PICOT Statement Paper
Alejandro
Rothstein-PICOTStatementandLiteratureSearch2.24.20191.docxPICOT Statement and Literature Search 5
Medication Errors in Nursing Due to Staffing Shortage
Avrohom J. Rothstein, RN
Grand Canyon University
NRS-433V | Introduction to Nursing Research
Professor Colleen Darrow, MSN/Ed
February 24, 2019
Medication Errors in Nursing Due to Staffing Shortage
The nursing problem selected for the evidence-based practice (EBP) project is medication errors in nursing due to staff shortage. Medication error is a significant problem in the healthcare industry, especially in this era of nursing shortages and high nurse turnovers. With fewer nurses working in healthcare today, there are increased chances of medication error resulting in adverse drug events (ADEs). The focus of the project will be the effectiveness of implementing health information technology compared the conventional ways of medication management to reduce medication errors in critically ill patients. The critically ill patients were selected as the patient population of interest because they are particularly vulnerable to injury, which requires high-risk medication or frequent use of intravenous infusions increasing the likelihood of medication errors occurring. Health information technology can play a critical role in improving the efficiency of nurses in providing the care needed and reducing errors in medication.
Errors are usually inevitable but can lead to detrimental consequences. However, the likelihood of mistakes occurring will decrease by establishing the appropriate measures in place. In the healthcare system, the problem of medication errors will be lower by having a system-wide approach or processes, and not just in the medication administration phase. Since there are many healthcare practitioners involved in the process, integrating a system-whole approach can help in reducing all the possible loopholes for errors. With the issue of the nursing shortage and nurse turnover increasing every day, health information technology may serve as a possible solution to this problem. This EBP project will delve this issue in more details using the following PICOT statement as the guide:
PICOT Statement Formulation
· Population – Critically ill patients
· Intervention – Integration of health information technology in the medication process
· Control – Use of conventional medication management processes
· Outcome – Reduction of medication errors
· Time – Length Hospital stay
PICOT Statement:
In critically ill patients, does the integration of health information technology compared to conventional methods in the medication management process reduce medication errors during hospital stays?
References
Bertsch, N. S., Bindler, R. J., Wilson, P. L., Kim, A. P., & Ward, B. (2016). Medication Therapy Management for Patients Receiving Oral Chemotherapy Agents at a Community Oncology Center: A Pilot Study. Hospital Pharmacy, 51(9), 721-729. doi:10.1310/hpj5109—721
Purpose: To determine the impact of a pharmacist-driven medication therapy management (MTM) program for patients receiving oral chemotherapy agents.
Methods: We assessed the impact of MTM consultations with a pharmacist for patients who were receiving a new prescription for an oral chemotherapy agent. Data were assessed for outcomes including (1) number of medication errors identified in electronic medical records (EMRs), (2) number of interventions performed by the pharmacist, (3) time spent on the MTM process, and (4) patient satisfaction. Data were compared between patients who received their oral chemotherapy agents from the onsite specialty pharmacy or from a mail-order pharmacy. The data were also examined for correlations, and logistic regression was utilized to determine the largest variant cofactor to create an equation for estimating the number of errors in a patient’s EMR.
Results: Fifteen patients received an MTM consultation, and the pharmacists identified an average of 6 medication EMR errors per patient. There was an average of 3 pharmacist-led interventions per patient. Multiple significant correlations were noted between the variables: (1) total number of prescriptions a patient was taking, (2) total number of medication errors identified, (3) time spent on the MTM process, and (4) total number of interventions performed by the pharmacist. Patient satisfaction was favorable for the program.
Conclusion: The implementation of a pharmacist-driven MTM program for patients receiving a prescription for an oral chemotherapy agent had a significant impact on patient care by improving medication reconciliation, identifying drug-related problems, and strengthening pharmacistpatient interactions in the oncology clinic.
Ehteshami, A., Rezaei, P., Tavakoli, N., & Kasaei, M. (2013). The role of health information technology in reducing preventable medical errors and improving patient safety. International Journal of Health System and Disaster Management, 1(4), 195. doi: http://www.ijhsdm.org/text.asp?2013/1/4/195/130378
Abstract
Medical errors have become an increasing public concern among policy-makers, healthcare providers and experts. Medical errors in the U.S. hospitals and healthcare institutions are the third leading cause of death and almost 98,000 people annually lose their lives in this way. According to healthcare and health industry leaders, using information technology enhances patient safety by preventing medical errors, assessment errors and surveillance system with rapid response and reduces the risk of harm created after the fact. In this paper, medical errors are investigated, the role of information technology in reducing and preventing medical errors is investigated, and recommendations are presented regarding the use of information technology for prevention and reduction of medical errors in healthcare institutions.
Scientific databases and electronic journal citations were searched to identify articles that discussed the role of health information technology in reducing preventable medical errors and improving patient safety. We used reference tracking and citation methods and searched by following keywords: Information technology, medical errors, computerized provider order entry (CPOE), and clinical decision support system (CDSS). A total of 33 related articles were included in this study from the 609 articles initially obtained from the searches. Nature of medical errors occurring in healthcare organizations includes medication prescribing, treatment, procedures, diagnostic and administrative errors. Among systems and techniques that are used to prevent and reduce medical errors, CPOE, CDSS, EHR (Electronic Health Record), BCMA (Barcode Medication Administration) and RFID (Radio Frequency Identification) are well known. Studies show that in reducing errors, and improving quality of care, CPOE, CDSS and EHR are more effective than other technologies. The integration of CPOE with CDSS, also likely leads to a further reduction of medical errors. CPOE covers all three healthcare quality problems (low use, misuse and overuse). Furthermore, EHR increases the effectiveness of healthcare and reduces medical errors through reminders, alerts and internal intelligent capabilities.
