Research Critiques and PICOT Statement Final Draft

Running head: ROUGH DRAFT QUANTITATIVE RESEARCH 1

ROUGH DRAFT QUANTITATIVE RESEARCH 2

PICO question-Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors?  Comment by Linnette Nolte: You need a nursing intervention. What is your intervention and measurable outcome?

ROUGH DRAFT QUANTITATIVE RESEARCH-EXAMPLE #1

Introduction and Background

According to Elden, N. M. K. & Ismail, A. (2016), “medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of the health care professional, patient, or consumer (National Coordinating Council for Medical Reporting and Prevention)”. Medication errors may occur during any phase of the medication delivery process. Med errors are the main cause of adverse events for hospitalized inpatients and among the highest and most common errors, harming 1.5 million individuals per year.   

Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? The purpose of this research is to improve safety and find strategies to help facilitate. With the main objective being patient safety. The studies aim to start this process is to “1) Determine the baseline rates of medication errors in the hospital; 2) Recognize the major types of medication error; 3) Reduce risks of medication errors through application of prevention strategies” (Elden, N. M. K., & Ismail, A. (2016).   Comment by Linnette Nolte: You are not doing research in this class. You are looking for a nursing intervention and research to support it. Comment by Linnette Nolte: Incomplete sentence

Methodology 

The method of this article will answer the PICOT question, among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? in three phases. The first phase deals with policy and procedure. The committee formed made sure to reinforce policies for the hospital. Doctors and nurses voluntarily reported all medication errors or errors related to medications. Clinical pharmacists were enlisted to follow nurses and read patients files in accordance with policy to monitor drug handling in all its stages. They would intervene if necessary, to prevent a potential error. The second phase deals with analyzing the reports and finding the root cause analysis to why these medication errors are happening. The aim in this phase focuses on improving patient safety and awareness of medical staff. The last phase is recalculating and comparing the information gathered in the first phase.   Comment by Linnette Nolte: What article? Citation?

The researcher used sampling in order to see the amount of med errors made after interventions were implemented and post third phase recalculation/information gathering.  

Results of Study 

Medication errors according to Elden, N. M. K., & Ismail, A. (2016), were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). 45% of those errors reached the patients included in the study. Of that 45%, 43.5% did not harm the patient and the other 1.7% did. After interventions and re-education of staff medication errors deceased from 6.7% to 3.6%.  

The anticipated outcome of the PICOT question is to reduce medication errors and improve patient safety. The researcher showed this by noting 1467 medication errors reported by physicians and nurses during the first phase to 1380 after intervention of observed medication administrations which is a 3.1% significant drop.  

ROUGH DRAFT QUANTITATIVE RESEARCH-EXAMPLE #2

Introduction and Background 

Significant attention to medication errors has increased over the last decade. “Medication administration errors (MAEs) according to McLeod, M., Barber, N., & Franklin, B. D. (n.d.) occur in 8.0% to 19.6% of doses in hospitals worldwide. Furthermore, the American Nurses Association (ANA) (2016) states that medication related deaths in the United States has surpassed other causes like chronic illnesses and motor vehicle accidents. With the current study conducted by McLeod, M., et al (n.d.), showing a link between persistent system-related challenges such as medicines not being available, limited equipment, inefficient workflow and frequent interruptions as known contributors to MAEs; the author has noted that variations in work based systems (such as medication ordering, and transport systems) can also have an affect the frequency of MAEs.   

The author does not show how medication errors can be eliminated due to limited research but examines medication errors from a different perspective: “how do nurses work within hospital systems to administer medications safely and successfully” (McLeod, M., et al. n.d.)? The authors perspective and the PICOT questions in this research aim to find out what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? 

Based on the aforementioned above problem, the primary focus of this study is to examine the systems used to administer medications safely and without harm. The objective generated from this study wishes to address any gaps between three interrelated areas: “(1) individual nurse practices and workarounds, (2) medication administration workflow, and (3) the frequency and nature of interruptions and distractions during medication administration” (McLeod, M., et al. n.d.). 

Methodology 

The research design employed by the author was “a mixed methods ethnographic study of medication administration by nursing staff” (McLeod, M., et al. n.d.). The author used both quantitative and qualitative research within this study. The quantitative part of the study looked at 30 participants using sampling observation on three units. Unit A used paper medication prescriptions, lockers and trolleys that help the medications and sometimes utilized patients own meds when applicable. Unit B used a technology to prescribe and administer medication called electronic. Unit C used two nurses as to administer medications. The difference in methods is that the first article focused on reeducating staff on policies and procedures dealing with medication administration whereas this article is trying to see what are some of the safe practices the hospital can put in place to reduce med errors and keep the patients safe.   Comment by Linnette Nolte: Benefits and limitations of both studies

Results 

The author notes that during the quantitative observation, “458 doses were included as observation evaluation (OEs) (445 non-IV and 13 IV doses). The MAE rates were 2.7% of non-IV OEs (95% confidence interval (CI), 1.2 to 4.2) and 30.8% of IV OEs (95% CI, 26.3 to 35.2)” (McLeod, M., et al. n.d.). The researcher comes to the realization after the study is complete that medication administration is not a linear process. There are multiple variations that facilitate and act as a barrier when administering medications. The first variation is structure. Structure-related aspects of the medication system acted as a physical constraint on some drug round tasks. The second variation is the nursing behavior. Some of the behaviors exhibited were either inherent (individual) or situational (environment). Either way in most cases, it had a negative effect when passing medications. Lastly, patient interactions. With patient interactions, the patient was observed as a hindrance of safe medication administration due to being easily distracted or just interrupting the nurse with conversation. The study was able to identify a median rate of 5.5 interruptions per drug round hour and 9.6 distractions per drug round hour which can be used as a bases when comparing with other researchers.  

Outcomes and comparison 

The anticipated outcome of the PICO question is reduction of med errors. The author’s research suggests similar outcomes to reduce medication administration errors (MAEs) by focusing on three main areas “(1) optimization of ward-based medication systems, (2) supporting nurses to manage interruptions and distractions, and (3) actively encouraging inpatient involvement with their medications where appropriate” (McLeod, M. et al. n.d.).  

References

Courtney, you conducted a good critique of these articles but you need a PICO question. You need to find a specific nursing intervention and a specific nursing outcome. Your articles need to support your intervention and outcome. Please revise for week 5. Linn