code Medication Administration Evidence-Based Checklist tool in data collection.

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Definition of Terms

• Bar-Code Medication Administration: This is “point-of-care technology that integrates nurse scanning of bar-coded medications with the patient’s electronic medication administration record” (Koppel et al., 2008; Hurley et al., 2007, p. 343).
• Perceived Usefulness: (PU) is “the degree to which a user believes that using [a] system will enhance his or her performance” (Bennet, 2017).
• Bar-Code Medication Administration Evidence-Based Checklist- “17 item checklist that evaluates nurses’ compliance using BCMA” (van der Veen et al., 2017).
• Donabedian’s theory- This is a known as “the structure, process, outcome (SPO) model, provides a framework that guides understanding, and allows for the examination of health services and evaluating quality of health care (Ayanian & Markel, 2016).
• Human-machine interface is “how clinicians and patients interact with technology”
• Normalization Process Theory is a theoretical model that “identifies, characterizes and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions” (May et al., 2018).
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• Workarounds: Defined as observed or desired behaviors that vary from organizationally prescribed or intended procedure (van der Veen et al. 2017)
• Workloads have been defined as “a combination of factors, including nursing time spent in direct patient care and other work, competency, physical exertion, and complexity of care” (Alghamdi, 2016).

Assumptions, Limitations, Delimitations

Assumptions

The research assumes that all RNs taking part in the intervention received adequate training and education to effectively and competently use BMCA. The DPI also assumes that all participants (Nurses) are aware of the 5 rights of medication administration, guidelines and recommendation for BMCA as well as the facility’s medication administration.

Further, the research upholds that despite the bias of self-reporting, the nurses provide accurate answers. On workarounds, the DPI assumes that they can be both conscious and unconscious and most nurses use different types of workarounds in medication administration.

Joint Commission (2018) revealed that technology alone cannot be used as an accurate patient identification. The staff need to be supported with adequate training and reliable procedures as accurate patient identification that involves shared responsibility and involvement of all stakeholders.

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Another assumption is the implementation of the Patient Protection Affordable Care Act (ACA; 2010) which called for healthcare to ‘‘Implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage” (ACA, 2010, p. 19) as noted in Section. 2717 [42 U.S.C. 300gg–17].

Another assumption is that implementation of bar coding technology in the delivery of care decreases the risk for medication errors. Additionally, there is the assumption that nurses would readily adopt the new technology. With the consistent use of barcoding technology, there is the assumption that a decline in medication errors occurs. The DPI also upholds the assumption that the re-education of nurses and normalization of the process of barcoding will decrease medication errors.

Harrington et al. (2013) identified that two months following education on correct sequencing, the scanning sequence was noted at 100% compliant from the nurses. This assumption shows that nurses would readily adopt the new technology with the consistent use of barcoding technology and same time reduce rate of medication errors occurs. Lastly, the DPI also assumes that the implementation of bar-coding technology in the delivery of care decreases the risk for medication errors.

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Limitations and Delimitations

One of the key limitations of the study is one the reliance on self-reporting in determining safe and effective use of BMCA. Nurses may alter the accuracy of the data, to downplay the use of workarounds in administering medications. The limitation of this research is that data for the analysis will only be collected from a hospital/healthcare institution in Milford.

The target population for the research project will be nurses working in M&M Medical Center and not the actual patients who dealt with nursing malpractice. The dependent and independent variables in the research study will be reinforcing bar coding, nurse education and rate of medication errors in the M&M

Medical Center.

Summary and Organization of the Remainder of the Project

In a health care facility’ psychiatric unit, nurse leaders recognized an increase in medication error rate. Anecdotal observations by the primary investigator (PI) identified a number of factors that contributed to the increased medication error rate. An expansive literature search for evidence-based research supports observed deviations, human-machine interface workarounds with bar-coding and environmental barriers that contribute to failure to use bar-coding technology. Therefore, a need exists to implement an evidence-based method to reinforce the use of bar-code technology in medication administration on a psychiatric unit in order to decrease the medication error rate.

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Despite the safety and operational efficiency benefits coupled with an existing bar-code system in the facility of interest, 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 four weeks.

Prior studies show that effective use of bar-code technology in medication administration is associated with reduced medication errors and improved operational efficiencies. However, few studies examine how reinforcement of BMCA through medication safety education improves use and integration in clinical settings. The research applies a quantitative approach to collect numerical data on the impact of reinforcing the use of bar-coding technology on medication error data in the acute psychiatric unit.

Donabedian’s conceptual model was used to evaluate and measure improvements to the quality of care by focusing on the components of the structure, process, and outcomes (Berwick, & Fox, 2016). 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. The DPI reduces the medication error rates, will improve patient safety and quality of care in the geriatric psychiatric unit.

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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.

Chapter 3 examined the methodology used in the project. The problem is redefined and a rationale for the clinical question provided. The chapter also includes a comprehensive analysis of research methodology and research design. Chapter 3 also defined the population and sample selection mechanism, the research materials and instrumentation, trustworthiness, validity, reliability and approaches used in data collection and management. The data analysis procedures were also comprehensively examined, ethical considerations analyzed and the limits and delimitations of the methodology discussed.

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