Khammarnia, M., Kassani, A., & Eslahi, M. (2015). The efficacy of patients’ wristband bar-code on prevention of medical errors: a meta-analysis study. Appl Clin Inform, 6(4), 716-27. doi: 10.4338/ACI-2015-06-R-0077
Abstract
Objectives. The study aimed to investigate the effectiveness of wristband bar-code medication scanning to reduce medical errors (ME).
Methods: A meta-analysis study was conducted. The relevant studies were searched in PubMed, Embase, Cochrane Library, Web of Science and Scopus from 1990 to March 2015. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted, and the quality of the included studies was evaluated using the STROBE checklist.
Results: In total, 14 articles involving 483 cases were included. The meta-analysis indicated that the use of wristband bar-code medication scanning can reduce the ME around 57.5% (OR=0.425, 95% CI: 0.28-0.65, P<0.001). The study results showed a marked heterogeneity in the subgroup analysis (I-squared=98%). This was I2=70.35, P-value=0.018 for the type of samples and I2=99%, P-value<0.001 for years and countries.
Conclusion: Wristband bar-code medication scanning can decrease the ME in hospital setting. Since the patient’s safety is the main goal of the World Health Organization, it is recommended that a unique patient identification barcode should be used with name, medical record number, and bar-coded financial number.
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., ... & Bates, D. W. (2015). Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems. BMJ Qual Saf, 24(4), 264-271. doi: dx.doi.org/10.1136/bmjqs-2014-003555
Abstract
Background: Medication computerised provider order entry (CPOE) has been shown to decrease errors and is being widely adopted. However, CPOE also has potential for introducing or contributing to errors.
Objectives: The objectives of this study are to (a) analyse medication error reports where CPOE was reported as a ‘contributing cause’ and (b) develop ‘use cases’ based on these reports to test vulnerability of current CPOE systems to these errors.
Methods: A review of medication errors reported to United States Pharmacopeia MEDMARX reporting system was made, and a taxonomy was developed for CPOE-related errors. For each error we evaluated what went wrong and why and identified potential prevention strategies and recurring error scenarios. These scenarios were then used to test vulnerability of leading CPOE systems, asking typical users to enter these erroneous orders to assess the degree to which these problematic orders could be entered.
Results: Between 2003 and 2010, 1.04 million medication errors were reported to MEDMARX, of which 63 040 were reported as CPOE related. A review of 10 060 CPOE-related cases was used to derive 101 codes describing what went wrong, 67 codes describing reasons why errors occurred, 73 codes describing potential prevention strategies and 21 codes describing recurring error scenarios. Ability to enter these erroneous order scenarios was tested on 13 CPOE systems at 16 sites. Overall, 298 (79.5%) of the erroneous orders were able to be entered including 100 (28.0%) being ‘easily’ placed, another 101 (28.3%) with only minor workarounds and no warnings.
Conclusions and relevance: Medication error reports provide valuable information for understanding CPOE-related errors. Reports were useful for developing taxonomy and identifying recurring errors to which current CPOE systems are vulnerable. Enhanced monitoring, reporting and testing of CPOE systems are important to improve CPOE safety
Trimble, A. N., Bishop, B., & Rampe, N. (2017). Medication errors associated with transition from insulin pens to insulin vials. American Journal of Health-System Pharmacy, 74(2), 70-75. doi:10.2146/ajhp150726
Abstract
Purpose: Three insulin administration errors that occurred after a hospital’s transition from insulin pens to vials are described, and process improvement initiatives implemented to prevent future errors are reviewed.
ensure safe insulin use included involving frontline nursing staff in medication safety committee meetings and requiring that all insulin glargine doses be prepared in designated insulin syringes in the pharmacy for dispensing to patient care units. Conclusion: After three major insulin administration errors, a review of processes and contributing factors was conducted. With additional education of nurses, improved staff communication, and implementation of other safety initiatives, no insulin administration errors were reported in the following year.
Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of barcode technology and an electronic medication administration record on adverse drug events. Hospital pharmacy, 51(6), 474-483. doi: 10.1310/hpj5106-474
Abstract
Background: Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking.
Objectives: This study evaluates the effects of the implementation of barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on the profile of ADEs in a hospital setting.
Methods: We conducted a before-and-after study examining the effects of the implementation of BCMA and eMAR technology on the profile of ADEs at a 400-bed academic medical center by using incident reports. We compared reported ADEs in pre- and post-implementation periods of 5 months to determine whether there was a reduction in the rate of ADEs within medication use phases. We further examined the severity of errors and described changes in the distribution of types of errors.
Results: A total of 775 electronic error-reporting system reports were included in this study: 397 (51%) in the pre-implementation period and 378 (49%) in the post-implementation period. The rate of ADEs significantly decreased from 0.26% to 0.20% after implementation of the technology (relative risk [RR], 0.78; 95% CI, 0.67-0.89). The rate of transcription errors decreased from 0.089% to 0.036% (RR, 0.40; 95% CI, 0.30-0.54), which was largely attributed to reduction of "wrong time" errors. The rate of administration errors was identical in both groups at 0.017% (RR, 0.98; 95% CI 0.58-1.66). The mean severity level of administration errors significantly decreased from 4.44 to 3.23 (p = .005).
Conclusion: The implementation of eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors. These technologies also reduced the harmful impact to patients caused by administration errors.
